Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TRIATH CR FEM COMP B RT CR SZ2

Facility

$10,529.50

Service Code	HCPCS C1776
Hospital Charge Code	270693813
Hospital Revenue Code	278
Min. Negotiated Rate	$299.04
Max. Negotiated Rate	$5,264.75
Rate for Payer: Aetna Commercial	$4,001.21
Rate for Payer: Aetna Medicare Advantage	$3,158.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,685.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,685.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,685.02
Rate for Payer: Cigna Commercial	$5,264.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42
Rate for Payer: UnitedHealthcare Community & State	$332.73
Rate for Payer: Wellpoint Medicaid Managed Care	$299.04

TRIATH CR FEM COMP B RT CR SZ2

Facility

$10,529.50

Service Code	HCPCS C1776
Hospital Charge Code	270693813
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.42
Max. Negotiated Rate	$2,548.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42

TRIATH FEM DIST AUG RT SZ4 5MM

Facility

$7,780.50

Service Code	HCPCS C1776
Hospital Charge Code	270697478
Hospital Revenue Code	278
Min. Negotiated Rate	$1,167.08
Max. Negotiated Rate	$1,882.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,556.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,882.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,167.08

TRIATH FEM DIST AUG RT SZ4 5MM

Facility

$7,780.50

Service Code	HCPCS C1776
Hospital Charge Code	270697478
Hospital Revenue Code	278
Min. Negotiated Rate	$220.97
Max. Negotiated Rate	$3,890.25
Rate for Payer: Aetna Commercial	$2,956.59
Rate for Payer: Aetna Medicare Advantage	$2,334.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,984.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,984.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,556.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,984.03
Rate for Payer: Cigna Commercial	$3,890.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,882.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,167.08
Rate for Payer: UnitedHealthcare Community & State	$245.86
Rate for Payer: Wellpoint Medicaid Managed Care	$220.97

TRIATH FEM DIST AUG RTSZ5 10MM

Facility

$45,253.00

Service Code	HCPCS C1776
Hospital Charge Code	270697477
Hospital Revenue Code	278
Min. Negotiated Rate	$1,285.19
Max. Negotiated Rate	$22,626.50
Rate for Payer: Aetna Commercial	$17,196.14
Rate for Payer: Aetna Medicare Advantage	$13,575.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,539.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,539.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,050.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,539.51
Rate for Payer: Cigna Commercial	$22,626.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,951.23
Rate for Payer: Qualcare PPO/HMO/WC	$6,787.95
Rate for Payer: UnitedHealthcare Community & State	$1,429.99
Rate for Payer: Wellpoint Medicaid Managed Care	$1,285.19

TRIATH FEM DIST AUG RTSZ5 10MM

Facility

$45,253.00

Service Code	HCPCS C1776
Hospital Charge Code	270697477
Hospital Revenue Code	278
Min. Negotiated Rate	$6,787.95
Max. Negotiated Rate	$10,951.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,050.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,951.23
Rate for Payer: Qualcare PPO/HMO/WC	$6,787.95

TRIATH FEMORAL COMP TS LT SZ2

Facility

$45,253.00

Service Code	HCPCS C1776
Hospital Charge Code	270699316
Hospital Revenue Code	278
Min. Negotiated Rate	$1,285.19
Max. Negotiated Rate	$22,626.50
Rate for Payer: Aetna Commercial	$17,196.14
Rate for Payer: Aetna Medicare Advantage	$13,575.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,539.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,539.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,050.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,539.51
Rate for Payer: Cigna Commercial	$22,626.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,951.23
Rate for Payer: Qualcare PPO/HMO/WC	$6,787.95
Rate for Payer: UnitedHealthcare Community & State	$1,429.99
Rate for Payer: Wellpoint Medicaid Managed Care	$1,285.19

