Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TIBIAL TRAY SZ 4

Facility

$65,168.10

Service Code	HCPCS C1713
Hospital Charge Code	270704971
Hospital Revenue Code	278
Min. Negotiated Rate	$1,850.77
Max. Negotiated Rate	$32,584.05
Rate for Payer: Aetna Commercial	$24,763.88
Rate for Payer: Aetna Medicare Advantage	$19,550.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,617.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,617.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,617.87
Rate for Payer: Cigna Commercial	$32,584.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,770.68
Rate for Payer: Qualcare PPO/HMO/WC	$9,775.22
Rate for Payer: UnitedHealthcare Community & State	$2,059.31
Rate for Payer: Wellpoint Medicaid Managed Care	$1,850.77

TIBIAL TRAY SZ 4

Facility

$65,168.10

Service Code	HCPCS C1713
Hospital Charge Code	270704971
Hospital Revenue Code	278
Min. Negotiated Rate	$9,775.22
Max. Negotiated Rate	$15,770.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,033.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,770.68
Rate for Payer: Qualcare PPO/HMO/WC	$9,775.22

TIBIAL TRAY SZ 5

Facility

$22,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270680022
Hospital Revenue Code	278
Min. Negotiated Rate	$3,360.00
Max. Negotiated Rate	$5,420.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,480.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,420.80
Rate for Payer: Qualcare PPO/HMO/WC	$3,360.00

TIBIAL TRAY SZ 5

Facility

$22,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270680022
Hospital Revenue Code	278
Min. Negotiated Rate	$636.16
Max. Negotiated Rate	$11,200.00
Rate for Payer: Aetna Commercial	$8,512.00
Rate for Payer: Aetna Medicare Advantage	$6,720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,712.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,712.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,480.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,712.00
Rate for Payer: Cigna Commercial	$11,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,420.80
Rate for Payer: Qualcare PPO/HMO/WC	$3,360.00
Rate for Payer: UnitedHealthcare Community & State	$707.84
Rate for Payer: Wellpoint Medicaid Managed Care	$636.16

TIBIAL TRAY TRAPEZOID SZ 3F/4T

Facility

$8,903.25

Service Code	HCPCS C1776
Hospital Charge Code	270670753
Hospital Revenue Code	278
Min. Negotiated Rate	$1,335.49
Max. Negotiated Rate	$2,154.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,780.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,154.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,335.49

TIBIAL TRAY TRAPEZOID SZ 3F/4T

Facility

$8,903.25

Service Code	HCPCS C1776
Hospital Charge Code	270670753
Hospital Revenue Code	278
Min. Negotiated Rate	$252.85
Max. Negotiated Rate	$4,451.62
Rate for Payer: Aetna Commercial	$3,383.24
Rate for Payer: Aetna Medicare Advantage	$2,670.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,270.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,270.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,780.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,270.33
Rate for Payer: Cigna Commercial	$4,451.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,154.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,335.49
Rate for Payer: UnitedHealthcare Community & State	$281.34
Rate for Payer: Wellpoint Medicaid Managed Care	$252.85

TIBIAL TRAY TRAPEZOID SZ5F/5T

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672124
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 TRAY TRAPEZOID SZ5F/5T

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672124
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 TRAP SZ1F/1T 2F/1T

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270671565
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 TRAY TRAP SZ1F/1T 2F/1T

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270671565
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 TRAP SZ1F/2T,2F/2T

Facility

$8,903.25

Service Code	HCPCS C1776
Hospital Charge Code	270668733
Hospital Revenue Code	278
Min. Negotiated Rate	$1,335.49
Max. Negotiated Rate	$2,154.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,780.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,154.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,335.49

TIBIAL TRAY TRAP SZ1F/2T,2F/2T

Facility

$8,903.25

Service Code	HCPCS C1776
Hospital Charge Code	270668733
Hospital Revenue Code	278
Min. Negotiated Rate	$252.85
Max. Negotiated Rate	$4,451.62
Rate for Payer: Aetna Commercial	$3,383.24
Rate for Payer: Aetna Medicare Advantage	$2,670.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,270.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,270.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,780.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,270.33
Rate for Payer: Cigna Commercial	$4,451.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,154.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,335.49
Rate for Payer: UnitedHealthcare Community & State	$281.34
Rate for Payer: Wellpoint Medicaid Managed Care	$252.85

