Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TIBIAL INSERT POST STB SZ2.9M

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270684355
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

TIBIAL INSERT POST STB SZ2.9M

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270684355
Hospital Revenue Code	278
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$110.60
Rate for Payer: Wellpoint Medicaid Managed Care	$99.40

TIBIAL INSERT POST STB SZ3 9MM

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672024
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

TIBIAL INSERT POST STB SZ3 9MM

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672024
Hospital Revenue Code	278
Min. Negotiated Rate	$113.60
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$126.40
Rate for Payer: Wellpoint Medicaid Managed Care	$113.60

TIBIAL INSERT PT STB SZ3 9MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676965
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

TIBIAL INSERT PT STB SZ3 9MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676965
Hospital Revenue Code	278
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$110.60
Rate for Payer: Wellpoint Medicaid Managed Care	$99.40

TIBIAL INSERT SCREW SZ 3 26MM

Facility

$9,675.00

Hospital Charge Code	270668737
Hospital Revenue Code	278
Min. Negotiated Rate	$1,451.25
Max. Negotiated Rate	$2,341.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,935.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,341.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,451.25

TIBIAL INSERT SCREW SZ 3 26MM

Facility

$9,675.00

Hospital Charge Code	270668737
Hospital Revenue Code	278
Min. Negotiated Rate	$274.77
Max. Negotiated Rate	$4,837.50
Rate for Payer: Aetna Commercial	$3,676.50
Rate for Payer: Aetna Medicare Advantage	$2,902.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,467.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,467.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,935.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,467.12
Rate for Payer: Cigna Commercial	$4,837.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,341.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,451.25
Rate for Payer: UnitedHealthcare Community & State	$305.73
Rate for Payer: Wellpoint Medicaid Managed Care	$274.77

TIBIAL INSERT SCW CND SZ3 22MM

Facility

$6,903.00

Service Code	HCPCS C1776
Hospital Charge Code	270674856
Hospital Revenue Code	278
Min. Negotiated Rate	$196.05
Max. Negotiated Rate	$3,451.50
Rate for Payer: Aetna Commercial	$2,623.14
Rate for Payer: Aetna Medicare Advantage	$2,070.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,760.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,760.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,760.27
Rate for Payer: Cigna Commercial	$3,451.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,670.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.45
Rate for Payer: UnitedHealthcare Community & State	$218.13
Rate for Payer: Wellpoint Medicaid Managed Care	$196.05

TIBIAL INSERT SCW CND SZ3 22MM

Facility

$6,903.00

Service Code	HCPCS C1776
Hospital Charge Code	270674856
Hospital Revenue Code	278
Min. Negotiated Rate	$1,035.45
Max. Negotiated Rate	$1,670.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,670.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.45

TIBIAL INSERT SET SCREW

Facility

$500.00

Service Code	HCPCS C1776
Hospital Charge Code	270672662
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 INSERT SET SCREW

Facility

$500.00

Service Code	HCPCS C1776
Hospital Charge Code	270672662
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 INSERT SPHERE 12 MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686215
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 INSERT SPHERE 12 MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686215
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 INSERT SZ2 22MM

Facility

$6,903.00

Service Code	HCPCS C1776
Hospital Charge Code	270671845
Hospital Revenue Code	278
Min. Negotiated Rate	$196.05
Max. Negotiated Rate	$3,451.50
Rate for Payer: Aetna Commercial	$2,623.14
Rate for Payer: Aetna Medicare Advantage	$2,070.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,760.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,760.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,760.27
Rate for Payer: Cigna Commercial	$3,451.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,670.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.45
Rate for Payer: UnitedHealthcare Community & State	$218.13
Rate for Payer: Wellpoint Medicaid Managed Care	$196.05

TIBIAL INSERT SZ2 22MM

Facility

$6,903.00

Service Code	HCPCS C1776
Hospital Charge Code	270671845
Hospital Revenue Code	278
Min. Negotiated Rate	$1,035.45
Max. Negotiated Rate	$1,670.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,670.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.45

