Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BASEPLATE TIBIAL RM/LL SZ 6

Facility

$6,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270668778
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 RM/LL SZ 7

Facility

$6,445.00

Hospital Charge Code	270668779
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 RM/LL SZ 7

Facility

$6,445.00

Hospital Charge Code	270668779
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 RM/LL SZ 8

Facility

$6,445.00

Hospital Charge Code	270668780
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 RM/LL SZ 8

Facility

$6,445.00

Hospital Charge Code	270668780
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 STEMMED SZ

Facility

$7,125.00

Hospital Charge Code	270667532
Hospital Revenue Code	278
Min. Negotiated Rate	$1,068.75
Max. Negotiated Rate	$1,724.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,724.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,068.75

BASEPLATE TIBIAL STEMMED SZ

Facility

$7,125.00

Hospital Charge Code	270667532
Hospital Revenue Code	278
Min. Negotiated Rate	$202.35
Max. Negotiated Rate	$3,562.50
Rate for Payer: Aetna Commercial	$2,707.50
Rate for Payer: Aetna Medicare Advantage	$2,137.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,816.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,816.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,816.88
Rate for Payer: Cigna Commercial	$3,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,724.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,068.75
Rate for Payer: UnitedHealthcare Community & State	$225.15
Rate for Payer: Wellpoint Medicaid Managed Care	$202.35

BASEPLATE TIBIAL STEMMED SZ 2

Facility

$7,125.00

Hospital Charge Code	270671019
Hospital Revenue Code	278
Min. Negotiated Rate	$202.35
Max. Negotiated Rate	$3,562.50
Rate for Payer: Aetna Commercial	$2,707.50
Rate for Payer: Aetna Medicare Advantage	$2,137.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,816.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,816.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,816.88
Rate for Payer: Cigna Commercial	$3,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,724.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,068.75
Rate for Payer: UnitedHealthcare Community & State	$225.15
Rate for Payer: Wellpoint Medicaid Managed Care	$202.35

BASEPLATE TIBIAL STEMMED SZ 2

Facility

$7,125.00

Hospital Charge Code	270671019
Hospital Revenue Code	278
Min. Negotiated Rate	$1,068.75
Max. Negotiated Rate	$1,724.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,724.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,068.75

BASEPLATE TIBIAL SZ 2

Facility

$4,446.55

Service Code	HCPCS C1776
Hospital Charge Code	270682131
Hospital Revenue Code	278
Min. Negotiated Rate	$126.28
Max. Negotiated Rate	$2,223.28
Rate for Payer: Aetna Commercial	$1,689.69
Rate for Payer: Aetna Medicare Advantage	$1,333.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,133.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,133.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$889.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,133.87
Rate for Payer: Cigna Commercial	$2,223.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,076.07
Rate for Payer: Qualcare PPO/HMO/WC	$666.98
Rate for Payer: UnitedHealthcare Community & State	$140.51
Rate for Payer: Wellpoint Medicaid Managed Care	$126.28

BASEPLATE TIBIAL SZ 2

Facility

$4,446.55

Service Code	HCPCS C1776
Hospital Charge Code	270682131
Hospital Revenue Code	278
Min. Negotiated Rate	$666.98
Max. Negotiated Rate	$1,076.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$889.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,076.07
Rate for Payer: Qualcare PPO/HMO/WC	$666.98

BASEPLATE TIBIAL SZ 6

Facility

$4,685.25

Service Code	HCPCS C1713
Hospital Charge Code	270691405
Hospital Revenue Code	278
Min. Negotiated Rate	$702.79
Max. Negotiated Rate	$1,133.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$937.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,133.83
Rate for Payer: Qualcare PPO/HMO/WC	$702.79

BASEPLATE TIBIAL SZ 6

Facility

$4,685.25

Service Code	HCPCS C1713
Hospital Charge Code	270691405
Hospital Revenue Code	278
Min. Negotiated Rate	$133.06
Max. Negotiated Rate	$2,342.62
Rate for Payer: Aetna Commercial	$1,780.39
Rate for Payer: Aetna Medicare Advantage	$1,405.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,194.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,194.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$937.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,194.74
Rate for Payer: Cigna Commercial	$2,342.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,133.83
Rate for Payer: Qualcare PPO/HMO/WC	$702.79
Rate for Payer: UnitedHealthcare Community & State	$148.05
Rate for Payer: Wellpoint Medicaid Managed Care	$133.06

BASE PLATE TIBIAL UNIVERSAL #3

Facility

$6,303.45

Service Code	HCPCS C1776
Hospital Charge Code	270672930
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

