Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TIBIALIS TENDON POSTERIOR FF

Facility

$13,651.65

Service Code	HCPCS C1763
Hospital Charge Code	270698011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,047.75
Max. Negotiated Rate	$3,303.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,730.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,303.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,047.75

TIBIALIS TENDON POSTERIOR FF

Facility

$13,651.65

Service Code	HCPCS C1763
Hospital Charge Code	270698011
Hospital Revenue Code	278
Min. Negotiated Rate	$387.71
Max. Negotiated Rate	$6,825.82
Rate for Payer: Aetna Commercial	$5,187.63
Rate for Payer: Aetna Medicare Advantage	$4,095.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,481.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,481.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,730.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,481.17
Rate for Payer: Cigna Commercial	$6,825.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,303.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,047.75
Rate for Payer: UnitedHealthcare Community & State	$431.39
Rate for Payer: Wellpoint Medicaid Managed Care	$387.71

TIBIAL KEEL CMT SZ E LARGE PSN

Facility

$18,487.50

Service Code	HCPCS C1776
Hospital Charge Code	270690150
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 KEEL CMT SZ E LARGE PSN

Facility

$18,487.50

Service Code	HCPCS C1776
Hospital Charge Code	270690150
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 KEELED BASE CMT SZ3 RIG

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270678166
Hospital Revenue Code	278
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

TIBIAL KEELED BASE CMT SZ3 RIG

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270678166
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

TIBIAL KNEE BASE FX BEAR SZ 2

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270685557
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

TIBIAL KNEE BASE FX BEAR SZ 2

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270685557
Hospital Revenue Code	278
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

TIBIAL KNEE BASE FX BEAR SZ 3

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686916
Hospital Revenue Code	278
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

TIBIAL KNEE BASE FX BEAR SZ 3

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686916
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

TIBIAL KNEE BASE FX BEAR SZ 5

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270685556
Hospital Revenue Code	278
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

TIBIAL KNEE BASE FX BEAR SZ 5

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270685556
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

TIBIAL KNEE LOCKING CLIP I/BII

Facility

$1,396.30

Hospital Charge Code	270669474
Hospital Revenue Code	278
Min. Negotiated Rate	$209.44
Max. Negotiated Rate	$337.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$279.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$337.90
Rate for Payer: Qualcare PPO/HMO/WC	$209.44

TIBIAL KNEE LOCKING CLIP I/BII

Facility

$1,396.30

Hospital Charge Code	270669474
Hospital Revenue Code	278
Min. Negotiated Rate	$39.65
Max. Negotiated Rate	$698.15
Rate for Payer: Aetna Commercial	$530.59
Rate for Payer: Aetna Medicare Advantage	$418.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$356.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$356.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$279.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$356.06
Rate for Payer: Cigna Commercial	$698.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$337.90
Rate for Payer: Qualcare PPO/HMO/WC	$209.44
Rate for Payer: UnitedHealthcare Community & State	$44.12
Rate for Payer: Wellpoint Medicaid Managed Care	$39.65

TIBIAL NAIL 10X 315

Facility

$6,180.00

Service Code	HCPCS C1713
Hospital Charge Code	270656597
Hospital Revenue Code	278
Min. Negotiated Rate	$927.00
Max. Negotiated Rate	$1,495.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,236.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,495.56
Rate for Payer: Qualcare PPO/HMO/WC	$927.00

TIBIAL NAIL 10X 315

Facility

$6,180.00

Service Code	HCPCS C1713
Hospital Charge Code	270656597
Hospital Revenue Code	278
Min. Negotiated Rate	$175.51
Max. Negotiated Rate	$3,090.00
Rate for Payer: Aetna Commercial	$2,348.40
Rate for Payer: Aetna Medicare Advantage	$1,854.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,575.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,575.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,236.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,575.90
Rate for Payer: Cigna Commercial	$3,090.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,495.56
Rate for Payer: Qualcare PPO/HMO/WC	$927.00
Rate for Payer: UnitedHealthcare Community & State	$195.29
Rate for Payer: Wellpoint Medicaid Managed Care	$175.51

