Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TIBIAL AUGMENT BLOCK

Facility

$5,165.00

Service Code	HCPCS C1776
Hospital Charge Code	270687123
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

TIBIAL AUGMENT BLOCK

Facility

$5,165.00

Service Code	HCPCS C1776
Hospital Charge Code	270687123
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 AUG. SCREWS SZ4T RT LAT

Facility

$3,861.00

Service Code	HCPCS C1713
Hospital Charge Code	270680583
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 AUG. SCREWS SZ4T RT LAT

Facility

$3,861.00

Service Code	HCPCS C1713
Hospital Charge Code	270680583
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. SCREWS SZ4T RT MED

Facility

$3,861.00

Service Code	HCPCS C1713
Hospital Charge Code	270680584
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. SCREWS SZ4T RT MED

Facility

$3,861.00

Service Code	HCPCS C1713
Hospital Charge Code	270680584
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 AUG SCREW SZ 2T 11MM LA

Facility

$413.75

Service Code	HCPCS C1713
Hospital Charge Code	270683131
Hospital Revenue Code	278
Min. Negotiated Rate	$62.06
Max. Negotiated Rate	$100.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.13
Rate for Payer: Qualcare PPO/HMO/WC	$62.06

TIBIAL AUG SCREW SZ 2T 11MM LA

Facility

$413.75

Service Code	HCPCS C1713
Hospital Charge Code	270683131
Hospital Revenue Code	278
Min. Negotiated Rate	$11.75
Max. Negotiated Rate	$206.88
Rate for Payer: Aetna Commercial	$157.22
Rate for Payer: Aetna Medicare Advantage	$124.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.51
Rate for Payer: Cigna Commercial	$206.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.13
Rate for Payer: Qualcare PPO/HMO/WC	$62.06
Rate for Payer: UnitedHealthcare Community & State	$13.07
Rate for Payer: Wellpoint Medicaid Managed Care	$11.75

TIBIAL AUG SCREW SZ 2T 11MM ME

Facility

$3,861.00

Service Code	HCPCS C1713
Hospital Charge Code	270683132
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 AUG SCREW SZ 2T 11MM ME

Facility

$3,861.00

Service Code	HCPCS C1713
Hospital Charge Code	270683132
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 BASE

Facility

$4,926.00

Hospital Charge Code	270335026
Hospital Revenue Code	278
Min. Negotiated Rate	$738.90
Max. Negotiated Rate	$1,192.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$985.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,192.09
Rate for Payer: Qualcare PPO/HMO/WC	$738.90

TIBIAL BASE

Facility

$4,926.00

Hospital Charge Code	270335026
Hospital Revenue Code	278
Min. Negotiated Rate	$139.90
Max. Negotiated Rate	$2,463.00
Rate for Payer: Aetna Commercial	$1,871.88
Rate for Payer: Aetna Medicare Advantage	$1,477.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,256.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,256.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$985.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,256.13
Rate for Payer: Cigna Commercial	$2,463.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,192.09
Rate for Payer: Qualcare PPO/HMO/WC	$738.90
Rate for Payer: UnitedHealthcare Community & State	$155.66
Rate for Payer: Wellpoint Medicaid Managed Care	$139.90

TIBIAL BASE

Facility

$9,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270667710
Hospital Revenue Code	278
Min. Negotiated Rate	$1,350.00
Max. Negotiated Rate	$2,178.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00

TIBIAL BASE

Facility

$9,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270667710
Hospital Revenue Code	278
Min. Negotiated Rate	$255.60
Max. Negotiated Rate	$4,500.00
Rate for Payer: Aetna Commercial	$3,420.00
Rate for Payer: Aetna Medicare Advantage	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,295.00
Rate for Payer: Cigna Commercial	$4,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00
Rate for Payer: UnitedHealthcare Community & State	$284.40
Rate for Payer: Wellpoint Medicaid Managed Care	$255.60

