Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

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	$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 PSN ASF CPS VE6-9CD 12MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690108
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

TIBIA PSN ASF CPS VE6-9CD 12MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690108
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

TIBIA TALAR DOME SZ2 INF 12MM

Facility

$63,270.00

Service Code	HCPCS C1776
Hospital Charge Code	270698107
Hospital Revenue Code	278
Min. Negotiated Rate	$1,796.87
Max. Negotiated Rate	$31,635.00
Rate for Payer: Aetna Commercial	$24,042.60
Rate for Payer: Aetna Medicare Advantage	$18,981.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,133.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,133.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,654.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,133.85
Rate for Payer: Cigna Commercial	$31,635.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,311.34
Rate for Payer: Qualcare PPO/HMO/WC	$9,490.50
Rate for Payer: UnitedHealthcare Community & State	$1,999.33
Rate for Payer: Wellpoint Medicaid Managed Care	$1,796.87

TIBIA TALAR DOME SZ2 INF 12MM

Facility

$63,270.00

Service Code	HCPCS C1776
Hospital Charge Code	270698107
Hospital Revenue Code	278
Min. Negotiated Rate	$9,490.50
Max. Negotiated Rate	$15,311.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,654.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,311.34
Rate for Payer: Qualcare PPO/HMO/WC	$9,490.50

TIBIA TOTAL ANKLE SZ2

Facility

$20,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677296
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

TIBIA TOTAL ANKLE SZ2

Facility

$20,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677296
Hospital Revenue Code	278
Min. Negotiated Rate	$568.00
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$7,600.00
Rate for Payer: Aetna Medicare Advantage	$6,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,100.00
Rate for Payer: Cigna Commercial	$10,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00
Rate for Payer: UnitedHealthcare Community & State	$632.00
Rate for Payer: Wellpoint Medicaid Managed Care	$568.00

TIBIA TOTAL ANKLE SZ4

Facility

$20,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678163
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

TIBIA TOTAL ANKLE SZ4

Facility

$20,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678163
Hospital Revenue Code	278
Min. Negotiated Rate	$568.00
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$7,600.00
Rate for Payer: Aetna Medicare Advantage	$6,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,100.00
Rate for Payer: Cigna Commercial	$10,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00
Rate for Payer: UnitedHealthcare Community & State	$632.00
Rate for Payer: Wellpoint Medicaid Managed Care	$568.00

TIBIA TOTAL ANKLE SZ4 +0MM

Facility

$11,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270678161
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.50
Max. Negotiated Rate	$2,722.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50

TIBIA TOTAL ANKLE SZ4 +0MM

Facility

$11,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270678161
Hospital Revenue Code	278
Min. Negotiated Rate	$319.50
Max. Negotiated Rate	$5,625.00
Rate for Payer: Aetna Commercial	$4,275.00
Rate for Payer: Aetna Medicare Advantage	$3,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,868.75
Rate for Payer: Cigna Commercial	$5,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50
Rate for Payer: UnitedHealthcare Community & State	$355.50
Rate for Payer: Wellpoint Medicaid Managed Care	$319.50

TIBIA TRIAL VA 3.5 MM SM 3H LT

Facility

$2,189.70

Service Code	HCPCS C1776
Hospital Charge Code	270686032
Hospital Revenue Code	278
Min. Negotiated Rate	$328.45
Max. Negotiated Rate	$529.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$437.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$529.91
Rate for Payer: Qualcare PPO/HMO/WC	$328.45

TIBIA TRIAL VA 3.5 MM SM 3H LT

Facility

$2,189.70

Service Code	HCPCS C1776
Hospital Charge Code	270686032
Hospital Revenue Code	278
Min. Negotiated Rate	$62.19
Max. Negotiated Rate	$1,094.85
Rate for Payer: Aetna Commercial	$832.09
Rate for Payer: Aetna Medicare Advantage	$656.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$558.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$558.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$437.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$558.37
Rate for Payer: Cigna Commercial	$1,094.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$529.91
Rate for Payer: Qualcare PPO/HMO/WC	$328.45
Rate for Payer: UnitedHealthcare Community & State	$69.19
Rate for Payer: Wellpoint Medicaid Managed Care	$62.19