TIBIAL NAIL 8X330

Facility

$6,180.00

Service Code	HCPCS C1713
Hospital Charge Code	270679170
Hospital Revenue Code	278
Min. Negotiated Rate	$927.00
Max. Negotiated Rate	$1,495.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,236.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,495.56
Rate for Payer: Qualcare PPO/HMO/WC	$927.00

TIBIAL NAIL 8X330

Facility

$6,180.00

Service Code	HCPCS C1713
Hospital Charge Code	270679170
Hospital Revenue Code	278
Min. Negotiated Rate	$175.51
Max. Negotiated Rate	$3,090.00
Rate for Payer: Aetna Commercial	$2,348.40
Rate for Payer: Aetna Medicare Advantage	$1,854.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,575.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,575.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,236.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,575.90
Rate for Payer: Cigna Commercial	$3,090.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,495.56
Rate for Payer: Qualcare PPO/HMO/WC	$927.00
Rate for Payer: UnitedHealthcare Community & State	$195.29
Rate for Payer: Wellpoint Medicaid Managed Care	$175.51

TIBIAL NAIL 9MMX 300MM

Facility

$6,670.00

Service Code	HCPCS C1713
Hospital Charge Code	270683794
Hospital Revenue Code	278
Min. Negotiated Rate	$189.43
Max. Negotiated Rate	$3,335.00
Rate for Payer: Aetna Commercial	$2,534.60
Rate for Payer: Aetna Medicare Advantage	$2,001.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,700.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,700.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,334.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,700.85
Rate for Payer: Cigna Commercial	$3,335.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,614.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,000.50
Rate for Payer: UnitedHealthcare Community & State	$210.77
Rate for Payer: Wellpoint Medicaid Managed Care	$189.43

TIBIAL NAIL 9MMX 300MM

Facility

$6,670.00

Service Code	HCPCS C1713
Hospital Charge Code	270683794
Hospital Revenue Code	278
Min. Negotiated Rate	$1,000.50
Max. Negotiated Rate	$1,614.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,334.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,614.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,000.50

TIBIAL NAIL 9X320MM

Facility

$14,300.00

Hospital Charge Code	270702712
Hospital Revenue Code	278
Min. Negotiated Rate	$2,145.00
Max. Negotiated Rate	$3,460.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,460.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,145.00

TIBIAL NAIL 9X320MM

Facility

$14,300.00

Hospital Charge Code	270702712
Hospital Revenue Code	278
Min. Negotiated Rate	$406.12
Max. Negotiated Rate	$7,150.00
Rate for Payer: Aetna Commercial	$5,434.00
Rate for Payer: Aetna Medicare Advantage	$4,290.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,646.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,646.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,860.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,646.50
Rate for Payer: Cigna Commercial	$7,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,460.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,145.00
Rate for Payer: UnitedHealthcare Community & State	$451.88
Rate for Payer: Wellpoint Medicaid Managed Care	$406.12

TIBIAL NAIL EXPRX BND 10X285MM

Facility

$19,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270699731
Hospital Revenue Code	278
Min. Negotiated Rate	$2,962.50
Max. Negotiated Rate	$4,779.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,779.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,962.50

TIBIAL NAIL EXPRX BND 10X285MM

Facility

$19,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270699731
Hospital Revenue Code	278
Min. Negotiated Rate	$560.90
Max. Negotiated Rate	$9,875.00
Rate for Payer: Aetna Commercial	$7,505.00
Rate for Payer: Aetna Medicare Advantage	$5,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,036.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,036.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,036.25
Rate for Payer: Cigna Commercial	$9,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,779.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,962.50
Rate for Payer: UnitedHealthcare Community & State	$624.10
Rate for Payer: Wellpoint Medicaid Managed Care	$560.90

TIBIAL NAIL STD 9x310MM

Facility

$11,980.00

Service Code	HCPCS C1713
Hospital Charge Code	270673976
Hospital Revenue Code	278
Min. Negotiated Rate	$1,797.00
Max. Negotiated Rate	$2,899.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,396.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,899.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,797.00

Know your out-of-pocket cost for care.

All Charges