TRIATH FEMORAL COMP TS LT SZ2

Facility

$45,253.00

Service Code	HCPCS C1776
Hospital Charge Code	270699316
Hospital Revenue Code	278
Min. Negotiated Rate	$6,787.95
Max. Negotiated Rate	$10,951.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,050.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,951.23
Rate for Payer: Qualcare PPO/HMO/WC	$6,787.95

TRIATH FEM POST AUGMNT SZ5 5MM

Facility

$8,177.00

Service Code	HCPCS C1776
Hospital Charge Code	270697479
Hospital Revenue Code	278
Min. Negotiated Rate	$1,226.55
Max. Negotiated Rate	$1,978.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,635.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,978.83
Rate for Payer: Qualcare PPO/HMO/WC	$1,226.55

TRIATH FEM POST AUGMNT SZ5 5MM

Facility

$8,177.00

Service Code	HCPCS C1776
Hospital Charge Code	270697479
Hospital Revenue Code	278
Min. Negotiated Rate	$232.23
Max. Negotiated Rate	$4,088.50
Rate for Payer: Aetna Commercial	$3,107.26
Rate for Payer: Aetna Medicare Advantage	$2,453.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,085.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,085.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,635.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,085.14
Rate for Payer: Cigna Commercial	$4,088.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,978.83
Rate for Payer: Qualcare PPO/HMO/WC	$1,226.55
Rate for Payer: UnitedHealthcare Community & State	$258.39
Rate for Payer: Wellpoint Medicaid Managed Care	$232.23

TRIATH FEM STEM CMNT 12X100MM

Facility

$8,274.50

Service Code	HCPCS C1776
Hospital Charge Code	270697480
Hospital Revenue Code	278
Min. Negotiated Rate	$235.00
Max. Negotiated Rate	$4,137.25
Rate for Payer: Aetna Commercial	$3,144.31
Rate for Payer: Aetna Medicare Advantage	$2,482.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,654.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,110.00
Rate for Payer: Cigna Commercial	$4,137.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,002.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,241.17
Rate for Payer: UnitedHealthcare Community & State	$261.47
Rate for Payer: Wellpoint Medicaid Managed Care	$235.00

TRIATH FEM STEM CMNT 12X100MM

Facility

$8,274.50

Service Code	HCPCS C1776
Hospital Charge Code	270697480
Hospital Revenue Code	278
Min. Negotiated Rate	$1,241.17
Max. Negotiated Rate	$2,002.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,654.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,002.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,241.17

TRIATHL CRUC RET FEM RTSZ2-CAP

Facility

$7,765.80

Service Code	HCPCS C1776
Hospital Charge Code	270692889
Hospital Revenue Code	278
Min. Negotiated Rate	$220.55
Max. Negotiated Rate	$3,882.90
Rate for Payer: Aetna Commercial	$2,951.00
Rate for Payer: Aetna Medicare Advantage	$2,329.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,980.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,980.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,553.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,980.28
Rate for Payer: Cigna Commercial	$3,882.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,879.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,164.87
Rate for Payer: UnitedHealthcare Community & State	$245.40
Rate for Payer: Wellpoint Medicaid Managed Care	$220.55

TRIATHL CRUC RET FEM RTSZ2-CAP

Facility

$7,765.80

Service Code	HCPCS C1776
Hospital Charge Code	270692889
Hospital Revenue Code	278
Min. Negotiated Rate	$1,164.87
Max. Negotiated Rate	$1,879.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,553.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,879.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,164.87

TRIATHLON BASEPLATE SIZE 7

Facility

$6,837.70

Service Code	HCPCS C1776
Hospital Charge Code	270692856
Hospital Revenue Code	278
Min. Negotiated Rate	$194.19
Max. Negotiated Rate	$3,418.85
Rate for Payer: Aetna Commercial	$2,598.33
Rate for Payer: Aetna Medicare Advantage	$2,051.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,743.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,743.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,367.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,743.61
Rate for Payer: Cigna Commercial	$3,418.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,654.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,025.65
Rate for Payer: UnitedHealthcare Community & State	$216.07
Rate for Payer: Wellpoint Medicaid Managed Care	$194.19

