Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BASEPLATE TIBIAL CMA #1

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270679702
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 TIBIAL CMA #2

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676753
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

BASEPLATE TIBIAL CMA #2

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676753
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 TIBIAL CMA #3

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676624
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

BASEPLATE TIBIAL CMA #3

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676624
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 TIBIAL CMA #4

Facility

$4,500.00

Hospital Charge Code	270676674
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

BASEPLATE TIBIAL CMA #4

Facility

$4,500.00

Hospital Charge Code	270676674
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 TIBIAL CMA #6

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676726
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 TIBIAL CMA #6

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676726
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

BASEPLATE TIBIAL LM/RL SZ 1

Facility

$6,445.00

Hospital Charge Code	270668767
Hospital Revenue Code	278
Min. Negotiated Rate	$966.75
Max. Negotiated Rate	$1,559.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,559.69
Rate for Payer: Qualcare PPO/HMO/WC	$966.75

BASEPLATE TIBIAL LM/RL SZ 1

Facility

$6,445.00

Hospital Charge Code	270668767
Hospital Revenue Code	278
Min. Negotiated Rate	$183.04
Max. Negotiated Rate	$3,222.50
Rate for Payer: Aetna Commercial	$2,449.10
Rate for Payer: Aetna Medicare Advantage	$1,933.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,643.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,643.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,643.47
Rate for Payer: Cigna Commercial	$3,222.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,559.69
Rate for Payer: Qualcare PPO/HMO/WC	$966.75
Rate for Payer: UnitedHealthcare Community & State	$203.66
Rate for Payer: Wellpoint Medicaid Managed Care	$183.04

BASEPLATE TIBIAL LM/RL SZ 2

Facility

$6,445.00

Hospital Charge Code	270668727
Hospital Revenue Code	278
Min. Negotiated Rate	$966.75
Max. Negotiated Rate	$1,559.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,559.69
Rate for Payer: Qualcare PPO/HMO/WC	$966.75

BASEPLATE TIBIAL LM/RL SZ 2

Facility

$6,445.00

Hospital Charge Code	270668727
Hospital Revenue Code	278
Min. Negotiated Rate	$183.04
Max. Negotiated Rate	$3,222.50
Rate for Payer: Aetna Commercial	$2,449.10
Rate for Payer: Aetna Medicare Advantage	$1,933.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,643.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,643.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,643.47
Rate for Payer: Cigna Commercial	$3,222.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,559.69
Rate for Payer: Qualcare PPO/HMO/WC	$966.75
Rate for Payer: UnitedHealthcare Community & State	$203.66
Rate for Payer: Wellpoint Medicaid Managed Care	$183.04

BASEPLATE TIBIAL LM/RL SZ 3

Facility

$6,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270668768
Hospital Revenue Code	278
Min. Negotiated Rate	$183.04
Max. Negotiated Rate	$3,222.50
Rate for Payer: Aetna Commercial	$2,449.10
Rate for Payer: Aetna Medicare Advantage	$1,933.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,643.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,643.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,643.47
Rate for Payer: Cigna Commercial	$3,222.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,559.69
Rate for Payer: Qualcare PPO/HMO/WC	$966.75
Rate for Payer: UnitedHealthcare Community & State	$203.66
Rate for Payer: Wellpoint Medicaid Managed Care	$183.04

BASEPLATE TIBIAL LM/RL SZ 3

Facility

$6,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270668768
Hospital Revenue Code	278
Min. Negotiated Rate	$966.75
Max. Negotiated Rate	$1,559.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,559.69
Rate for Payer: Qualcare PPO/HMO/WC	$966.75

BASEPLATE TIBIAL LM/RL SZ 4

Facility

$6,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270668488
Hospital Revenue Code	278
Min. Negotiated Rate	$966.75
Max. Negotiated Rate	$1,559.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,559.69
Rate for Payer: Qualcare PPO/HMO/WC	$966.75

BASEPLATE TIBIAL LM/RL SZ 4

Facility

$6,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270668488
Hospital Revenue Code	278
Min. Negotiated Rate	$183.04
Max. Negotiated Rate	$3,222.50
Rate for Payer: Aetna Commercial	$2,449.10
Rate for Payer: Aetna Medicare Advantage	$1,933.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,643.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,643.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,643.47
Rate for Payer: Cigna Commercial	$3,222.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,559.69
Rate for Payer: Qualcare PPO/HMO/WC	$966.75
Rate for Payer: UnitedHealthcare Community & State	$203.66
Rate for Payer: Wellpoint Medicaid Managed Care	$183.04

