Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TIBIAL POSTERIOR STAB SZ2 18MM

Facility

$5,360.00

Service Code	HCPCS C1776
Hospital Charge Code	270668732
Hospital Revenue Code	278
Min. Negotiated Rate	$804.00
Max. Negotiated Rate	$1,297.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,072.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,297.12
Rate for Payer: Qualcare PPO/HMO/WC	$804.00

TIBIAL POSTERIOR STAB SZ2 18MM

Facility

$5,360.00

Service Code	HCPCS C1776
Hospital Charge Code	270668732
Hospital Revenue Code	278
Min. Negotiated Rate	$152.22
Max. Negotiated Rate	$2,680.00
Rate for Payer: Aetna Commercial	$2,036.80
Rate for Payer: Aetna Medicare Advantage	$1,608.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,366.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,366.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,072.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,366.80
Rate for Payer: Cigna Commercial	$2,680.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,297.12
Rate for Payer: Qualcare PPO/HMO/WC	$804.00
Rate for Payer: UnitedHealthcare Community & State	$169.38
Rate for Payer: Wellpoint Medicaid Managed Care	$152.22

TIBIAL POSTERIOR STAB. SZ2 22M

Facility

$4,284.65

Service Code	HCPCS C1776
Hospital Charge Code	270669871
Hospital Revenue Code	278
Min. Negotiated Rate	$642.70
Max. Negotiated Rate	$1,036.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$856.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.89
Rate for Payer: Qualcare PPO/HMO/WC	$642.70

TIBIAL POSTERIOR STAB. SZ2 22M

Facility

$4,284.65

Service Code	HCPCS C1776
Hospital Charge Code	270669871
Hospital Revenue Code	278
Min. Negotiated Rate	$121.68
Max. Negotiated Rate	$2,142.32
Rate for Payer: Aetna Commercial	$1,628.17
Rate for Payer: Aetna Medicare Advantage	$1,285.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,092.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,092.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$856.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,092.59
Rate for Payer: Cigna Commercial	$2,142.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.89
Rate for Payer: Qualcare PPO/HMO/WC	$642.70
Rate for Payer: UnitedHealthcare Community & State	$135.39
Rate for Payer: Wellpoint Medicaid Managed Care	$121.68

TIBIAL POSTERIOR STAB SZ3 13MM

Facility

$4,284.65

Service Code	HCPCS C1776
Hospital Charge Code	270670880
Hospital Revenue Code	278
Min. Negotiated Rate	$642.70
Max. Negotiated Rate	$1,036.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$856.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.89
Rate for Payer: Qualcare PPO/HMO/WC	$642.70

TIBIAL POSTERIOR STAB SZ3 13MM

Facility

$4,284.65

Service Code	HCPCS C1776
Hospital Charge Code	270670880
Hospital Revenue Code	278
Min. Negotiated Rate	$121.68
Max. Negotiated Rate	$2,142.32
Rate for Payer: Aetna Commercial	$1,628.17
Rate for Payer: Aetna Medicare Advantage	$1,285.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,092.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,092.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$856.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,092.59
Rate for Payer: Cigna Commercial	$2,142.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.89
Rate for Payer: Qualcare PPO/HMO/WC	$642.70
Rate for Payer: UnitedHealthcare Community & State	$135.39
Rate for Payer: Wellpoint Medicaid Managed Care	$121.68

TIBIAL POSTERIOR STAB SZ6 13MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677944
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 POSTERIOR STAB SZ6 13MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677944
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 POSTERIOR SZ1 26MM STAB

Facility

$5,360.00

Service Code	HCPCS C1776
Hospital Charge Code	270668730
Hospital Revenue Code	278
Min. Negotiated Rate	$152.22
Max. Negotiated Rate	$2,680.00
Rate for Payer: Aetna Commercial	$2,036.80
Rate for Payer: Aetna Medicare Advantage	$1,608.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,366.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,366.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,072.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,366.80
Rate for Payer: Cigna Commercial	$2,680.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,297.12
Rate for Payer: Qualcare PPO/HMO/WC	$804.00
Rate for Payer: UnitedHealthcare Community & State	$169.38
Rate for Payer: Wellpoint Medicaid Managed Care	$152.22

TIBIAL POSTERIOR SZ1 26MM STAB

Facility

$5,360.00

Service Code	HCPCS C1776
Hospital Charge Code	270668730
Hospital Revenue Code	278
Min. Negotiated Rate	$804.00
Max. Negotiated Rate	$1,297.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,072.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,297.12
Rate for Payer: Qualcare PPO/HMO/WC	$804.00

TIBIAL POSTERIOR SZ3 15MM STAB

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270668546
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 POSTERIOR SZ3 15MM STAB

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270668546
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 POST STB INSRT SZ0 11MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680414
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 POST STB INSRT SZ0 11MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680414
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 POST STB INSRT SZ1 22MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270673368
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 POST STB INSRT SZ1 22MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270673368
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 POST STB INSRT SZ4 13MM

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672121
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 POST STB INSRT SZ4 13MM

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672121
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 POST STB INSRT SZ4 15MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677536
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 POST STB INSRT SZ4 15MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677536
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 POST STB INSRT SZ4 18MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270673794
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 POST STB INSRT SZ4 18MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270673794
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 POST STB INSRT SZ5 11MM

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672123
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 POST STB INSRT SZ5 11MM

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672123
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 POST STB INSRT SZ5 13MM

Facility

$3,500.00

Hospital Charge Code	270676256
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

Know your out-of-pocket cost for care.

All Charges