TIBIA TRIAL VA 3.5 MM SM 3H RT

Facility

$2,189.70

Service Code	HCPCS C1776
Hospital Charge Code	270686031
Hospital Revenue Code	278
Min. Negotiated Rate	$62.19
Max. Negotiated Rate	$1,094.85
Rate for Payer: Aetna Commercial	$832.09
Rate for Payer: Aetna Medicare Advantage	$656.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$558.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$558.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$437.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$558.37
Rate for Payer: Cigna Commercial	$1,094.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$529.91
Rate for Payer: Qualcare PPO/HMO/WC	$328.45
Rate for Payer: UnitedHealthcare Community & State	$69.19
Rate for Payer: Wellpoint Medicaid Managed Care	$62.19

TIBIA TRIAL VA 3.5 MM SM 3H RT

Facility

$2,189.70

Service Code	HCPCS C1776
Hospital Charge Code	270686031
Hospital Revenue Code	278
Min. Negotiated Rate	$328.45
Max. Negotiated Rate	$529.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$437.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$529.91
Rate for Payer: Qualcare PPO/HMO/WC	$328.45

TIBIA UNIVERSAL SZ6 LT EMPOWR

Facility

$10,337.50

Service Code	HCPCS C1776
Hospital Charge Code	270692549
Hospital Revenue Code	278
Min. Negotiated Rate	$293.58
Max. Negotiated Rate	$5,168.75
Rate for Payer: Aetna Commercial	$3,928.25
Rate for Payer: Aetna Medicare Advantage	$3,101.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,636.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,636.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,067.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,636.06
Rate for Payer: Cigna Commercial	$5,168.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,501.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,550.62
Rate for Payer: UnitedHealthcare Community & State	$326.67
Rate for Payer: Wellpoint Medicaid Managed Care	$293.58

TIBIA UNIVERSAL SZ6 LT EMPOWR

Facility

$10,337.50

Service Code	HCPCS C1776
Hospital Charge Code	270692549
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.62
Max. Negotiated Rate	$2,501.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,067.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,501.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,550.62

TIBILA BEARING 67MM

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270681761
Hospital Revenue Code	278
Min. Negotiated Rate	$149.10
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$165.90
Rate for Payer: Wellpoint Medicaid Managed Care	$149.10

TIBILA BEARING 67MM

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270681761
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

TIBILA BEARING 75 MM

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270687124
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

TIBILA BEARING 75 MM

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270687124
Hospital Revenue Code	278
Min. Negotiated Rate	$149.10
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$165.90
Rate for Payer: Wellpoint Medicaid Managed Care	$149.10

TIBILA BEARING CONDYL 63/67x16

Facility

$12,930.00

Hospital Charge Code	270676087
Hospital Revenue Code	278
Min. Negotiated Rate	$1,939.50
Max. Negotiated Rate	$3,129.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,586.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,129.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,939.50

TIBILA BEARING CONDYL 63/67x16

Facility

$12,930.00

Hospital Charge Code	270676087
Hospital Revenue Code	278
Min. Negotiated Rate	$367.21
Max. Negotiated Rate	$6,465.00
Rate for Payer: Aetna Commercial	$4,913.40
Rate for Payer: Aetna Medicare Advantage	$3,879.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,297.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,297.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,586.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,297.15
Rate for Payer: Cigna Commercial	$6,465.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,129.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,939.50
Rate for Payer: UnitedHealthcare Community & State	$408.59
Rate for Payer: Wellpoint Medicaid Managed Care	$367.21

TIBILA CUTTING BLOCK

Facility

$500.00

Hospital Charge Code	270678757
Hospital Revenue Code	272
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) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$15.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

TIBILA CUTTING BLOCK

Facility

$500.00

Hospital Charge Code	270678757
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

Know your out-of-pocket cost for care.

All Charges