TIBIAL TRAY TRAP SZ1F/3T 2F/3T

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270669784
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 TRAP SZ1F/3T 2F/3T

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270669784
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 TRAY TRAP SZ 4F/3T

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270673795
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 TRAY TRAP SZ 4F/3T

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270673795
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 TRAP SZ 4F/5T

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270675367
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 TRAY TRAP SZ 4F/5T

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270675367
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 TRIATHLON BP SZ #7

Facility

$4,446.55

Service Code	HCPCS C1776
Hospital Charge Code	270681038
Hospital Revenue Code	278
Min. Negotiated Rate	$126.28
Max. Negotiated Rate	$2,223.28
Rate for Payer: Aetna Commercial	$1,689.69
Rate for Payer: Aetna Medicare Advantage	$1,333.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,133.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,133.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$889.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,133.87
Rate for Payer: Cigna Commercial	$2,223.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,076.07
Rate for Payer: Qualcare PPO/HMO/WC	$666.98
Rate for Payer: UnitedHealthcare Community & State	$140.51
Rate for Payer: Wellpoint Medicaid Managed Care	$126.28

TIBIAL TRIATHLON BP SZ #7

Facility

$4,446.55

Service Code	HCPCS C1776
Hospital Charge Code	270681038
Hospital Revenue Code	278
Min. Negotiated Rate	$666.98
Max. Negotiated Rate	$1,076.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$889.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,076.07
Rate for Payer: Qualcare PPO/HMO/WC	$666.98

TIBIA NP CEMENTED SZ2 RT STD

Facility

$14,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270697281
Hospital Revenue Code	278
Min. Negotiated Rate	$397.60
Max. Negotiated Rate	$7,000.00
Rate for Payer: Aetna Commercial	$5,320.00
Rate for Payer: Aetna Medicare Advantage	$4,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,570.00
Rate for Payer: Cigna Commercial	$7,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,388.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00
Rate for Payer: UnitedHealthcare Community & State	$442.40
Rate for Payer: Wellpoint Medicaid Managed Care	$397.60

TIBIA NP CEMENTED SZ2 RT STD

Facility

$14,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270697281
Hospital Revenue Code	278
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$3,388.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,388.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00

TIBIA POR COASTED SZ 11 LEFT

Facility

$11,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270692716
Hospital Revenue Code	278
Min. Negotiated Rate	$328.02
Max. Negotiated Rate	$5,775.00
Rate for Payer: Aetna Commercial	$4,389.00
Rate for Payer: Aetna Medicare Advantage	$3,465.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,945.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,945.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,945.25
Rate for Payer: Cigna Commercial	$5,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,795.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,732.50
Rate for Payer: UnitedHealthcare Community & State	$364.98
Rate for Payer: Wellpoint Medicaid Managed Care	$328.02

TIBIA POR COASTED SZ 11 LEFT

Facility

$11,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270692716
Hospital Revenue Code	278
Min. Negotiated Rate	$1,732.50
Max. Negotiated Rate	$2,795.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,310.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,795.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,732.50

TIBIA PRESSFIT BP 8 LT POROUS

Facility

$11,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270692263
Hospital Revenue Code	278
Min. Negotiated Rate	$328.02
Max. Negotiated Rate	$5,775.00
Rate for Payer: Aetna Commercial	$4,389.00
Rate for Payer: Aetna Medicare Advantage	$3,465.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,945.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,945.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,945.25
Rate for Payer: Cigna Commercial	$5,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,795.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,732.50
Rate for Payer: UnitedHealthcare Community & State	$364.98
Rate for Payer: Wellpoint Medicaid Managed Care	$328.02

Know your out-of-pocket cost for care.

All Charges