Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TIBIAL BEARING INSERT SZ 1

Facility

$5,233.60

Service Code	HCPCS C1713
Hospital Charge Code	270705094
Hospital Revenue Code	278
Min. Negotiated Rate	$148.63
Max. Negotiated Rate	$2,616.80
Rate for Payer: Aetna Commercial	$1,988.77
Rate for Payer: Aetna Medicare Advantage	$1,570.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,334.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,334.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,046.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,334.57
Rate for Payer: Cigna Commercial	$2,616.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,266.53
Rate for Payer: Qualcare PPO/HMO/WC	$785.04
Rate for Payer: UnitedHealthcare Community & State	$165.38
Rate for Payer: Wellpoint Medicaid Managed Care	$148.63

TIBIAL BEARING INSERT SZ 1

Facility

$5,233.60

Service Code	HCPCS C1713
Hospital Charge Code	270705094
Hospital Revenue Code	278
Min. Negotiated Rate	$785.04
Max. Negotiated Rate	$1,266.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,046.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,266.53
Rate for Payer: Qualcare PPO/HMO/WC	$785.04

TIBIAL BEARING INSERT SZ 2

Facility

$5,208.30

Service Code	HCPCS C1713
Hospital Charge Code	270705127
Hospital Revenue Code	278
Min. Negotiated Rate	$147.92
Max. Negotiated Rate	$2,604.15
Rate for Payer: Aetna Commercial	$1,979.15
Rate for Payer: Aetna Medicare Advantage	$1,562.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,328.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,328.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,041.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,328.12
Rate for Payer: Cigna Commercial	$2,604.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,260.41
Rate for Payer: Qualcare PPO/HMO/WC	$781.25
Rate for Payer: UnitedHealthcare Community & State	$164.58
Rate for Payer: Wellpoint Medicaid Managed Care	$147.92

TIBIAL BEARING INSERT SZ 2

Facility

$5,208.30

Service Code	HCPCS C1713
Hospital Charge Code	270705127
Hospital Revenue Code	278
Min. Negotiated Rate	$781.25
Max. Negotiated Rate	$1,260.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,041.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,260.41
Rate for Payer: Qualcare PPO/HMO/WC	$781.25

TIBIAL BEARING INSERT SZ4 13MM

Facility

$4,985.30

Service Code	HCPCS C1776
Hospital Charge Code	270697649
Hospital Revenue Code	278
Min. Negotiated Rate	$747.79
Max. Negotiated Rate	$1,206.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.44
Rate for Payer: Qualcare PPO/HMO/WC	$747.79

TIBIAL BEARING INSERT SZ4 13MM

Facility

$4,985.30

Service Code	HCPCS C1776
Hospital Charge Code	270697649
Hospital Revenue Code	278
Min. Negotiated Rate	$141.58
Max. Negotiated Rate	$2,492.65
Rate for Payer: Aetna Commercial	$1,894.41
Rate for Payer: Aetna Medicare Advantage	$1,495.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,271.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,271.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,271.25
Rate for Payer: Cigna Commercial	$2,492.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.44
Rate for Payer: Qualcare PPO/HMO/WC	$747.79
Rate for Payer: UnitedHealthcare Community & State	$157.54
Rate for Payer: Wellpoint Medicaid Managed Care	$141.58

TIBIAL BEARING INSRT PS 5/11MM

Facility

$6,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270672933
Hospital Revenue Code	278
Min. Negotiated Rate	$195.25
Max. Negotiated Rate	$3,437.50
Rate for Payer: Aetna Commercial	$2,612.50
Rate for Payer: Aetna Medicare Advantage	$2,062.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,753.12
Rate for Payer: Cigna Commercial	$3,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,663.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25
Rate for Payer: UnitedHealthcare Community & State	$217.25
Rate for Payer: Wellpoint Medicaid Managed Care	$195.25

TIBIAL BEARING INSRT PS 5/11MM

Facility

$6,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270672933
Hospital Revenue Code	278
Min. Negotiated Rate	$1,031.25
Max. Negotiated Rate	$1,663.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,663.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25

TIBIAL BEARING INSRT PS 5/16MM

Facility

$6,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270672932
Hospital Revenue Code	278
Min. Negotiated Rate	$195.25
Max. Negotiated Rate	$3,437.50
Rate for Payer: Aetna Commercial	$2,612.50
Rate for Payer: Aetna Medicare Advantage	$2,062.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,753.12
Rate for Payer: Cigna Commercial	$3,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,663.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25
Rate for Payer: UnitedHealthcare Community & State	$217.25
Rate for Payer: Wellpoint Medicaid Managed Care	$195.25