BASE PLATE TIBIAL UNIVERSAL #3

Facility

$6,303.45

Service Code	HCPCS C1776
Hospital Charge Code	270672930
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 TRIATHLN PRIMRY TIB

Facility

$4,171.75

Service Code	HCPCS C1776
Hospital Charge Code	270693031
Hospital Revenue Code	278
Min. Negotiated Rate	$118.48
Max. Negotiated Rate	$2,085.88
Rate for Payer: Aetna Commercial	$1,585.27
Rate for Payer: Aetna Medicare Advantage	$1,251.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,063.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,063.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$834.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,063.80
Rate for Payer: Cigna Commercial	$2,085.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,009.56
Rate for Payer: Qualcare PPO/HMO/WC	$625.76
Rate for Payer: UnitedHealthcare Community & State	$131.83
Rate for Payer: Wellpoint Medicaid Managed Care	$118.48

BASEPLATE TRIATHLN PRIMRY TIB

Facility

$4,171.75

Service Code	HCPCS C1776
Hospital Charge Code	270693031
Hospital Revenue Code	278
Min. Negotiated Rate	$625.76
Max. Negotiated Rate	$1,009.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$834.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,009.56
Rate for Payer: Qualcare PPO/HMO/WC	$625.76

BASEPLATE TRIATHLON TIBIA SZ6

Facility

$6,835.00

Service Code	HCPCS C1776
Hospital Charge Code	270692258
Hospital Revenue Code	278
Min. Negotiated Rate	$194.11
Max. Negotiated Rate	$3,417.50
Rate for Payer: Aetna Commercial	$2,597.30
Rate for Payer: Aetna Medicare Advantage	$2,050.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,742.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,742.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,367.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,742.92
Rate for Payer: Cigna Commercial	$3,417.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,654.07
Rate for Payer: Qualcare PPO/HMO/WC	$1,025.25
Rate for Payer: UnitedHealthcare Community & State	$215.99
Rate for Payer: Wellpoint Medicaid Managed Care	$194.11

BASEPLATE TRIATHLON TIBIA SZ6

Facility

$6,835.00

Service Code	HCPCS C1776
Hospital Charge Code	270692258
Hospital Revenue Code	278
Min. Negotiated Rate	$1,025.25
Max. Negotiated Rate	$1,654.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,367.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,654.07
Rate for Payer: Qualcare PPO/HMO/WC	$1,025.25

BASEPLATE UNIVERSAL TIBIAL SZ4

Facility

$4,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270691262
Hospital Revenue Code	278
Min. Negotiated Rate	$138.31
Max. Negotiated Rate	$2,435.00
Rate for Payer: Aetna Commercial	$1,850.60
Rate for Payer: Aetna Medicare Advantage	$1,461.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,241.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,241.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$974.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,241.85
Rate for Payer: Cigna Commercial	$2,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,178.54
Rate for Payer: Qualcare PPO/HMO/WC	$730.50
Rate for Payer: UnitedHealthcare Community & State	$153.89
Rate for Payer: Wellpoint Medicaid Managed Care	$138.31

BASEPLATE UNIVERSAL TIBIAL SZ4

Facility

$4,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270691262
Hospital Revenue Code	278
Min. Negotiated Rate	$730.50
Max. Negotiated Rate	$1,178.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$974.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,178.54
Rate for Payer: Qualcare PPO/HMO/WC	$730.50

BASE TIBIAL LONG OSS 63mm

Facility

$18,655.00

Service Code	HCPCS C1776
Hospital Charge Code	270673540
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

BASE TIBIAL LONG OSS 63mm

Facility

$18,655.00

Service Code	HCPCS C1776
Hospital Charge Code	270673540
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

BASIC LIFE SUPP(BLS) ER

Facility

$1,600.00

Hospital Charge Code	26000513
Hospital Revenue Code	540
Min. Negotiated Rate	$45.44
Max. Negotiated Rate	$3,644.00
Rate for Payer: Aetna Commercial	$608.00
Rate for Payer: Aetna Medicare Advantage	$480.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$408.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$408.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$408.00
Rate for Payer: Cigna Commercial	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$416.00
Rate for Payer: Oxford Commercial	$3,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$240.00
Rate for Payer: UnitedHealthcare Commercial	$3,644.00
Rate for Payer: UnitedHealthcare Community & State	$50.56
Rate for Payer: Wellpoint Medicaid Managed Care	$45.44

BASIC LIFE SUPP(BLS) ER

Facility

$1,600.00

Hospital Charge Code	26000513
Hospital Revenue Code	540
Min. Negotiated Rate	$240.00
Max. Negotiated Rate	$240.00
Rate for Payer: Qualcare PPO/HMO/WC	$240.00

Know your out-of-pocket cost for care.

All Charges