TRIATHLON BASEPLATE SIZE 7

Facility

$6,837.70

Service Code	HCPCS C1776
Hospital Charge Code	270692856
Hospital Revenue Code	278
Min. Negotiated Rate	$1,025.65
Max. Negotiated Rate	$1,654.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,367.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,654.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,025.65

TRIATHLON CR FEM COMP LT SZ6

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270692854
Hospital Revenue Code	278
Min. Negotiated Rate	$299.04
Max. Negotiated Rate	$5,264.73
Rate for Payer: Aetna Commercial	$4,001.19
Rate for Payer: Aetna Medicare Advantage	$3,158.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,685.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,685.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,685.01
Rate for Payer: Cigna Commercial	$5,264.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42
Rate for Payer: UnitedHealthcare Community & State	$332.73
Rate for Payer: Wellpoint Medicaid Managed Care	$299.04

TRIATHLON CR FEM COMP LT SZ6

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270692854
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.42
Max. Negotiated Rate	$2,548.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42

TRIATHLON CR FEM COMPONENT 3L

Facility

$10,529.05

Service Code	HCPCS C1776
Hospital Charge Code	270692079
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.36
Max. Negotiated Rate	$2,548.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.03
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.36

TRIATHLON CR FEM COMPONENT 3L

Facility

$10,529.05

Service Code	HCPCS C1776
Hospital Charge Code	270692079
Hospital Revenue Code	278
Min. Negotiated Rate	$299.03
Max. Negotiated Rate	$5,264.52
Rate for Payer: Aetna Commercial	$4,001.04
Rate for Payer: Aetna Medicare Advantage	$3,158.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,684.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,684.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,684.91
Rate for Payer: Cigna Commercial	$5,264.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.03
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.36
Rate for Payer: UnitedHealthcare Community & State	$332.72
Rate for Payer: Wellpoint Medicaid Managed Care	$299.03

TRIATHLON CRF SZ 4 SDE LFT T

Facility

$10,529.50

Service Code	HCPCS C1776
Hospital Charge Code	270692360
Hospital Revenue Code	278
Min. Negotiated Rate	$299.04
Max. Negotiated Rate	$5,264.75
Rate for Payer: Aetna Commercial	$4,001.21
Rate for Payer: Aetna Medicare Advantage	$3,158.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,685.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,685.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,685.02
Rate for Payer: Cigna Commercial	$5,264.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42
Rate for Payer: UnitedHealthcare Community & State	$332.73
Rate for Payer: Wellpoint Medicaid Managed Care	$299.04

TRIATHLON CRF SZ 4 SDE LFT T

Facility

$10,529.50

Service Code	HCPCS C1776
Hospital Charge Code	270692360
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.42
Max. Negotiated Rate	$2,548.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42

TRIATHLONCRF SZE #4 LT TYP CR

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270691185
Hospital Revenue Code	278
Min. Negotiated Rate	$299.04
Max. Negotiated Rate	$5,264.73
Rate for Payer: Aetna Commercial	$4,001.19
Rate for Payer: Aetna Medicare Advantage	$3,158.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,685.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,685.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,685.01
Rate for Payer: Cigna Commercial	$5,264.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42
Rate for Payer: UnitedHealthcare Community & State	$332.73
Rate for Payer: Wellpoint Medicaid Managed Care	$299.04

TRIATHLONCRF SZE #4 LT TYP CR

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270691185
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.42
Max. Negotiated Rate	$2,548.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42

TRIATHLON CRUCIATE RETAIN FEM

Facility

$11,726.20

Service Code	HCPCS C1713
Hospital Charge Code	270704901
Hospital Revenue Code	278
Min. Negotiated Rate	$1,758.93
Max. Negotiated Rate	$2,837.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,345.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,837.74
Rate for Payer: Qualcare PPO/HMO/WC	$1,758.93

Know your out-of-pocket cost for care.

All Charges