Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TRAY TIBIAL FIXED SZ5 RIGHT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677519
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

TRAY TIBIAL I-BEAM 63mm

Facility

$6,610.00

Hospital Charge Code	270671041
Hospital Revenue Code	278
Min. Negotiated Rate	$991.50
Max. Negotiated Rate	$1,599.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,322.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,599.62
Rate for Payer: Qualcare PPO/HMO/WC	$991.50

TRAY TIBIAL I-BEAM 63mm

Facility

$6,610.00

Hospital Charge Code	270671041
Hospital Revenue Code	278
Min. Negotiated Rate	$187.72
Max. Negotiated Rate	$3,305.00
Rate for Payer: Aetna Commercial	$2,511.80
Rate for Payer: Aetna Medicare Advantage	$1,983.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,685.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,685.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,322.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,685.55
Rate for Payer: Cigna Commercial	$3,305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,599.62
Rate for Payer: Qualcare PPO/HMO/WC	$991.50
Rate for Payer: UnitedHealthcare Community & State	$208.88
Rate for Payer: Wellpoint Medicaid Managed Care	$187.72

TRAY TIBIAL REGENEREX PRIMARY

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270663938
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

TRAY TIBIAL REGENEREX PRIMARY

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270663938
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

TRAY TIBIAL TRAPEZOID SZ 3F/2T

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677100
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

TRAY TIBIAL TRAPEZOID SZ 3F/2T

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677100
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

TRAY TIBIAL TRAPEZOID SZ 3F/3T

Facility

$8,310.00

Service Code	HCPCS C1776
Hospital Charge Code	270668746
Hospital Revenue Code	278
Min. Negotiated Rate	$236.00
Max. Negotiated Rate	$4,155.00
Rate for Payer: Aetna Commercial	$3,157.80
Rate for Payer: Aetna Medicare Advantage	$2,493.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,119.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,119.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,662.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,119.05
Rate for Payer: Cigna Commercial	$4,155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,011.02
Rate for Payer: Qualcare PPO/HMO/WC	$1,246.50
Rate for Payer: UnitedHealthcare Community & State	$262.60
Rate for Payer: Wellpoint Medicaid Managed Care	$236.00

TRAY TIBIAL TRAPEZOID SZ 3F/3T

Facility

$8,310.00

Service Code	HCPCS C1776
Hospital Charge Code	270668746
Hospital Revenue Code	278
Min. Negotiated Rate	$1,246.50
Max. Negotiated Rate	$2,011.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,662.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,011.02
Rate for Payer: Qualcare PPO/HMO/WC	$1,246.50

TRAY TIBIAL TRAPEZOID SZ 4FT/4

Facility

$8,903.25

Hospital Charge Code	270669600
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

TRAY TIBIAL TRAPEZOID SZ 4FT/4

Facility

$8,903.25

Hospital Charge Code	270669600
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

TRAY TIBIAL TRAPEZOID SZ 5F/4T

Facility

$5,000.00

Hospital Charge Code	270677252
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

TRAY TIBIAL TRAPEZOID SZ 5F/4T

Facility

$5,000.00

Hospital Charge Code	270677252
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

TRAY TIBIAL TRAPEZOID SZ 6F/6T

Facility

$11,560.00

Hospital Charge Code	270668934
Hospital Revenue Code	278
Min. Negotiated Rate	$328.30
Max. Negotiated Rate	$5,780.00
Rate for Payer: Aetna Commercial	$4,392.80
Rate for Payer: Aetna Medicare Advantage	$3,468.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,947.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,947.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,312.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,947.80
Rate for Payer: Cigna Commercial	$5,780.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,797.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,734.00
Rate for Payer: UnitedHealthcare Community & State	$365.30
Rate for Payer: Wellpoint Medicaid Managed Care	$328.30

TRAY TIBIAL TRAPEZOID SZ 6F/6T

Facility

$11,560.00

Hospital Charge Code	270668934
Hospital Revenue Code	278
Min. Negotiated Rate	$1,734.00
Max. Negotiated Rate	$2,797.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,312.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,797.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,734.00

TRAY TOTAL KNEE

Facility

$1,431.40

Hospital Charge Code	270654127
Hospital Revenue Code	272
Min. Negotiated Rate	$214.71
Max. Negotiated Rate	$214.71
Rate for Payer: Qualcare PPO/HMO/WC	$214.71

