Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BASEPLATE GLENOID THR 24.5X30

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270696980
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

BASEPLATE GLENOID THR 24.5X30

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270696980
Hospital Revenue Code	278
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

BASEPLATE GLENOID THRD 027X30

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270699524
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

BASEPLATE GLENOID THRD 027X30

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270699524
Hospital Revenue Code	278
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

BASEPLATE GLEN REVII 25X15MM4H

Facility

$8,645.00

Service Code	HCPCS C1776
Hospital Charge Code	270657914
Hospital Revenue Code	278
Min. Negotiated Rate	$1,296.75
Max. Negotiated Rate	$2,092.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,729.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,092.09
Rate for Payer: Qualcare PPO/HMO/WC	$1,296.75

BASEPLATE GLEN REVII 25X15MM4H

Facility

$8,645.00

Service Code	HCPCS C1776
Hospital Charge Code	270657914
Hospital Revenue Code	278
Min. Negotiated Rate	$245.52
Max. Negotiated Rate	$4,322.50
Rate for Payer: Aetna Commercial	$3,285.10
Rate for Payer: Aetna Medicare Advantage	$2,593.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,204.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,204.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,729.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,204.47
Rate for Payer: Cigna Commercial	$4,322.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,092.09
Rate for Payer: Qualcare PPO/HMO/WC	$1,296.75
Rate for Payer: UnitedHealthcare Community & State	$273.18
Rate for Payer: Wellpoint Medicaid Managed Care	$245.52

BASEPLATE KNEE SZ 2

Facility

$6,303.45

Service Code	HCPCS C1776
Hospital Charge Code	270691993
Hospital Revenue Code	278
Min. Negotiated Rate	$179.02
Max. Negotiated Rate	$3,151.72
Rate for Payer: Aetna Commercial	$2,395.31
Rate for Payer: Aetna Medicare Advantage	$1,891.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,607.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,607.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,260.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,607.38
Rate for Payer: Cigna Commercial	$3,151.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,525.43
Rate for Payer: Qualcare PPO/HMO/WC	$945.52
Rate for Payer: UnitedHealthcare Community & State	$199.19
Rate for Payer: Wellpoint Medicaid Managed Care	$179.02

BASEPLATE KNEE SZ 2

Facility

$6,303.45

Service Code	HCPCS C1776
Hospital Charge Code	270691993
Hospital Revenue Code	278
Min. Negotiated Rate	$945.52
Max. Negotiated Rate	$1,525.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,260.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,525.43
Rate for Payer: Qualcare PPO/HMO/WC	$945.52

BASEPLATE MINI W ADP 25MM

Facility

$11,585.00

Hospital Charge Code	270668582
Hospital Revenue Code	278
Min. Negotiated Rate	$1,737.75
Max. Negotiated Rate	$2,803.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,317.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,803.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,737.75

BASEPLATE MINI W ADP 25MM

Facility

$11,585.00

Hospital Charge Code	270668582
Hospital Revenue Code	278
Min. Negotiated Rate	$329.01
Max. Negotiated Rate	$5,792.50
Rate for Payer: Aetna Commercial	$4,402.30
Rate for Payer: Aetna Medicare Advantage	$3,475.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,954.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,954.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,317.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,954.18
Rate for Payer: Cigna Commercial	$5,792.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,803.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,737.75
Rate for Payer: UnitedHealthcare Community & State	$366.09
Rate for Payer: Wellpoint Medicaid Managed Care	$329.01

BASEPLATE REVERSE COMP 25MM

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270669244
Hospital Revenue Code	278
Min. Negotiated Rate	$227.20
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$252.80
Rate for Payer: Wellpoint Medicaid Managed Care	$227.20

BASEPLATE REVERSE COMP 25MM

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270669244
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

BASEPLATE RSA GLENOID SZ 28MM

Facility

$7,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270671578
Hospital Revenue Code	278
Min. Negotiated Rate	$1,072.50
Max. Negotiated Rate	$1,730.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,430.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,730.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,072.50

BASEPLATE RSA GLENOID SZ 28MM

Facility

$7,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270671578
Hospital Revenue Code	278
Min. Negotiated Rate	$203.06
Max. Negotiated Rate	$3,575.00
Rate for Payer: Aetna Commercial	$2,717.00
Rate for Payer: Aetna Medicare Advantage	$2,145.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,823.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,823.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,430.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,823.25
Rate for Payer: Cigna Commercial	$3,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,730.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,072.50
Rate for Payer: UnitedHealthcare Community & State	$225.94
Rate for Payer: Wellpoint Medicaid Managed Care	$203.06