TIBIAL BASE ADVAN COCR NP SZ4

Facility

$14,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270697441
Hospital Revenue Code	278
Min. Negotiated Rate	$397.60
Max. Negotiated Rate	$7,000.00
Rate for Payer: Aetna Commercial	$5,320.00
Rate for Payer: Aetna Medicare Advantage	$4,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,570.00
Rate for Payer: Cigna Commercial	$7,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,388.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00
Rate for Payer: UnitedHealthcare Community & State	$442.40
Rate for Payer: Wellpoint Medicaid Managed Care	$397.60

TIBIAL BASE ADVAN COCR NP SZ4

Facility

$14,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270697441
Hospital Revenue Code	278
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$3,388.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,388.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00

TIBIAL BASE COMPONENT SZ 2

Facility

$29,665.00

Hospital Charge Code	270669431
Hospital Revenue Code	278
Min. Negotiated Rate	$4,449.75
Max. Negotiated Rate	$7,178.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,933.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,178.93
Rate for Payer: Qualcare PPO/HMO/WC	$4,449.75

TIBIAL BASE COMPONENT SZ 2

Facility

$29,665.00

Hospital Charge Code	270669431
Hospital Revenue Code	278
Min. Negotiated Rate	$842.49
Max. Negotiated Rate	$14,832.50
Rate for Payer: Aetna Commercial	$11,272.70
Rate for Payer: Aetna Medicare Advantage	$8,899.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,564.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,564.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,933.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,564.57
Rate for Payer: Cigna Commercial	$14,832.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,178.93
Rate for Payer: Qualcare PPO/HMO/WC	$4,449.75
Rate for Payer: UnitedHealthcare Community & State	$937.41
Rate for Payer: Wellpoint Medicaid Managed Care	$842.49

TIBIAL BASEPLATE #5

Facility

$4,470.00

Service Code	HCPCS C1713
Hospital Charge Code	270692142
Hospital Revenue Code	278
Min. Negotiated Rate	$670.50
Max. Negotiated Rate	$1,081.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$894.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,081.74
Rate for Payer: Qualcare PPO/HMO/WC	$670.50

TIBIAL BASEPLATE #5

Facility

$4,470.00

Service Code	HCPCS C1713
Hospital Charge Code	270692142
Hospital Revenue Code	278
Min. Negotiated Rate	$126.95
Max. Negotiated Rate	$2,235.00
Rate for Payer: Aetna Commercial	$1,698.60
Rate for Payer: Aetna Medicare Advantage	$1,341.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,139.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,139.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$894.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,139.85
Rate for Payer: Cigna Commercial	$2,235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,081.74
Rate for Payer: Qualcare PPO/HMO/WC	$670.50
Rate for Payer: UnitedHealthcare Community & State	$141.25
Rate for Payer: Wellpoint Medicaid Managed Care	$126.95

TIBIAL BASEPLATE 67MM

Facility

$19,650.00

Service Code	HCPCS C1776
Hospital Charge Code	270681760
Hospital Revenue Code	278
Min. Negotiated Rate	$2,947.50
Max. Negotiated Rate	$4,755.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,930.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,755.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,947.50

TIBIAL BASEPLATE 67MM

Facility

$19,650.00

Service Code	HCPCS C1776
Hospital Charge Code	270681760
Hospital Revenue Code	278
Min. Negotiated Rate	$558.06
Max. Negotiated Rate	$9,825.00
Rate for Payer: Aetna Commercial	$7,467.00
Rate for Payer: Aetna Medicare Advantage	$5,895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,010.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,010.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,930.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,010.75
Rate for Payer: Cigna Commercial	$9,825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,755.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,947.50
Rate for Payer: UnitedHealthcare Community & State	$620.94
Rate for Payer: Wellpoint Medicaid Managed Care	$558.06

TIBIAL BASEPLATE CMA #5

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676677
Hospital Revenue Code	278
Min. Negotiated Rate	$127.80
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Community & State	$142.20
Rate for Payer: Wellpoint Medicaid Managed Care	$127.80

TIBIAL BASEPLATE CMA #5

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676677
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

TIBIAL BASEPLATE STEMMED SZ 1

Facility

$7,500.00

Hospital Charge Code	270669294
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

Know your out-of-pocket cost for care.

All Charges