Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

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	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

TIBIA INST PSN ASF VE6-9 14MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270698345
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

TIBIA INST PSN ASF VE6-9 14MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270698345
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

TIBIAL ARTICULAR SUR SZ64 15MM

Facility

$13,273.75

Hospital Charge Code	270669473
Hospital Revenue Code	278
Min. Negotiated Rate	$376.97
Max. Negotiated Rate	$6,636.88
Rate for Payer: Aetna Commercial	$5,044.02
Rate for Payer: Aetna Medicare Advantage	$3,982.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,384.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,384.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,654.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,384.81
Rate for Payer: Cigna Commercial	$6,636.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,212.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,991.06
Rate for Payer: UnitedHealthcare Community & State	$419.45
Rate for Payer: Wellpoint Medicaid Managed Care	$376.97

TIBIAL ARTICULAR SUR SZ64 15MM

Facility

$13,273.75

Hospital Charge Code	270669473
Hospital Revenue Code	278
Min. Negotiated Rate	$1,991.06
Max. Negotiated Rate	$3,212.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,654.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,212.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,991.06

TIBIAL ATTU ROTAT SZ 5 5MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690791
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

TIBIAL ATTU ROTAT SZ 5 5MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690791
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

TIBIAL AUG BLK SZ 2T 8MM

Facility

$3,864.00

Service Code	HCPCS C1776
Hospital Charge Code	270677687
Hospital Revenue Code	278
Min. Negotiated Rate	$579.60
Max. Negotiated Rate	$935.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$935.09
Rate for Payer: Qualcare PPO/HMO/WC	$579.60

TIBIAL AUG BLK SZ 2T 8MM

Facility

$3,864.00

Service Code	HCPCS C1776
Hospital Charge Code	270677687
Hospital Revenue Code	278
Min. Negotiated Rate	$109.74
Max. Negotiated Rate	$1,932.00
Rate for Payer: Aetna Commercial	$1,468.32
Rate for Payer: Aetna Medicare Advantage	$1,159.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$985.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$985.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$985.32
Rate for Payer: Cigna Commercial	$1,932.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$935.09
Rate for Payer: Qualcare PPO/HMO/WC	$579.60
Rate for Payer: UnitedHealthcare Community & State	$122.10
Rate for Payer: Wellpoint Medicaid Managed Care	$109.74

TIBIAL AUG BLK SZ 3 11MM LLRM

Facility

$2,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270671717
Hospital Revenue Code	278
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$855.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Community & State	$71.10
Rate for Payer: Wellpoint Medicaid Managed Care	$63.90

TIBIAL AUG BLK SZ 3 11MM LLRM

Facility

$2,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270671717
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

TIBIAL AUG BLK SZ 3 11MM RLLM

Facility

$2,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270671718
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

TIBIAL AUG BLK SZ 3 11MM RLLM

Facility

$2,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270671718
Hospital Revenue Code	278
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$855.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Community & State	$71.10
Rate for Payer: Wellpoint Medicaid Managed Care	$63.90

TIBIAL AUG BLK SZ 3T 8MM

Facility

$3,861.00

Service Code	HCPCS C1776
Hospital Charge Code	270673569
Hospital Revenue Code	278
Min. Negotiated Rate	$109.65
Max. Negotiated Rate	$1,930.50
Rate for Payer: Aetna Commercial	$1,467.18
Rate for Payer: Aetna Medicare Advantage	$1,158.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$984.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$984.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$984.55
Rate for Payer: Cigna Commercial	$1,930.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.36
Rate for Payer: Qualcare PPO/HMO/WC	$579.15
Rate for Payer: UnitedHealthcare Community & State	$122.01
Rate for Payer: Wellpoint Medicaid Managed Care	$109.65

TIBIAL AUG BLK SZ 3T 8MM

Facility

$3,861.00

Service Code	HCPCS C1776
Hospital Charge Code	270673569
Hospital Revenue Code	278
Min. Negotiated Rate	$579.15
Max. Negotiated Rate	$934.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.36
Rate for Payer: Qualcare PPO/HMO/WC	$579.15

TIBIAL AUGMENATION # 2 20MM LM

Facility

$7,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270687675
Hospital Revenue Code	278
Min. Negotiated Rate	$1,155.00
Max. Negotiated Rate	$1,863.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,863.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00