BASEPLATE SZ 3 UNIVERIAL

Facility

$6,243.95

Service Code	HCPCS C1776
Hospital Charge Code	270691043
Hospital Revenue Code	278
Min. Negotiated Rate	$936.59
Max. Negotiated Rate	$1,511.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,248.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,511.04
Rate for Payer: Qualcare PPO/HMO/WC	$936.59

BASEPLATE SZ 3 UNIVERIAL

Facility

$6,243.95

Service Code	HCPCS C1776
Hospital Charge Code	270691043
Hospital Revenue Code	278
Min. Negotiated Rate	$177.33
Max. Negotiated Rate	$3,121.97
Rate for Payer: Aetna Commercial	$2,372.70
Rate for Payer: Aetna Medicare Advantage	$1,873.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,592.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,592.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,248.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,592.21
Rate for Payer: Cigna Commercial	$3,121.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,511.04
Rate for Payer: Qualcare PPO/HMO/WC	$936.59
Rate for Payer: UnitedHealthcare Community & State	$197.31
Rate for Payer: Wellpoint Medicaid Managed Care	$177.33

BASEPLATE THREADED 24.5X25

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270691235
Hospital Revenue Code	278
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

BASEPLATE THREADED 24.5X25

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270691235
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

BASEPLATE TIBIA EVOL15MMSZ5SZ6

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697691
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

BASEPLATE TIBIA EVOL15MMSZ5SZ6

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697691
Hospital Revenue Code	278
Min. Negotiated Rate	$127.80
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Community & State	$142.20
Rate for Payer: Wellpoint Medicaid Managed Care	$127.80

BASE PLATE TIBIAL

Facility

$4,470.00

Service Code	HCPCS C1776
Hospital Charge Code	270692081
Hospital Revenue Code	278
Min. Negotiated Rate	$126.95
Max. Negotiated Rate	$2,235.00
Rate for Payer: Aetna Commercial	$1,698.60
Rate for Payer: Aetna Medicare Advantage	$1,341.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,139.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,139.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$894.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,139.85
Rate for Payer: Cigna Commercial	$2,235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,081.74
Rate for Payer: Qualcare PPO/HMO/WC	$670.50
Rate for Payer: UnitedHealthcare Community & State	$141.25
Rate for Payer: Wellpoint Medicaid Managed Care	$126.95

BASE PLATE TIBIAL

Facility

$4,470.00

Service Code	HCPCS C1776
Hospital Charge Code	270692081
Hospital Revenue Code	278
Min. Negotiated Rate	$670.50
Max. Negotiated Rate	$1,081.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$894.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,081.74
Rate for Payer: Qualcare PPO/HMO/WC	$670.50

BASEPLATE TIBIAL 63MM LNG

Facility

$18,655.00

Service Code	HCPCS C1776
Hospital Charge Code	270673720
Hospital Revenue Code	278
Min. Negotiated Rate	$2,798.25
Max. Negotiated Rate	$4,514.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,731.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,514.51
Rate for Payer: Qualcare PPO/HMO/WC	$2,798.25

BASEPLATE TIBIAL 63MM LNG

Facility

$18,655.00

Service Code	HCPCS C1776
Hospital Charge Code	270673720
Hospital Revenue Code	278
Min. Negotiated Rate	$529.80
Max. Negotiated Rate	$9,327.50
Rate for Payer: Aetna Commercial	$7,088.90
Rate for Payer: Aetna Medicare Advantage	$5,596.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,757.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,757.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,731.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,757.02
Rate for Payer: Cigna Commercial	$9,327.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,514.51
Rate for Payer: Qualcare PPO/HMO/WC	$2,798.25
Rate for Payer: UnitedHealthcare Community & State	$589.50
Rate for Payer: Wellpoint Medicaid Managed Care	$529.80

BASEPLATE TIBIAL CMA #1

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270679702
Hospital Revenue Code	278
Min. Negotiated Rate	$127.80
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Community & State	$142.20
Rate for Payer: Wellpoint Medicaid Managed Care	$127.80

Know your out-of-pocket cost for care.

All Charges