Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TIBIAL POST STB INSRT SZ5 13MM

Facility

$3,500.00

Hospital Charge Code	270676256
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 SZ1 15MM STAB

Facility

$5,360.00

Service Code	HCPCS C1713
Hospital Charge Code	270668437
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 POST SZ1 15MM STAB

Facility

$5,360.00

Service Code	HCPCS C1713
Hospital Charge Code	270668437
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 PREP KIT SZ4 CR

Facility

$1,750.00

Hospital Charge Code	270698201
Hospital Revenue Code	272
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$262.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

TIBIAL PREP KIT SZ4 CR

Facility

$1,750.00

Hospital Charge Code	270698201
Hospital Revenue Code	272
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$665.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$455.00
Rate for Payer: Oxford Commercial	$350.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50
Rate for Payer: UnitedHealthcare Commercial	$350.00
Rate for Payer: UnitedHealthcare Community & State	$55.30
Rate for Payer: Wellpoint Medicaid Managed Care	$49.70

TIBIAL PROPHECY ALIGNMENT

Facility

$6,095.00

Service Code	HCPCS C1776
Hospital Charge Code	270670900
Hospital Revenue Code	278
Min. Negotiated Rate	$914.25
Max. Negotiated Rate	$1,474.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,219.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,474.99
Rate for Payer: Qualcare PPO/HMO/WC	$914.25

TIBIAL PROPHECY ALIGNMENT

Facility

$6,095.00

Service Code	HCPCS C1776
Hospital Charge Code	270670900
Hospital Revenue Code	278
Min. Negotiated Rate	$173.10
Max. Negotiated Rate	$3,047.50
Rate for Payer: Aetna Commercial	$2,316.10
Rate for Payer: Aetna Medicare Advantage	$1,828.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,554.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,554.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,219.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,554.22
Rate for Payer: Cigna Commercial	$3,047.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,474.99
Rate for Payer: Qualcare PPO/HMO/WC	$914.25
Rate for Payer: UnitedHealthcare Community & State	$192.60
Rate for Payer: Wellpoint Medicaid Managed Care	$173.10

TIBIAL PSN REV HALF BLOCK 5 MM

Facility

$7,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270690104
Hospital Revenue Code	278
Min. Negotiated Rate	$226.49
Max. Negotiated Rate	$3,987.50
Rate for Payer: Aetna Commercial	$3,030.50
Rate for Payer: Aetna Medicare Advantage	$2,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,033.62
Rate for Payer: Cigna Commercial	$3,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25
Rate for Payer: UnitedHealthcare Community & State	$252.01
Rate for Payer: Wellpoint Medicaid Managed Care	$226.49

TIBIAL PSN REV HALF BLOCK 5 MM

Facility

$7,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270690104
Hospital Revenue Code	278
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,929.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

TIBIAL SOFT TISSUE FASTENER

Facility

$3,720.00

Service Code	HCPCS C1713
Hospital Charge Code	270679465
Hospital Revenue Code	278
Min. Negotiated Rate	$558.00
Max. Negotiated Rate	$900.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$744.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$900.24
Rate for Payer: Qualcare PPO/HMO/WC	$558.00

TIBIAL SOFT TISSUE FASTENER

Facility

$3,720.00

Service Code	HCPCS C1713
Hospital Charge Code	270679465
Hospital Revenue Code	278
Min. Negotiated Rate	$105.65
Max. Negotiated Rate	$1,860.00
Rate for Payer: Aetna Commercial	$1,413.60
Rate for Payer: Aetna Medicare Advantage	$1,116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$948.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$948.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$744.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$948.60
Rate for Payer: Cigna Commercial	$1,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$900.24
Rate for Payer: Qualcare PPO/HMO/WC	$558.00
Rate for Payer: UnitedHealthcare Community & State	$117.55
Rate for Payer: Wellpoint Medicaid Managed Care	$105.65

TIBIAL SPACER MOLD 70x42MM

Facility

$3,785.00

Service Code	HCPCS C1776
Hospital Charge Code	270672773
Hospital Revenue Code	278
Min. Negotiated Rate	$567.75
Max. Negotiated Rate	$915.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$757.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$915.97
Rate for Payer: Qualcare PPO/HMO/WC	$567.75

