Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TIBIAL COMPONENT MEDIUM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686974
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 SIZE 3 12MM

Facility

$5,695.00

Hospital Charge Code	270673197
Hospital Revenue Code	278
Min. Negotiated Rate	$161.74
Max. Negotiated Rate	$2,847.50
Rate for Payer: Aetna Commercial	$2,164.10
Rate for Payer: Aetna Medicare Advantage	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,452.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,452.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,139.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,452.22
Rate for Payer: Cigna Commercial	$2,847.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,378.19
Rate for Payer: Qualcare PPO/HMO/WC	$854.25
Rate for Payer: UnitedHealthcare Community & State	$179.96
Rate for Payer: Wellpoint Medicaid Managed Care	$161.74

TIBIAL COMPONENT SIZE 3 12MM

Facility

$5,695.00

Hospital Charge Code	270673197
Hospital Revenue Code	278
Min. Negotiated Rate	$854.25
Max. Negotiated Rate	$1,378.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,139.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,378.19
Rate for Payer: Qualcare PPO/HMO/WC	$854.25

TIBIAL COMPONENT SIZE #4

Facility

$7,179.60

Service Code	HCPCS C1776
Hospital Charge Code	270690853
Hospital Revenue Code	278
Min. Negotiated Rate	$1,076.94
Max. Negotiated Rate	$1,737.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,435.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,737.46
Rate for Payer: Qualcare PPO/HMO/WC	$1,076.94

TIBIAL COMPONENT SIZE #4

Facility

$7,179.60

Service Code	HCPCS C1776
Hospital Charge Code	270690853
Hospital Revenue Code	278
Min. Negotiated Rate	$203.90
Max. Negotiated Rate	$3,589.80
Rate for Payer: Aetna Commercial	$2,728.25
Rate for Payer: Aetna Medicare Advantage	$2,153.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,830.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,830.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,435.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,830.80
Rate for Payer: Cigna Commercial	$3,589.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,737.46
Rate for Payer: Qualcare PPO/HMO/WC	$1,076.94
Rate for Payer: UnitedHealthcare Community & State	$226.88
Rate for Payer: Wellpoint Medicaid Managed Care	$203.90

TIBIAL COMPONENT SMALL

Facility

$8,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270680960
Hospital Revenue Code	278
Min. Negotiated Rate	$248.50
Max. Negotiated Rate	$4,375.00
Rate for Payer: Aetna Commercial	$3,325.00
Rate for Payer: Aetna Medicare Advantage	$2,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,231.25
Rate for Payer: Cigna Commercial	$4,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50
Rate for Payer: UnitedHealthcare Community & State	$276.50
Rate for Payer: Wellpoint Medicaid Managed Care	$248.50

TIBIAL COMPONENT SMALL

Facility

$8,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270680960
Hospital Revenue Code	278
Min. Negotiated Rate	$1,312.50
Max. Negotiated Rate	$2,117.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50

TIBIAL CUTTING BLOCK RT SZ3

Facility

$1,625.00

Hospital Charge Code	270673641
Hospital Revenue Code	272
Min. Negotiated Rate	$46.15
Max. Negotiated Rate	$812.50
Rate for Payer: Aetna Commercial	$617.50
Rate for Payer: Aetna Medicare Advantage	$487.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$414.38
Rate for Payer: Cigna Commercial	$812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$422.50
Rate for Payer: Oxford Commercial	$325.00
Rate for Payer: Qualcare PPO/HMO/WC	$243.75
Rate for Payer: UnitedHealthcare Commercial	$325.00
Rate for Payer: UnitedHealthcare Community & State	$51.35
Rate for Payer: Wellpoint Medicaid Managed Care	$46.15

TIBIAL CUTTING BLOCK RT SZ3

Facility

$1,625.00

Hospital Charge Code	270673641
Hospital Revenue Code	272
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$243.75
Rate for Payer: Qualcare PPO/HMO/WC	$243.75

TIBIAL CUTTING BLOCK RT SZ4

Facility

$2,625.00

Hospital Charge Code	270675307
Hospital Revenue Code	272
Min. Negotiated Rate	$393.75
Max. Negotiated Rate	$393.75
Rate for Payer: Qualcare PPO/HMO/WC	$393.75

TIBIAL CUTTING BLOCK RT SZ4

Facility

$2,625.00

Hospital Charge Code	270675307
Hospital Revenue Code	272
Min. Negotiated Rate	$74.55
Max. Negotiated Rate	$1,312.50
Rate for Payer: Aetna Commercial	$997.50
Rate for Payer: Aetna Medicare Advantage	$787.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$669.38
Rate for Payer: Cigna Commercial	$1,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$682.50
Rate for Payer: Oxford Commercial	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$393.75
Rate for Payer: UnitedHealthcare Commercial	$525.00
Rate for Payer: UnitedHealthcare Community & State	$82.95
Rate for Payer: Wellpoint Medicaid Managed Care	$74.55

TIBIAL CUTTING BLOCK SZ2 LEFT

Facility

$625.00

Hospital Charge Code	270676450
Hospital Revenue Code	272
Min. Negotiated Rate	$17.75
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$125.00
Rate for Payer: UnitedHealthcare Community & State	$19.75
Rate for Payer: Wellpoint Medicaid Managed Care	$17.75

TIBIAL CUTTING BLOCK SZ2 LEFT

Facility

$625.00

Hospital Charge Code	270676450
Hospital Revenue Code	272
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