TIBIAL AUGMENATION # 2 20MM LM

Facility

$7,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270687675
Hospital Revenue Code	278
Min. Negotiated Rate	$218.68
Max. Negotiated Rate	$3,850.00
Rate for Payer: Aetna Commercial	$2,926.00
Rate for Payer: Aetna Medicare Advantage	$2,310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,963.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,963.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,963.50
Rate for Payer: Cigna Commercial	$3,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,863.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00
Rate for Payer: UnitedHealthcare Community & State	$243.32
Rate for Payer: Wellpoint Medicaid Managed Care	$218.68

TIBIAL AUGMENATION # 2 20MM RM

Facility

$7,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270687674
Hospital Revenue Code	278
Min. Negotiated Rate	$218.68
Max. Negotiated Rate	$3,850.00
Rate for Payer: Aetna Commercial	$2,926.00
Rate for Payer: Aetna Medicare Advantage	$2,310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,963.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,963.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,963.50
Rate for Payer: Cigna Commercial	$3,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,863.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00
Rate for Payer: UnitedHealthcare Community & State	$243.32
Rate for Payer: Wellpoint Medicaid Managed Care	$218.68

TIBIAL AUGMENATION # 2 20MM RM

Facility

$7,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270687674
Hospital Revenue Code	278
Min. Negotiated Rate	$1,155.00
Max. Negotiated Rate	$1,863.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,863.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00

TIBIAL AUGMEN SCREWED S410MM

Facility

$7,065.00

Service Code	HCPCS C1776
Hospital Charge Code	270687964
Hospital Revenue Code	278
Min. Negotiated Rate	$1,059.75
Max. Negotiated Rate	$1,709.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,413.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,709.73
Rate for Payer: Qualcare PPO/HMO/WC	$1,059.75

TIBIAL AUGMEN SCREWED S410MM

Facility

$7,065.00

Service Code	HCPCS C1776
Hospital Charge Code	270687964
Hospital Revenue Code	278
Min. Negotiated Rate	$200.65
Max. Negotiated Rate	$3,532.50
Rate for Payer: Aetna Commercial	$2,684.70
Rate for Payer: Aetna Medicare Advantage	$2,119.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,801.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,801.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,413.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,801.58
Rate for Payer: Cigna Commercial	$3,532.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,709.73
Rate for Payer: Qualcare PPO/HMO/WC	$1,059.75
Rate for Payer: UnitedHealthcare Community & State	$223.25
Rate for Payer: Wellpoint Medicaid Managed Care	$200.65

TIBIAL AUGMENT BK 1/2 SZ1 18MM

Facility

$3,861.00

Service Code	HCPCS C1776
Hospital Charge Code	270673369
Hospital Revenue Code	278
Min. Negotiated Rate	$579.15
Max. Negotiated Rate	$934.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.36
Rate for Payer: Qualcare PPO/HMO/WC	$579.15

TIBIAL AUGMENT BK 1/2 SZ1 18MM

Facility

$3,861.00

Service Code	HCPCS C1776
Hospital Charge Code	270673369
Hospital Revenue Code	278
Min. Negotiated Rate	$109.65
Max. Negotiated Rate	$1,930.50
Rate for Payer: Aetna Commercial	$1,467.18
Rate for Payer: Aetna Medicare Advantage	$1,158.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$984.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$984.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$984.55
Rate for Payer: Cigna Commercial	$1,930.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.36
Rate for Payer: Qualcare PPO/HMO/WC	$579.15
Rate for Payer: UnitedHealthcare Community & State	$122.01
Rate for Payer: Wellpoint Medicaid Managed Care	$109.65

TIBIAL AUGMENT BLOCK

Facility

$5,165.00

Service Code	HCPCS C1776
Hospital Charge Code	270687122
Hospital Revenue Code	278
Min. Negotiated Rate	$774.75
Max. Negotiated Rate	$1,249.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,033.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,249.93
Rate for Payer: Qualcare PPO/HMO/WC	$774.75

TIBIAL AUGMENT BLOCK

Facility

$5,165.00

Service Code	HCPCS C1776
Hospital Charge Code	270687122
Hospital Revenue Code	278
Min. Negotiated Rate	$146.69
Max. Negotiated Rate	$2,582.50
Rate for Payer: Aetna Commercial	$1,962.70
Rate for Payer: Aetna Medicare Advantage	$1,549.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,317.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,317.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,033.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,317.08
Rate for Payer: Cigna Commercial	$2,582.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,249.93
Rate for Payer: Qualcare PPO/HMO/WC	$774.75
Rate for Payer: UnitedHealthcare Community & State	$163.21
Rate for Payer: Wellpoint Medicaid Managed Care	$146.69

Know your out-of-pocket cost for care.

All Charges