TIBIAL SPACER MOLD 70x42MM

Facility

$3,785.00

Service Code	HCPCS C1776
Hospital Charge Code	270672773
Hospital Revenue Code	278
Min. Negotiated Rate	$107.49
Max. Negotiated Rate	$1,892.50
Rate for Payer: Aetna Commercial	$1,438.30
Rate for Payer: Aetna Medicare Advantage	$1,135.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$965.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$965.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$757.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$965.17
Rate for Payer: Cigna Commercial	$1,892.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$915.97
Rate for Payer: Qualcare PPO/HMO/WC	$567.75
Rate for Payer: UnitedHealthcare Community & State	$119.61
Rate for Payer: Wellpoint Medicaid Managed Care	$107.49

TIBIAL STEM EXTENSION 100MM

Facility

$6,300.00

Hospital Charge Code	270672659
Hospital Revenue Code	278
Min. Negotiated Rate	$178.92
Max. Negotiated Rate	$3,150.00
Rate for Payer: Aetna Commercial	$2,394.00
Rate for Payer: Aetna Medicare Advantage	$1,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,606.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,606.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,606.50
Rate for Payer: Cigna Commercial	$3,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,524.60
Rate for Payer: Qualcare PPO/HMO/WC	$945.00
Rate for Payer: UnitedHealthcare Community & State	$199.08
Rate for Payer: Wellpoint Medicaid Managed Care	$178.92

TIBIAL STEM EXTENSION 100MM

Facility

$6,300.00

Hospital Charge Code	270672659
Hospital Revenue Code	278
Min. Negotiated Rate	$945.00
Max. Negotiated Rate	$1,524.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,524.60
Rate for Payer: Qualcare PPO/HMO/WC	$945.00

TIBIAL STEM EXTENSION 150MM

Facility

$8,400.00

Hospital Charge Code	270672660
Hospital Revenue Code	278
Min. Negotiated Rate	$1,260.00
Max. Negotiated Rate	$2,032.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,680.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,032.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,260.00

TIBIAL STEM EXTENSION 150MM

Facility

$8,400.00

Hospital Charge Code	270672660
Hospital Revenue Code	278
Min. Negotiated Rate	$238.56
Max. Negotiated Rate	$4,200.00
Rate for Payer: Aetna Commercial	$3,192.00
Rate for Payer: Aetna Medicare Advantage	$2,520.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,142.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,142.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,680.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,142.00
Rate for Payer: Cigna Commercial	$4,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,032.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,260.00
Rate for Payer: UnitedHealthcare Community & State	$265.44
Rate for Payer: Wellpoint Medicaid Managed Care	$238.56

TIBIAL STEM EXTENSION 25MM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672657
Hospital Revenue Code	278
Min. Negotiated Rate	$56.80
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$63.20
Rate for Payer: Wellpoint Medicaid Managed Care	$56.80

TIBIAL STEM EXTENSION 25MM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672657
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

TIBIAL STEM EXTENSION 50MM

Facility

$3,000.00

Hospital Charge Code	270672658
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

TIBIAL STEM EXTENSION 50MM

Facility

$3,000.00

Hospital Charge Code	270672658
Hospital Revenue Code	278
Min. Negotiated Rate	$85.20
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$94.80
Rate for Payer: Wellpoint Medicaid Managed Care	$85.20

TIBIAL TRAY 67MM W/LCKG BAR

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270646501
Hospital Revenue Code	278
Min. Negotiated Rate	$184.60
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$2,470.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00
Rate for Payer: UnitedHealthcare Community & State	$205.40
Rate for Payer: Wellpoint Medicaid Managed Care	$184.60

TIBIAL TRAY 67MM W/LCKG BAR

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270646501
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

TIBIAL TRAY CEMENTED 2.5F/2.5T

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678219
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 TRAY CEMENTED 2.5F/2.5T

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677171
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

Know your out-of-pocket cost for care.

All Charges