TIBIAL INSERT SZ3 13MM TS

Facility

$23,925.00

Service Code	HCPCS C1776
Hospital Charge Code	270693303
Hospital Revenue Code	278
Min. Negotiated Rate	$679.47
Max. Negotiated Rate	$11,962.50
Rate for Payer: Aetna Commercial	$9,091.50
Rate for Payer: Aetna Medicare Advantage	$7,177.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,100.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,100.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,100.88
Rate for Payer: Cigna Commercial	$11,962.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,789.85
Rate for Payer: Qualcare PPO/HMO/WC	$3,588.75
Rate for Payer: UnitedHealthcare Community & State	$756.03
Rate for Payer: Wellpoint Medicaid Managed Care	$679.47

TIBIAL INSERT SZ3 13MM TS

Facility

$23,925.00

Service Code	HCPCS C1776
Hospital Charge Code	270693303
Hospital Revenue Code	278
Min. Negotiated Rate	$3,588.75
Max. Negotiated Rate	$5,789.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,789.85
Rate for Payer: Qualcare PPO/HMO/WC	$3,588.75

TIBIAL INSERT SZ 3 14MM

Facility

$6,945.00

Service Code	HCPCS C1776
Hospital Charge Code	270668531
Hospital Revenue Code	278
Min. Negotiated Rate	$1,041.75
Max. Negotiated Rate	$1,680.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,389.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,680.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,041.75

TIBIAL INSERT SZ 3 14MM

Facility

$6,945.00

Service Code	HCPCS C1776
Hospital Charge Code	270668531
Hospital Revenue Code	278
Min. Negotiated Rate	$197.24
Max. Negotiated Rate	$3,472.50
Rate for Payer: Aetna Commercial	$2,639.10
Rate for Payer: Aetna Medicare Advantage	$2,083.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,770.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,770.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,389.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,770.97
Rate for Payer: Cigna Commercial	$3,472.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,680.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,041.75
Rate for Payer: UnitedHealthcare Community & State	$219.46
Rate for Payer: Wellpoint Medicaid Managed Care	$197.24

TIBIAL INSERT SZ 3 18MM

Facility

$6,903.00

Service Code	HCPCS C1776
Hospital Charge Code	270674013
Hospital Revenue Code	278
Min. Negotiated Rate	$196.05
Max. Negotiated Rate	$3,451.50
Rate for Payer: Aetna Commercial	$2,623.14
Rate for Payer: Aetna Medicare Advantage	$2,070.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,760.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,760.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,760.27
Rate for Payer: Cigna Commercial	$3,451.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,670.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.45
Rate for Payer: UnitedHealthcare Community & State	$218.13
Rate for Payer: Wellpoint Medicaid Managed Care	$196.05

TIBIAL INSERT SZ 3 18MM

Facility

$6,903.00

Service Code	HCPCS C1776
Hospital Charge Code	270674013
Hospital Revenue Code	278
Min. Negotiated Rate	$1,035.45
Max. Negotiated Rate	$1,670.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,670.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.45

TIBIAL INSERT SZ 3-4 10MM

Facility

$4,898.85

Hospital Charge Code	270671356
Hospital Revenue Code	278
Min. Negotiated Rate	$734.83
Max. Negotiated Rate	$1,185.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$979.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,185.52
Rate for Payer: Qualcare PPO/HMO/WC	$734.83

TIBIAL INSERT SZ 3-4 10MM

Facility

$4,898.85

Hospital Charge Code	270671356
Hospital Revenue Code	278
Min. Negotiated Rate	$139.13
Max. Negotiated Rate	$2,449.43
Rate for Payer: Aetna Commercial	$1,861.56
Rate for Payer: Aetna Medicare Advantage	$1,469.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,249.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,249.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$979.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,249.21
Rate for Payer: Cigna Commercial	$2,449.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,185.52
Rate for Payer: Qualcare PPO/HMO/WC	$734.83
Rate for Payer: UnitedHealthcare Community & State	$154.80
Rate for Payer: Wellpoint Medicaid Managed Care	$139.13

TIBIAL INSERT SZ4 11 MM POST

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270684045
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

Know your out-of-pocket cost for care.

All Charges