Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BEARING OXFORD SZ B 8 MM RM/LL

Facility

$9,900.00

Service Code	HCPCS C1776
Hospital Charge Code	270684004
Hospital Revenue Code	278
Min. Negotiated Rate	$1,485.00
Max. Negotiated Rate	$2,395.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,980.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,395.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,485.00

BEARING OXFORD SZ B 8 MM RM/LL

Facility

$9,900.00

Service Code	HCPCS C1776
Hospital Charge Code	270684004
Hospital Revenue Code	278
Min. Negotiated Rate	$281.16
Max. Negotiated Rate	$4,950.00
Rate for Payer: Aetna Commercial	$3,762.00
Rate for Payer: Aetna Medicare Advantage	$2,970.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,524.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,524.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,524.50
Rate for Payer: Cigna Commercial	$4,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,395.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,485.00
Rate for Payer: UnitedHealthcare Community & State	$312.84
Rate for Payer: Wellpoint Medicaid Managed Care	$281.16

BEARING PS VAN 10x63/67 183620

Facility

$5,135.00

Service Code	HCPCS C1776
Hospital Charge Code	270639768
Hospital Revenue Code	278
Min. Negotiated Rate	$770.25
Max. Negotiated Rate	$1,242.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,027.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,242.67
Rate for Payer: Qualcare PPO/HMO/WC	$770.25

BEARING PS VAN 10x63/67 183620

Facility

$5,135.00

Service Code	HCPCS C1776
Hospital Charge Code	270639768
Hospital Revenue Code	278
Min. Negotiated Rate	$145.83
Max. Negotiated Rate	$2,567.50
Rate for Payer: Aetna Commercial	$1,951.30
Rate for Payer: Aetna Medicare Advantage	$1,540.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,309.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,309.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,027.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,309.42
Rate for Payer: Cigna Commercial	$2,567.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,242.67
Rate for Payer: Qualcare PPO/HMO/WC	$770.25
Rate for Payer: UnitedHealthcare Community & State	$162.27
Rate for Payer: Wellpoint Medicaid Managed Care	$145.83

BEARING SHOULDER 40MM 3 VITE

Facility

$12,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697962
Hospital Revenue Code	278
Min. Negotiated Rate	$355.00
Max. Negotiated Rate	$6,250.00
Rate for Payer: Aetna Commercial	$4,750.00
Rate for Payer: Aetna Medicare Advantage	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,187.50
Rate for Payer: Cigna Commercial	$6,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.00
Rate for Payer: UnitedHealthcare Community & State	$395.00
Rate for Payer: Wellpoint Medicaid Managed Care	$355.00

BEARING SHOULDER 40MM 3 VITE

Facility

$12,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697962
Hospital Revenue Code	278
Min. Negotiated Rate	$1,875.00
Max. Negotiated Rate	$3,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.00

BEARING TBIAL VNGRD PS10X71/75

Facility

$5,135.00

Service Code	HCPCS C1776
Hospital Charge Code	270642310
Hospital Revenue Code	278
Min. Negotiated Rate	$770.25
Max. Negotiated Rate	$1,242.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,027.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,242.67
Rate for Payer: Qualcare PPO/HMO/WC	$770.25

BEARING TBIAL VNGRD PS10X71/75

Facility

$5,135.00

Service Code	HCPCS C1776
Hospital Charge Code	270642310
Hospital Revenue Code	278
Min. Negotiated Rate	$145.83
Max. Negotiated Rate	$2,567.50
Rate for Payer: Aetna Commercial	$1,951.30
Rate for Payer: Aetna Medicare Advantage	$1,540.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,309.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,309.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,027.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,309.42
Rate for Payer: Cigna Commercial	$2,567.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,242.67
Rate for Payer: Qualcare PPO/HMO/WC	$770.25
Rate for Payer: UnitedHealthcare Community & State	$162.27
Rate for Payer: Wellpoint Medicaid Managed Care	$145.83

BEARING TIBIAL 10x240x25mm

Facility

$5,070.00

Hospital Charge Code	270673872
Hospital Revenue Code	278
Min. Negotiated Rate	$143.99
Max. Negotiated Rate	$2,535.00
Rate for Payer: Aetna Commercial	$1,926.60
Rate for Payer: Aetna Medicare Advantage	$1,521.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,292.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,292.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,014.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,292.85
Rate for Payer: Cigna Commercial	$2,535.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,226.94
Rate for Payer: Qualcare PPO/HMO/WC	$760.50
Rate for Payer: UnitedHealthcare Community & State	$160.21
Rate for Payer: Wellpoint Medicaid Managed Care	$143.99

BEARING TIBIAL 10x240x25mm

Facility

$5,070.00

Hospital Charge Code	270673872
Hospital Revenue Code	278
Min. Negotiated Rate	$760.50
Max. Negotiated Rate	$1,226.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,014.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,226.94
Rate for Payer: Qualcare PPO/HMO/WC	$760.50

BEARING TIBIAL 10x63/67mm

Facility

$12,930.00

Hospital Charge Code	270675558
Hospital Revenue Code	278
Min. Negotiated Rate	$1,939.50
Max. Negotiated Rate	$3,129.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,586.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,129.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,939.50

BEARING TIBIAL 10x63/67mm

Facility

$12,930.00

Hospital Charge Code	270675558
Hospital Revenue Code	278
Min. Negotiated Rate	$367.21
Max. Negotiated Rate	$6,465.00
Rate for Payer: Aetna Commercial	$4,913.40
Rate for Payer: Aetna Medicare Advantage	$3,879.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,297.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,297.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,586.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,297.15
Rate for Payer: Cigna Commercial	$6,465.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,129.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,939.50
Rate for Payer: UnitedHealthcare Community & State	$408.59
Rate for Payer: Wellpoint Medicaid Managed Care	$367.21