BASEPLATE TIBIAL LM/RL SZ 5

Facility

$6,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270668769
Hospital Revenue Code	278
Min. Negotiated Rate	$183.04
Max. Negotiated Rate	$3,222.50
Rate for Payer: Aetna Commercial	$2,449.10
Rate for Payer: Aetna Medicare Advantage	$1,933.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,643.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,643.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,643.47
Rate for Payer: Cigna Commercial	$3,222.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,559.69
Rate for Payer: Qualcare PPO/HMO/WC	$966.75
Rate for Payer: UnitedHealthcare Community & State	$203.66
Rate for Payer: Wellpoint Medicaid Managed Care	$183.04

BASEPLATE TIBIAL LM/RL SZ 5

Facility

$6,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270668769
Hospital Revenue Code	278
Min. Negotiated Rate	$966.75
Max. Negotiated Rate	$1,559.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,559.69
Rate for Payer: Qualcare PPO/HMO/WC	$966.75

BASEPLATE TIBIAL LM/RL SZ 6

Facility

$6,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270668770
Hospital Revenue Code	278
Min. Negotiated Rate	$966.75
Max. Negotiated Rate	$1,559.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,559.69
Rate for Payer: Qualcare PPO/HMO/WC	$966.75

BASEPLATE TIBIAL LM/RL SZ 6

Facility

$6,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270668770
Hospital Revenue Code	278
Min. Negotiated Rate	$183.04
Max. Negotiated Rate	$3,222.50
Rate for Payer: Aetna Commercial	$2,449.10
Rate for Payer: Aetna Medicare Advantage	$1,933.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,643.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,643.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,643.47
Rate for Payer: Cigna Commercial	$3,222.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,559.69
Rate for Payer: Qualcare PPO/HMO/WC	$966.75
Rate for Payer: UnitedHealthcare Community & State	$203.66
Rate for Payer: Wellpoint Medicaid Managed Care	$183.04

BASEPLATE TIBIAL LM/RL SZ 7

Facility

$6,445.00

Hospital Charge Code	270668771
Hospital Revenue Code	278
Min. Negotiated Rate	$183.04
Max. Negotiated Rate	$3,222.50
Rate for Payer: Aetna Commercial	$2,449.10
Rate for Payer: Aetna Medicare Advantage	$1,933.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,643.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,643.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,643.47
Rate for Payer: Cigna Commercial	$3,222.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,559.69
Rate for Payer: Qualcare PPO/HMO/WC	$966.75
Rate for Payer: UnitedHealthcare Community & State	$203.66
Rate for Payer: Wellpoint Medicaid Managed Care	$183.04

BASEPLATE TIBIAL LM/RL SZ 7

Facility

$6,445.00

Hospital Charge Code	270668771
Hospital Revenue Code	278
Min. Negotiated Rate	$966.75
Max. Negotiated Rate	$1,559.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,559.69
Rate for Payer: Qualcare PPO/HMO/WC	$966.75

BASEPLATE TIBIAL LM/RL SZ 8

Facility

$6,445.00

Hospital Charge Code	270668772
Hospital Revenue Code	278
Min. Negotiated Rate	$183.04
Max. Negotiated Rate	$3,222.50
Rate for Payer: Aetna Commercial	$2,449.10
Rate for Payer: Aetna Medicare Advantage	$1,933.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,643.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,643.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,643.47
Rate for Payer: Cigna Commercial	$3,222.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,559.69
Rate for Payer: Qualcare PPO/HMO/WC	$966.75
Rate for Payer: UnitedHealthcare Community & State	$203.66
Rate for Payer: Wellpoint Medicaid Managed Care	$183.04

BASEPLATE TIBIAL LM/RL SZ 8

Facility

$6,445.00

Hospital Charge Code	270668772
Hospital Revenue Code	278
Min. Negotiated Rate	$966.75
Max. Negotiated Rate	$1,559.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,559.69
Rate for Payer: Qualcare PPO/HMO/WC	$966.75

Know your out-of-pocket cost for care.

All Charges