Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TIBIAL GMK TRAY HINGE 2 20MM

Facility

$14,905.00

Service Code	HCPCS C1776
Hospital Charge Code	270687695
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 2 20MM

Facility

$14,905.00

Service Code	HCPCS C1776
Hospital Charge Code	270687695
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

TIBIAL GMK TRAY HINGE RIGHT S4

Facility

$24,345.00

Service Code	HCPCS C1776
Hospital Charge Code	270687949
Hospital Revenue Code	278
Min. Negotiated Rate	$3,651.75
Max. Negotiated Rate	$5,891.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,869.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,891.49
Rate for Payer: Qualcare PPO/HMO/WC	$3,651.75

TIBIAL GMK TRAY HINGE RIGHT S4

Facility

$24,345.00

Service Code	HCPCS C1776
Hospital Charge Code	270687949
Hospital Revenue Code	278
Min. Negotiated Rate	$691.40
Max. Negotiated Rate	$12,172.50
Rate for Payer: Aetna Commercial	$9,251.10
Rate for Payer: Aetna Medicare Advantage	$7,303.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,207.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,207.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,869.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,207.98
Rate for Payer: Cigna Commercial	$12,172.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,891.49
Rate for Payer: Qualcare PPO/HMO/WC	$3,651.75
Rate for Payer: UnitedHealthcare Community & State	$769.30
Rate for Payer: Wellpoint Medicaid Managed Care	$691.40

TIBIAL HINGE ELEOS ROTIONAL ST

Facility

$11,645.00

Service Code	HCPCS C1776
Hospital Charge Code	270682843
Hospital Revenue Code	278
Min. Negotiated Rate	$330.72
Max. Negotiated Rate	$5,822.50
Rate for Payer: Aetna Commercial	$4,425.10
Rate for Payer: Aetna Medicare Advantage	$3,493.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,969.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,969.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,329.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,969.47
Rate for Payer: Cigna Commercial	$5,822.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,818.09
Rate for Payer: Qualcare PPO/HMO/WC	$1,746.75
Rate for Payer: UnitedHealthcare Community & State	$367.98
Rate for Payer: Wellpoint Medicaid Managed Care	$330.72

TIBIAL HINGE ELEOS ROTIONAL ST

Facility

$11,645.00

Service Code	HCPCS C1776
Hospital Charge Code	270682843
Hospital Revenue Code	278
Min. Negotiated Rate	$1,746.75
Max. Negotiated Rate	$2,818.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,329.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,818.09
Rate for Payer: Qualcare PPO/HMO/WC	$1,746.75

TIBIAL INLAY POLY SZ 1 6.5MM

Facility

$3,955.00

Hospital Charge Code	270668679
Hospital Revenue Code	278
Min. Negotiated Rate	$112.32
Max. Negotiated Rate	$1,977.50
Rate for Payer: Aetna Commercial	$1,502.90
Rate for Payer: Aetna Medicare Advantage	$1,186.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,008.52
Rate for Payer: Cigna Commercial	$1,977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: Qualcare PPO/HMO/WC	$593.25
Rate for Payer: UnitedHealthcare Community & State	$124.98
Rate for Payer: Wellpoint Medicaid Managed Care	$112.32

TIBIAL INLAY POLY SZ 1 6.5MM

Facility

$3,955.00

Hospital Charge Code	270668679
Hospital Revenue Code	278
Min. Negotiated Rate	$593.25
Max. Negotiated Rate	$957.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: Qualcare PPO/HMO/WC	$593.25

TIBIAL INLAY POLY SZ 1 7.5MM

Facility

$3,955.00

Hospital Charge Code	270668680
Hospital Revenue Code	278
Min. Negotiated Rate	$112.32
Max. Negotiated Rate	$1,977.50
Rate for Payer: Aetna Commercial	$1,502.90
Rate for Payer: Aetna Medicare Advantage	$1,186.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,008.52
Rate for Payer: Cigna Commercial	$1,977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: Qualcare PPO/HMO/WC	$593.25
Rate for Payer: UnitedHealthcare Community & State	$124.98
Rate for Payer: Wellpoint Medicaid Managed Care	$112.32

TIBIAL INLAY POLY SZ 1 7.5MM

Facility

$3,955.00

Hospital Charge Code	270668680
Hospital Revenue Code	278
Min. Negotiated Rate	$593.25
Max. Negotiated Rate	$957.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: Qualcare PPO/HMO/WC	$593.25

TIBIAL INLAY POLY SZ 1 8.5MM

Facility

$3,955.00

Hospital Charge Code	270668681
Hospital Revenue Code	278
Min. Negotiated Rate	$593.25
Max. Negotiated Rate	$957.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: Qualcare PPO/HMO/WC	$593.25

TIBIAL INLAY POLY SZ 1 8.5MM

Facility

$3,955.00

Hospital Charge Code	270668681
Hospital Revenue Code	278
Min. Negotiated Rate	$112.32
Max. Negotiated Rate	$1,977.50
Rate for Payer: Aetna Commercial	$1,502.90
Rate for Payer: Aetna Medicare Advantage	$1,186.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,008.52
Rate for Payer: Cigna Commercial	$1,977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: Qualcare PPO/HMO/WC	$593.25
Rate for Payer: UnitedHealthcare Community & State	$124.98
Rate for Payer: Wellpoint Medicaid Managed Care	$112.32

TIBIAL INLAY POLY SZ 2 6.5MM

Facility

$3,955.00

Hospital Charge Code	270668682
Hospital Revenue Code	278
Min. Negotiated Rate	$593.25
Max. Negotiated Rate	$957.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: Qualcare PPO/HMO/WC	$593.25