TIBIAL BEARING INSRT PS 5/16MM

Facility

$6,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270672932
Hospital Revenue Code	278
Min. Negotiated Rate	$1,031.25
Max. Negotiated Rate	$1,663.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,663.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25

TIBIAL BONE MODEL

Facility

$500.00

Hospital Charge Code	270672254
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

TIBIAL BONE MODEL

Facility

$500.00

Hospital Charge Code	270672254
Hospital Revenue Code	272
Min. Negotiated Rate	$14.20
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$15.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

TIBIAL BONE MODEL 4.9020

Facility

$500.00

Hospital Charge Code	270672255
Hospital Revenue Code	278
Min. Negotiated Rate	$14.20
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$15.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

TIBIAL BONE MODEL 4.9020

Facility

$500.00

Hospital Charge Code	270672255
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

TIBIAL BUSHING

Facility

$1,605.00

Service Code	HCPCS C1713
Hospital Charge Code	270664277
Hospital Revenue Code	278
Min. Negotiated Rate	$240.75
Max. Negotiated Rate	$388.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$321.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$388.41
Rate for Payer: Qualcare PPO/HMO/WC	$240.75

TIBIAL BUSHING

Facility

$1,605.00

Service Code	HCPCS C1713
Hospital Charge Code	270664277
Hospital Revenue Code	278
Min. Negotiated Rate	$45.58
Max. Negotiated Rate	$802.50
Rate for Payer: Aetna Commercial	$609.90
Rate for Payer: Aetna Medicare Advantage	$481.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$409.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$409.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$321.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$409.27
Rate for Payer: Cigna Commercial	$802.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$388.41
Rate for Payer: Qualcare PPO/HMO/WC	$240.75
Rate for Payer: UnitedHealthcare Community & State	$50.72
Rate for Payer: Wellpoint Medicaid Managed Care	$45.58

TIBIAL CHECKPOINT STERILE

Facility

$270.00

Hospital Charge Code	270668097
Hospital Revenue Code	272
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$40.50
Rate for Payer: Qualcare PPO/HMO/WC	$40.50

TIBIAL CHECKPOINT STERILE

Facility

$270.00

Hospital Charge Code	270668097
Hospital Revenue Code	272
Min. Negotiated Rate	$7.67
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$102.60
Rate for Payer: Aetna Medicare Advantage	$81.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.85
Rate for Payer: Cigna Commercial	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.20
Rate for Payer: Oxford Commercial	$54.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.50
Rate for Payer: UnitedHealthcare Commercial	$54.00
Rate for Payer: UnitedHealthcare Community & State	$8.53
Rate for Payer: Wellpoint Medicaid Managed Care	$7.67

TIBIAL COMPONENT 12MM

Facility

$14,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270672591
Hospital Revenue Code	278
Min. Negotiated Rate	$408.96
Max. Negotiated Rate	$7,200.00
Rate for Payer: Aetna Commercial	$5,472.00
Rate for Payer: Aetna Medicare Advantage	$4,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,672.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,672.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,880.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,672.00
Rate for Payer: Cigna Commercial	$7,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,484.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,160.00
Rate for Payer: UnitedHealthcare Community & State	$455.04
Rate for Payer: Wellpoint Medicaid Managed Care	$408.96

TIBIAL COMPONENT 12MM

Facility

$14,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270672591
Hospital Revenue Code	278
Min. Negotiated Rate	$2,160.00
Max. Negotiated Rate	$3,484.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,880.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,484.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,160.00

TIBIAL COMPONENT # 5

Facility

$6,837.70

Service Code	HCPCS C1776
Hospital Charge Code	270691024
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

TIBIAL COMPONENT # 5

Facility

$6,837.70

Service Code	HCPCS C1776
Hospital Charge Code	270691024
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

TIBIAL COMPONENT 80MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676066
Hospital Revenue Code	278
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$316.00
Rate for Payer: Wellpoint Medicaid Managed Care	$284.00

TIBIAL COMPONENT 80MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676066
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

TIBIAL COMPONENT MEDIUM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686974
Hospital Revenue Code	278
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$316.00
Rate for Payer: Wellpoint Medicaid Managed Care	$284.00

Know your out-of-pocket cost for care.

All Charges