TIBIAL CUTTING BLOCK SZ2 RIGHT

Facility

$2,625.00

Hospital Charge Code	270672252
Hospital Revenue Code	272
Min. Negotiated Rate	$74.55
Max. Negotiated Rate	$1,312.50
Rate for Payer: Aetna Commercial	$997.50
Rate for Payer: Aetna Medicare Advantage	$787.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$669.38
Rate for Payer: Cigna Commercial	$1,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$682.50
Rate for Payer: Oxford Commercial	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$393.75
Rate for Payer: UnitedHealthcare Commercial	$525.00
Rate for Payer: UnitedHealthcare Community & State	$82.95
Rate for Payer: Wellpoint Medicaid Managed Care	$74.55

TIBIAL CUTTING BLOCK SZ2 RIGHT

Facility

$2,625.00

Hospital Charge Code	270672252
Hospital Revenue Code	272
Min. Negotiated Rate	$393.75
Max. Negotiated Rate	$393.75
Rate for Payer: Qualcare PPO/HMO/WC	$393.75

TIBIAL CUTTING BLOCK SZ 4 LEFT

Facility

$625.00

Hospital Charge Code	270671996
Hospital Revenue Code	272
Min. Negotiated Rate	$17.75
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$125.00
Rate for Payer: UnitedHealthcare Community & State	$19.75
Rate for Payer: Wellpoint Medicaid Managed Care	$17.75

TIBIAL CUTTING BLOCK SZ 4 LEFT

Facility

$625.00

Hospital Charge Code	270671996
Hospital Revenue Code	272
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

TIBIAL CUTTING BLOCK UNIVERAL

Facility

$4,200.00

Hospital Charge Code	270686931
Hospital Revenue Code	272
Min. Negotiated Rate	$630.00
Max. Negotiated Rate	$630.00
Rate for Payer: Qualcare PPO/HMO/WC	$630.00

TIBIAL CUTTING BLOCK UNIVERAL

Facility

$4,200.00

Hospital Charge Code	270686931
Hospital Revenue Code	272
Min. Negotiated Rate	$119.28
Max. Negotiated Rate	$2,100.00
Rate for Payer: Aetna Commercial	$1,596.00
Rate for Payer: Aetna Medicare Advantage	$1,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,071.00
Rate for Payer: Cigna Commercial	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,092.00
Rate for Payer: Oxford Commercial	$840.00
Rate for Payer: Qualcare PPO/HMO/WC	$630.00
Rate for Payer: UnitedHealthcare Commercial	$840.00
Rate for Payer: UnitedHealthcare Community & State	$132.72
Rate for Payer: Wellpoint Medicaid Managed Care	$119.28

TIBIAL ELEOS MODUL CAP ONE SZ

Facility

$850.00

Service Code	HCPCS C1776
Hospital Charge Code	270682848
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

TIBIAL ELEOS MODUL CAP ONE SZ

Facility

$850.00

Service Code	HCPCS C1776
Hospital Charge Code	270682848
Hospital Revenue Code	278
Min. Negotiated Rate	$24.14
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Community & State	$26.86
Rate for Payer: Wellpoint Medicaid Managed Care	$24.14

TIBIAL FIXED KEEL CMT SZ D L

Facility

$18,487.50

Service Code	HCPCS C1776
Hospital Charge Code	270690105
Hospital Revenue Code	278
Min. Negotiated Rate	$525.04
Max. Negotiated Rate	$9,243.75
Rate for Payer: Aetna Commercial	$7,025.25
Rate for Payer: Aetna Medicare Advantage	$5,546.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,714.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,714.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,697.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,714.31
Rate for Payer: Cigna Commercial	$9,243.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,473.98
Rate for Payer: Qualcare PPO/HMO/WC	$2,773.12
Rate for Payer: UnitedHealthcare Community & State	$584.21
Rate for Payer: Wellpoint Medicaid Managed Care	$525.04

TIBIAL FIXED KEEL CMT SZ D L

Facility

$18,487.50

Service Code	HCPCS C1776
Hospital Charge Code	270690105
Hospital Revenue Code	278
Min. Negotiated Rate	$2,773.12
Max. Negotiated Rate	$4,473.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,697.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,473.98
Rate for Payer: Qualcare PPO/HMO/WC	$2,773.12

TIBIAL GMK TRAY HINGE 20 MM S

Facility

$14,905.00

Service Code	HCPCS C1776
Hospital Charge Code	270687685
Hospital Revenue Code	278
Min. Negotiated Rate	$2,235.75
Max. Negotiated Rate	$3,607.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,981.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,607.01
Rate for Payer: Qualcare PPO/HMO/WC	$2,235.75

TIBIAL GMK TRAY HINGE 20 MM S

Facility

$14,905.00

Service Code	HCPCS C1776
Hospital Charge Code	270687685
Hospital Revenue Code	278
Min. Negotiated Rate	$423.30
Max. Negotiated Rate	$7,452.50
Rate for Payer: Aetna Commercial	$5,663.90
Rate for Payer: Aetna Medicare Advantage	$4,471.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,800.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,800.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,981.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,800.78
Rate for Payer: Cigna Commercial	$7,452.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,607.01
Rate for Payer: Qualcare PPO/HMO/WC	$2,235.75
Rate for Payer: UnitedHealthcare Community & State	$471.00
Rate for Payer: Wellpoint Medicaid Managed Care	$423.30

Know your out-of-pocket cost for care.

All Charges