TIBIAL INLAY POLY SZ 2 6.5MM

Facility

$3,955.00

Hospital Charge Code	270668682
Hospital Revenue Code	278
Min. Negotiated Rate	$112.32
Max. Negotiated Rate	$1,977.50
Rate for Payer: Aetna Commercial	$1,502.90
Rate for Payer: Aetna Medicare Advantage	$1,186.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,008.52
Rate for Payer: Cigna Commercial	$1,977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: Qualcare PPO/HMO/WC	$593.25
Rate for Payer: UnitedHealthcare Community & State	$124.98
Rate for Payer: Wellpoint Medicaid Managed Care	$112.32

TIBIAL INLAY POLY SZ 2 7.5MM

Facility

$3,955.00

Hospital Charge Code	270668683
Hospital Revenue Code	278
Min. Negotiated Rate	$593.25
Max. Negotiated Rate	$957.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: Qualcare PPO/HMO/WC	$593.25

TIBIAL INLAY POLY SZ 2 7.5MM

Facility

$3,955.00

Hospital Charge Code	270668683
Hospital Revenue Code	278
Min. Negotiated Rate	$112.32
Max. Negotiated Rate	$1,977.50
Rate for Payer: Aetna Commercial	$1,502.90
Rate for Payer: Aetna Medicare Advantage	$1,186.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,008.52
Rate for Payer: Cigna Commercial	$1,977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: Qualcare PPO/HMO/WC	$593.25
Rate for Payer: UnitedHealthcare Community & State	$124.98
Rate for Payer: Wellpoint Medicaid Managed Care	$112.32

TIBIAL INLAY POLY SZ 2 8.5MM

Facility

$3,955.00

Hospital Charge Code	270668684
Hospital Revenue Code	278
Min. Negotiated Rate	$593.25
Max. Negotiated Rate	$957.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: Qualcare PPO/HMO/WC	$593.25

TIBIAL INLAY POLY SZ 2 8.5MM

Facility

$3,955.00

Hospital Charge Code	270668684
Hospital Revenue Code	278
Min. Negotiated Rate	$112.32
Max. Negotiated Rate	$1,977.50
Rate for Payer: Aetna Commercial	$1,502.90
Rate for Payer: Aetna Medicare Advantage	$1,186.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,008.52
Rate for Payer: Cigna Commercial	$1,977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: Qualcare PPO/HMO/WC	$593.25
Rate for Payer: UnitedHealthcare Community & State	$124.98
Rate for Payer: Wellpoint Medicaid Managed Care	$112.32

TIBIAL INLAY POLY SZ 3 6.5MM

Facility

$3,955.00

Hospital Charge Code	270668685
Hospital Revenue Code	278
Min. Negotiated Rate	$112.32
Max. Negotiated Rate	$1,977.50
Rate for Payer: Aetna Commercial	$1,502.90
Rate for Payer: Aetna Medicare Advantage	$1,186.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,008.52
Rate for Payer: Cigna Commercial	$1,977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: Qualcare PPO/HMO/WC	$593.25
Rate for Payer: UnitedHealthcare Community & State	$124.98
Rate for Payer: Wellpoint Medicaid Managed Care	$112.32

TIBIAL INLAY POLY SZ 3 6.5MM

Facility

$3,955.00

Hospital Charge Code	270668685
Hospital Revenue Code	278
Min. Negotiated Rate	$593.25
Max. Negotiated Rate	$957.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: Qualcare PPO/HMO/WC	$593.25

TIBIAL INLAY POLY SZ 3 7.5MM

Facility

$3,955.00

Hospital Charge Code	270668686
Hospital Revenue Code	278
Min. Negotiated Rate	$593.25
Max. Negotiated Rate	$957.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: Qualcare PPO/HMO/WC	$593.25

TIBIAL INLAY POLY SZ 3 7.5MM

Facility

$3,955.00

Hospital Charge Code	270668686
Hospital Revenue Code	278
Min. Negotiated Rate	$112.32
Max. Negotiated Rate	$1,977.50
Rate for Payer: Aetna Commercial	$1,502.90
Rate for Payer: Aetna Medicare Advantage	$1,186.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,008.52
Rate for Payer: Cigna Commercial	$1,977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: Qualcare PPO/HMO/WC	$593.25
Rate for Payer: UnitedHealthcare Community & State	$124.98
Rate for Payer: Wellpoint Medicaid Managed Care	$112.32

TIBIAL INLAY POLY SZ 3 8.5MM

Facility

$3,955.00

Hospital Charge Code	270668687
Hospital Revenue Code	278
Min. Negotiated Rate	$112.32
Max. Negotiated Rate	$1,977.50
Rate for Payer: Aetna Commercial	$1,502.90
Rate for Payer: Aetna Medicare Advantage	$1,186.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,008.52
Rate for Payer: Cigna Commercial	$1,977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: Qualcare PPO/HMO/WC	$593.25
Rate for Payer: UnitedHealthcare Community & State	$124.98
Rate for Payer: Wellpoint Medicaid Managed Care	$112.32

TIBIAL INLAY POLY SZ 3 8.5MM

Facility

$3,955.00

Hospital Charge Code	270668687
Hospital Revenue Code	278
Min. Negotiated Rate	$593.25
Max. Negotiated Rate	$957.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: Qualcare PPO/HMO/WC	$593.25

TIBIAL INLAY POLY SZ 4 6.5MM

Facility

$3,955.00

Hospital Charge Code	270668688
Hospital Revenue Code	278
Min. Negotiated Rate	$593.25
Max. Negotiated Rate	$957.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: Qualcare PPO/HMO/WC	$593.25

Know your out-of-pocket cost for care.

All Charges