Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TIB/FIB 2 VWS-RT

Facility

$6,601.19

Service Code	HCPCS 73590RT
Hospital Charge Code	94061379
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

TIB/FIB 2 VWS-RT

Facility

$6,601.19

Service Code	HCPCS 73590RT
Hospital Charge Code	94061379
Hospital Revenue Code	320
Min. Negotiated Rate	$187.47
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,716.31
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$208.60
Rate for Payer: Wellpoint Medicaid Managed Care	$187.47

TIB/HUM CALI DRILL- 4.3MM

Facility

$1,116.00

Hospital Charge Code	270665469
Hospital Revenue Code	272
Min. Negotiated Rate	$31.69
Max. Negotiated Rate	$558.00
Rate for Payer: Aetna Commercial	$424.08
Rate for Payer: Aetna Medicare Advantage	$334.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$284.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$284.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$284.58
Rate for Payer: Cigna Commercial	$558.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.16
Rate for Payer: Oxford Commercial	$223.20
Rate for Payer: Qualcare PPO/HMO/WC	$167.40
Rate for Payer: UnitedHealthcare Commercial	$223.20
Rate for Payer: UnitedHealthcare Community & State	$35.27
Rate for Payer: Wellpoint Medicaid Managed Care	$31.69

TIB/HUM CALI DRILL- 4.3MM

Facility

$1,116.00

Hospital Charge Code	270665469
Hospital Revenue Code	272
Min. Negotiated Rate	$167.40
Max. Negotiated Rate	$167.40
Rate for Payer: Qualcare PPO/HMO/WC	$167.40

TIBIA ADAPTIS INFINITY SZ3

Facility

$59,635.00

Service Code	HCPCS C1776
Hospital Charge Code	270698106
Hospital Revenue Code	278
Min. Negotiated Rate	$8,945.25
Max. Negotiated Rate	$14,431.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,927.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,431.67
Rate for Payer: Qualcare PPO/HMO/WC	$8,945.25

TIBIA ADAPTIS INFINITY SZ3

Facility

$59,635.00

Service Code	HCPCS C1776
Hospital Charge Code	270698106
Hospital Revenue Code	278
Min. Negotiated Rate	$1,693.63
Max. Negotiated Rate	$29,817.50
Rate for Payer: Aetna Commercial	$22,661.30
Rate for Payer: Aetna Medicare Advantage	$17,890.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,206.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,206.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,927.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,206.92
Rate for Payer: Cigna Commercial	$29,817.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,431.67
Rate for Payer: Qualcare PPO/HMO/WC	$8,945.25
Rate for Payer: UnitedHealthcare Community & State	$1,884.47
Rate for Payer: Wellpoint Medicaid Managed Care	$1,693.63

TIBIA ANKLE JT TM PROLONG SZ5

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697285
Hospital Revenue Code	278
Min. Negotiated Rate	$1,725.00
Max. Negotiated Rate	$2,783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,783.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,725.00

TIBIA ANKLE JT TM PROLONG SZ5

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697285
Hospital Revenue Code	278
Min. Negotiated Rate	$326.60
Max. Negotiated Rate	$5,750.00
Rate for Payer: Aetna Commercial	$4,370.00
Rate for Payer: Aetna Medicare Advantage	$3,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,932.50
Rate for Payer: Cigna Commercial	$5,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,783.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,725.00
Rate for Payer: UnitedHealthcare Community & State	$363.40
Rate for Payer: Wellpoint Medicaid Managed Care	$326.60

TIBIA ANKLE JT TM SZ5

Facility

$22,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270697283
Hospital Revenue Code	278
Min. Negotiated Rate	$624.80
Max. Negotiated Rate	$11,000.00
Rate for Payer: Aetna Commercial	$8,360.00
Rate for Payer: Aetna Medicare Advantage	$6,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,610.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,610.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,610.00
Rate for Payer: Cigna Commercial	$11,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,324.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,300.00
Rate for Payer: UnitedHealthcare Community & State	$695.20
Rate for Payer: Wellpoint Medicaid Managed Care	$624.80

TIBIA ANKLE JT TM SZ5

Facility

$22,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270697283
Hospital Revenue Code	278
Min. Negotiated Rate	$3,300.00
Max. Negotiated Rate	$5,324.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,324.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,300.00

TIBIA ARTHROSCOPY SURGERY

Facility

$50,586.00

Service Code	HCPCS 29855
Hospital Charge Code	1600000769
Hospital Revenue Code	360
Min. Negotiated Rate	$7,587.90
Max. Negotiated Rate	$7,587.90
Rate for Payer: Qualcare PPO/HMO/WC	$7,587.90