BEARING TIBIAL 10X71/75 183640

Facility

$11,205.00

Service Code	HCPCS C1776
Hospital Charge Code	270636756
Hospital Revenue Code	278
Min. Negotiated Rate	$318.22
Max. Negotiated Rate	$5,602.50
Rate for Payer: Aetna Commercial	$4,257.90
Rate for Payer: Aetna Medicare Advantage	$3,361.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,857.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,857.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,241.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,857.28
Rate for Payer: Cigna Commercial	$5,602.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,711.61
Rate for Payer: Qualcare PPO/HMO/WC	$1,680.75
Rate for Payer: UnitedHealthcare Community & State	$354.08
Rate for Payer: Wellpoint Medicaid Managed Care	$318.22

BEARING TIBIAL 10X71/75 183640

Facility

$11,205.00

Service Code	HCPCS C1776
Hospital Charge Code	270636756
Hospital Revenue Code	278
Min. Negotiated Rate	$1,680.75
Max. Negotiated Rate	$2,711.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,241.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,711.61
Rate for Payer: Qualcare PPO/HMO/WC	$1,680.75

BEARING TIBIAL 10x71/75mm

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270647563
Hospital Revenue Code	278
Min. Negotiated Rate	$1,782.00
Max. Negotiated Rate	$2,874.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,376.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,874.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,782.00

BEARING TIBIAL 10x71/75mm

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270647563
Hospital Revenue Code	278
Min. Negotiated Rate	$337.39
Max. Negotiated Rate	$5,940.00
Rate for Payer: Aetna Commercial	$4,514.40
Rate for Payer: Aetna Medicare Advantage	$3,564.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,029.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,029.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,376.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,029.40
Rate for Payer: Cigna Commercial	$5,940.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,874.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,782.00
Rate for Payer: UnitedHealthcare Community & State	$375.41
Rate for Payer: Wellpoint Medicaid Managed Care	$337.39

BEARING TIBIAL 12x79/83mm

Facility

$13,195.00

Hospital Charge Code	270669892
Hospital Revenue Code	278
Min. Negotiated Rate	$374.74
Max. Negotiated Rate	$6,597.50
Rate for Payer: Aetna Commercial	$5,014.10
Rate for Payer: Aetna Medicare Advantage	$3,958.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,364.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,364.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,639.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,364.72
Rate for Payer: Cigna Commercial	$6,597.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,193.19
Rate for Payer: Qualcare PPO/HMO/WC	$1,979.25
Rate for Payer: UnitedHealthcare Community & State	$416.96
Rate for Payer: Wellpoint Medicaid Managed Care	$374.74

BEARING TIBIAL 12x79/83mm

Facility

$13,195.00

Hospital Charge Code	270669892
Hospital Revenue Code	278
Min. Negotiated Rate	$1,979.25
Max. Negotiated Rate	$3,193.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,639.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,193.19
Rate for Payer: Qualcare PPO/HMO/WC	$1,979.25

BEARING TIBIAL 14x79/83MM

Facility

$4,000.00

Hospital Charge Code	270676549
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

BEARING TIBIAL 14x79/83MM

Facility

$4,000.00

Hospital Charge Code	270676549
Hospital Revenue Code	278
Min. Negotiated Rate	$113.60
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$126.40
Rate for Payer: Wellpoint Medicaid Managed Care	$113.60

BEARING TIBIAL 16x63/67MM

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270666325
Hospital Revenue Code	278
Min. Negotiated Rate	$113.60
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$126.40
Rate for Payer: Wellpoint Medicaid Managed Care	$113.60

BEARING TIBIAL 16x63/67MM

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270666325
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

BEARING TIBIAL 18mm x63/67mm

Facility

$5,135.00

Service Code	HCPCS C1776
Hospital Charge Code	270665997
Hospital Revenue Code	278
Min. Negotiated Rate	$770.25
Max. Negotiated Rate	$1,242.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,027.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,242.67
Rate for Payer: Qualcare PPO/HMO/WC	$770.25

BEARING TIBIAL 18mm x63/67mm

Facility

$5,135.00

Service Code	HCPCS C1776
Hospital Charge Code	270665997
Hospital Revenue Code	278
Min. Negotiated Rate	$145.83
Max. Negotiated Rate	$2,567.50
Rate for Payer: Aetna Commercial	$1,951.30
Rate for Payer: Aetna Medicare Advantage	$1,540.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,309.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,309.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,027.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,309.42
Rate for Payer: Cigna Commercial	$2,567.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,242.67
Rate for Payer: Qualcare PPO/HMO/WC	$770.25
Rate for Payer: UnitedHealthcare Community & State	$162.27
Rate for Payer: Wellpoint Medicaid Managed Care	$145.83

BEARING TIBIAL 18x63/67MM

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270679529
Hospital Revenue Code	278
Min. Negotiated Rate	$337.39
Max. Negotiated Rate	$5,940.00
Rate for Payer: Aetna Commercial	$4,514.40
Rate for Payer: Aetna Medicare Advantage	$3,564.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,029.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,029.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,376.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,029.40
Rate for Payer: Cigna Commercial	$5,940.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,874.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,782.00
Rate for Payer: UnitedHealthcare Community & State	$375.41
Rate for Payer: Wellpoint Medicaid Managed Care	$337.39

Know your out-of-pocket cost for care.

All Charges