TRAY TOTAL KNEE

Facility

$1,431.40

Hospital Charge Code	270654127
Hospital Revenue Code	272
Min. Negotiated Rate	$40.65
Max. Negotiated Rate	$715.70
Rate for Payer: Aetna Commercial	$543.93
Rate for Payer: Aetna Medicare Advantage	$429.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$365.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$365.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$365.01
Rate for Payer: Cigna Commercial	$715.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.16
Rate for Payer: Oxford Commercial	$286.28
Rate for Payer: Qualcare PPO/HMO/WC	$214.71
Rate for Payer: UnitedHealthcare Commercial	$286.28
Rate for Payer: UnitedHealthcare Community & State	$45.23
Rate for Payer: Wellpoint Medicaid Managed Care	$40.65

TRAY TRACH

Facility

$757.65

Hospital Charge Code	270805001
Hospital Revenue Code	270
Min. Negotiated Rate	$21.52
Max. Negotiated Rate	$378.82
Rate for Payer: Aetna Commercial	$287.91
Rate for Payer: Aetna Medicare Advantage	$227.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$193.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$193.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$193.20
Rate for Payer: Cigna Commercial	$378.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.99
Rate for Payer: Oxford Commercial	$151.53
Rate for Payer: Qualcare PPO/HMO/WC	$113.65
Rate for Payer: UnitedHealthcare Commercial	$151.53
Rate for Payer: UnitedHealthcare Community & State	$23.94
Rate for Payer: Wellpoint Medicaid Managed Care	$21.52

TRAY TRACH

Facility

$757.65

Hospital Charge Code	270805001
Hospital Revenue Code	270
Min. Negotiated Rate	$113.65
Max. Negotiated Rate	$113.65
Rate for Payer: Qualcare PPO/HMO/WC	$113.65

TRAY TRACH CATH DRESSG

Facility

$10.29

Hospital Charge Code	270110140
Hospital Revenue Code	272
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$5.14
Rate for Payer: Aetna Commercial	$3.91
Rate for Payer: Aetna Medicare Advantage	$3.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.62
Rate for Payer: Cigna Commercial	$5.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.68
Rate for Payer: Oxford Commercial	$2.06
Rate for Payer: Qualcare PPO/HMO/WC	$1.54
Rate for Payer: UnitedHealthcare Commercial	$2.06
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

TRAY TRACH CATH DRESSG

Facility

$10.29

Hospital Charge Code	270110140
Hospital Revenue Code	272
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.54

TRAY TRIO CT BASIC SET 15CM

Facility

$700.00

Hospital Charge Code	270689090
Hospital Revenue Code	272
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$105.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.00

TRAY TRIO CT BASIC SET 15CM

Facility

$700.00

Hospital Charge Code	270689090
Hospital Revenue Code	272
Min. Negotiated Rate	$19.88
Max. Negotiated Rate	$350.00
Rate for Payer: Aetna Commercial	$266.00
Rate for Payer: Aetna Medicare Advantage	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.50
Rate for Payer: Cigna Commercial	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.00
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.00
Rate for Payer: UnitedHealthcare Commercial	$140.00
Rate for Payer: UnitedHealthcare Community & State	$22.12
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

TRAY TRIPLE LEMEN MULTI 7FR

Facility

$642.75

Hospital Charge Code	270665276
Hospital Revenue Code	272
Min. Negotiated Rate	$96.41
Max. Negotiated Rate	$96.41
Rate for Payer: Qualcare PPO/HMO/WC	$96.41

TRAY TRIPLE LEMEN MULTI 7FR

Facility

$642.75

Hospital Charge Code	270665276
Hospital Revenue Code	272
Min. Negotiated Rate	$18.25
Max. Negotiated Rate	$321.38
Rate for Payer: Aetna Commercial	$244.25
Rate for Payer: Aetna Medicare Advantage	$192.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.90
Rate for Payer: Cigna Commercial	$321.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.12
Rate for Payer: Oxford Commercial	$128.55
Rate for Payer: Qualcare PPO/HMO/WC	$96.41
Rate for Payer: UnitedHealthcare Commercial	$128.55
Rate for Payer: UnitedHealthcare Community & State	$20.31
Rate for Payer: Wellpoint Medicaid Managed Care	$18.25

Know your out-of-pocket cost for care.

All Charges