TIBIA ARTHROSCOPY SURGERY

Facility

$50,586.00

Service Code	HCPCS 29855
Hospital Charge Code	1600000769
Hospital Revenue Code	360
Min. Negotiated Rate	$1,598.52
Max. Negotiated Rate	$31,271.12
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31,271.12
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,152.36
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,587.90
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$1,598.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$15,880.57
Rate for Payer: Wellpoint Medicaid Managed Care	$15,569.19

TIBIA BASE FIXED BEARING SZ 7

Facility

$8,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270673972
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

TIBIA BASE FIXED BEARING SZ 7

Facility

$8,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270673972
Hospital Revenue Code	278
Min. Negotiated Rate	$234.30
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Community & State	$260.70
Rate for Payer: Wellpoint Medicaid Managed Care	$234.30

TIBIA COMPON TRIATHLON SZ3

Facility

$6,837.70

Service Code	HCPCS C1776
Hospital Charge Code	270692077
Hospital Revenue Code	278
Min. Negotiated Rate	$194.19
Max. Negotiated Rate	$3,418.85
Rate for Payer: Aetna Commercial	$2,598.33
Rate for Payer: Aetna Medicare Advantage	$2,051.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,743.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,743.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,367.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,743.61
Rate for Payer: Cigna Commercial	$3,418.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,654.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,025.65
Rate for Payer: UnitedHealthcare Community & State	$216.07
Rate for Payer: Wellpoint Medicaid Managed Care	$194.19

TIBIA COMPON TRIATHLON SZ3

Facility

$6,837.70

Service Code	HCPCS C1776
Hospital Charge Code	270692077
Hospital Revenue Code	278
Min. Negotiated Rate	$1,025.65
Max. Negotiated Rate	$1,654.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,367.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,654.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,025.65

TIBIA EMPOWER COATED

Facility

$11,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270691775
Hospital Revenue Code	278
Min. Negotiated Rate	$328.02
Max. Negotiated Rate	$5,775.00
Rate for Payer: Aetna Commercial	$4,389.00
Rate for Payer: Aetna Medicare Advantage	$3,465.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,945.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,945.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,945.25
Rate for Payer: Cigna Commercial	$5,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,795.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,732.50
Rate for Payer: UnitedHealthcare Community & State	$364.98
Rate for Payer: Wellpoint Medicaid Managed Care	$328.02

TIBIA EMPOWER COATED

Facility

$11,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270691775
Hospital Revenue Code	278
Min. Negotiated Rate	$1,732.50
Max. Negotiated Rate	$2,795.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,310.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,795.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,732.50

TIBIA INSERT PSN SUR VE 7 20MM

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	270698344
Hospital Revenue Code	278
Min. Negotiated Rate	$530.19
Max. Negotiated Rate	$9,334.38
Rate for Payer: Aetna Commercial	$7,094.12
Rate for Payer: Aetna Medicare Advantage	$5,600.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,760.53
Rate for Payer: Cigna Commercial	$9,334.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31
Rate for Payer: UnitedHealthcare Community & State	$589.93
Rate for Payer: Wellpoint Medicaid Managed Care	$530.19

TIBIA INSERT PSN SUR VE 7 20MM

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	698344
Hospital Revenue Code	278
Min. Negotiated Rate	$530.19
Max. Negotiated Rate	$9,334.38
Rate for Payer: Aetna Commercial	$7,094.12
Rate for Payer: Aetna Medicare Advantage	$5,600.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,760.53
Rate for Payer: Cigna Commercial	$9,334.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31
Rate for Payer: UnitedHealthcare Community & State	$589.93
Rate for Payer: Wellpoint Medicaid Managed Care	$530.19

TIBIA INSERT PSN SUR VE 7 20MM

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	270698344
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.31
Max. Negotiated Rate	$4,517.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31

TIBIA INSERT PSN SUR VE 7 20MM

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	698344
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.31
Max. Negotiated Rate	$4,517.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31

TIBIA INS MP EVO CS 12MM SZ5RT

Facility

$8,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697692
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$2,057.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

TIBIA INS MP EVO CS 12MM SZ5RT

Facility

$8,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697692
Hospital Revenue Code	278
Min. Negotiated Rate	$241.40
Max. Negotiated Rate	$4,250.00
Rate for Payer: Aetna Commercial	$3,230.00
Rate for Payer: Aetna Medicare Advantage	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,167.50
Rate for Payer: Cigna Commercial	$4,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00
Rate for Payer: UnitedHealthcare Community & State	$268.60
Rate for Payer: Wellpoint Medicaid Managed Care	$241.40

TIBIA INST PSN ASF VE6-9 14MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	698345
Hospital Revenue Code	278
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

Know your out-of-pocket cost for care.

All Charges