Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BEARING TIBIAL 18x63/67MM

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270679529
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 7MM SMALL RIGHT

Facility

$7,200.00

Service Code	HCPCS C1776
Hospital Charge Code	270684005
Hospital Revenue Code	278
Min. Negotiated Rate	$204.48
Max. Negotiated Rate	$3,600.00
Rate for Payer: Aetna Commercial	$2,736.00
Rate for Payer: Aetna Medicare Advantage	$2,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,836.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,836.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,440.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,836.00
Rate for Payer: Cigna Commercial	$3,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,742.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,080.00
Rate for Payer: UnitedHealthcare Community & State	$227.52
Rate for Payer: Wellpoint Medicaid Managed Care	$204.48

BEARING TIBIAL 7MM SMALL RIGHT

Facility

$7,200.00

Service Code	HCPCS C1776
Hospital Charge Code	270684005
Hospital Revenue Code	278
Min. Negotiated Rate	$1,080.00
Max. Negotiated Rate	$1,742.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,440.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,742.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,080.00

BEARING TIBIAL INSERT 13 MM

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270691023
Hospital Revenue Code	278
Min. Negotiated Rate	$762.35
Max. Negotiated Rate	$1,229.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: Qualcare PPO/HMO/WC	$762.35

BEARING TIBIAL INSERT 13 MM

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270691023
Hospital Revenue Code	278
Min. Negotiated Rate	$144.34
Max. Negotiated Rate	$2,541.18
Rate for Payer: Aetna Commercial	$1,931.29
Rate for Payer: Aetna Medicare Advantage	$1,524.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,296.00
Rate for Payer: Cigna Commercial	$2,541.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: Qualcare PPO/HMO/WC	$762.35
Rate for Payer: UnitedHealthcare Community & State	$160.60
Rate for Payer: Wellpoint Medicaid Managed Care	$144.34

BEARING TIBIAL OSS 22mm

Facility

$6,085.00

Service Code	HCPCS C1776
Hospital Charge Code	270673542
Hospital Revenue Code	278
Min. Negotiated Rate	$912.75
Max. Negotiated Rate	$1,472.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,217.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,472.57
Rate for Payer: Qualcare PPO/HMO/WC	$912.75

BEARING TIBIAL OSS 22mm

Facility

$6,085.00

Service Code	HCPCS C1776
Hospital Charge Code	270673542
Hospital Revenue Code	278
Min. Negotiated Rate	$172.81
Max. Negotiated Rate	$3,042.50
Rate for Payer: Aetna Commercial	$2,312.30
Rate for Payer: Aetna Medicare Advantage	$1,825.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,551.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,551.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,217.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,551.67
Rate for Payer: Cigna Commercial	$3,042.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,472.57
Rate for Payer: Qualcare PPO/HMO/WC	$912.75
Rate for Payer: UnitedHealthcare Community & State	$192.29
Rate for Payer: Wellpoint Medicaid Managed Care	$172.81

BEARING TIBIAL PS + 63/67 10MM

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270641842
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 PS + 63/67 10MM

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270641842
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 TRIAT X3 10MM

Facility

$5,659.85

Service Code	HCPCS C1776
Hospital Charge Code	270700354
Hospital Revenue Code	278
Min. Negotiated Rate	$848.98
Max. Negotiated Rate	$1,369.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,131.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,369.68
Rate for Payer: Qualcare PPO/HMO/WC	$848.98

BEARING TIBIAL TRIAT X3 10MM

Facility

$5,659.85

Service Code	HCPCS C1776
Hospital Charge Code	270700354
Hospital Revenue Code	278
Min. Negotiated Rate	$160.74
Max. Negotiated Rate	$2,829.93
Rate for Payer: Aetna Commercial	$2,150.74
Rate for Payer: Aetna Medicare Advantage	$1,697.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,443.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,443.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,131.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,443.26
Rate for Payer: Cigna Commercial	$2,829.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,369.68
Rate for Payer: Qualcare PPO/HMO/WC	$848.98
Rate for Payer: UnitedHealthcare Community & State	$178.85
Rate for Payer: Wellpoint Medicaid Managed Care	$160.74

BEARING TIBIAL VANGUARD+ 14MM

Facility

$5,000.00

Hospital Charge Code	270677027
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

BEARING TIBIAL VANGUARD+ 14MM

Facility

$5,000.00

Hospital Charge Code	270677027
Hospital Revenue Code	278
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$158.00
Rate for Payer: Wellpoint Medicaid Managed Care	$142.00

BEARING TIBIA VANG 14MM 63/67

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270694500
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 TIBIA VANG 14MM 63/67

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270694500
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 TIB SIAPH C LEFT 16MM

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270680032
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

BEARING TIB SIAPH C LEFT 16MM

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270680032
Hospital Revenue Code	278
Min. Negotiated Rate	$85.20
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$94.80
Rate for Payer: Wellpoint Medicaid Managed Care	$85.20

BEARING TIB SSK 12X 63 67

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270692328
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 TIB SSK 12X 63 67

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270692328
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 TIB SSK 16X63/67

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270692340
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 TIB SSK 16X63/67

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270692340
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 VIVACIT-E DM 28X38MM

Facility

$13,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270693270
Hospital Revenue Code	278
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$3,267.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

BEARING VIVACIT-E DM 28X38MM

Facility

$13,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270693270
Hospital Revenue Code	278
Min. Negotiated Rate	$383.40
Max. Negotiated Rate	$6,750.00
Rate for Payer: Aetna Commercial	$5,130.00
Rate for Payer: Aetna Medicare Advantage	$4,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$6,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
Rate for Payer: UnitedHealthcare Community & State	$426.60
Rate for Payer: Wellpoint Medicaid Managed Care	$383.40

BEARING VNGD SSK PSC TIB 18X71

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270687241
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 VNGD SSK PSC TIB 18X71

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270687241
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