Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TRIATHLON CRUCIATE RETAIN FEM

Facility

$11,726.20

Service Code	HCPCS C1713
Hospital Charge Code	270704901
Hospital Revenue Code	278
Min. Negotiated Rate	$333.02
Max. Negotiated Rate	$5,863.10
Rate for Payer: Aetna Commercial	$4,455.96
Rate for Payer: Aetna Medicare Advantage	$3,517.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,990.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,990.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,345.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,990.18
Rate for Payer: Cigna Commercial	$5,863.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,837.74
Rate for Payer: Qualcare PPO/HMO/WC	$1,758.93
Rate for Payer: UnitedHealthcare Community & State	$370.55
Rate for Payer: Wellpoint Medicaid Managed Care	$333.02

TRIATHLON CRUC RET FEM SZ6 RT

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270692910
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 CRUC RET FEM SZ6 RT

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270692910
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 CRUC RET FEM SZ7 RT

Facility

$8,844.75

Service Code	HCPCS C1776
Hospital Charge Code	270693063
Hospital Revenue Code	278
Min. Negotiated Rate	$1,326.71
Max. Negotiated Rate	$2,140.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,768.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,140.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,326.71

TRIATHLON CRUC RET FEM SZ7 RT

Facility

$8,844.75

Service Code	HCPCS C1776
Hospital Charge Code	270693063
Hospital Revenue Code	278
Min. Negotiated Rate	$251.19
Max. Negotiated Rate	$4,422.38
Rate for Payer: Aetna Commercial	$3,361.01
Rate for Payer: Aetna Medicare Advantage	$2,653.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,255.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,255.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,768.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,255.41
Rate for Payer: Cigna Commercial	$4,422.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,140.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,326.71
Rate for Payer: UnitedHealthcare Community & State	$279.49
Rate for Payer: Wellpoint Medicaid Managed Care	$251.19

TRIATHLON CRU RET FEM CR SZ5LT

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270691178
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 CRU RET FEM CR SZ5LT

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270691178
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 FEMORAL CR SZ3

Facility

$7,237.65

Service Code	HCPCS C1776
Hospital Charge Code	270697037
Hospital Revenue Code	278
Min. Negotiated Rate	$1,085.65
Max. Negotiated Rate	$1,751.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,447.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,751.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,085.65

TRIATHLON FEMORAL CR SZ3

Facility

$7,237.65

Service Code	HCPCS C1776
Hospital Charge Code	270697037
Hospital Revenue Code	278
Min. Negotiated Rate	$205.55
Max. Negotiated Rate	$3,618.82
Rate for Payer: Aetna Commercial	$2,750.31
Rate for Payer: Aetna Medicare Advantage	$2,171.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,845.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,845.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,447.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,845.60
Rate for Payer: Cigna Commercial	$3,618.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,751.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,085.65
Rate for Payer: UnitedHealthcare Community & State	$228.71
Rate for Payer: Wellpoint Medicaid Managed Care	$205.55

TRIATHLON FEM STAB PS SZ4 LT

Facility

$7,565.00

Service Code	HCPCS C1776
Hospital Charge Code	270691263
Hospital Revenue Code	278
Min. Negotiated Rate	$1,134.75
Max. Negotiated Rate	$1,830.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,513.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,830.73
Rate for Payer: Qualcare PPO/HMO/WC	$1,134.75

TRIATHLON FEM STAB PS SZ4 LT

Facility

$7,565.00

Service Code	HCPCS C1776
Hospital Charge Code	270691263
Hospital Revenue Code	278
Min. Negotiated Rate	$214.85
Max. Negotiated Rate	$3,782.50
Rate for Payer: Aetna Commercial	$2,874.70
Rate for Payer: Aetna Medicare Advantage	$2,269.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,929.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,929.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,513.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,929.08
Rate for Payer: Cigna Commercial	$3,782.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,830.73
Rate for Payer: Qualcare PPO/HMO/WC	$1,134.75
Rate for Payer: UnitedHealthcare Community & State	$239.05
Rate for Payer: Wellpoint Medicaid Managed Care	$214.85

TRIATHLON FEMUR CR SZ 2 LT

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270697481
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 FEMUR CR SZ 2 LT

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270697481
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 FEMUR PS SZ 2 LT

Facility

$6,531.90

Service Code	HCPCS C1776
Hospital Charge Code	270697487
Hospital Revenue Code	278
Min. Negotiated Rate	$185.51
Max. Negotiated Rate	$3,265.95
Rate for Payer: Aetna Commercial	$2,482.12
Rate for Payer: Aetna Medicare Advantage	$1,959.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,665.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,665.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,306.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,665.63
Rate for Payer: Cigna Commercial	$3,265.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,580.72
Rate for Payer: Qualcare PPO/HMO/WC	$979.78
Rate for Payer: UnitedHealthcare Community & State	$206.41
Rate for Payer: Wellpoint Medicaid Managed Care	$185.51

TRIATHLON FEMUR PS SZ 2 LT

Facility

$6,531.90

Service Code	HCPCS C1776
Hospital Charge Code	270697487
Hospital Revenue Code	278
Min. Negotiated Rate	$979.78
Max. Negotiated Rate	$1,580.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,306.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,580.72
Rate for Payer: Qualcare PPO/HMO/WC	$979.78

TRIATHLON METAL PATELLA A38X11

Facility

$2,550.50

Service Code	HCPCS C1776
Hospital Charge Code	270692853
Hospital Revenue Code	278
Min. Negotiated Rate	$382.57
Max. Negotiated Rate	$617.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$510.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$617.22
Rate for Payer: Qualcare PPO/HMO/WC	$382.57

TRIATHLON METAL PATELLA A38X11

Facility

$2,550.50

Service Code	HCPCS C1776
Hospital Charge Code	270692853
Hospital Revenue Code	278
Min. Negotiated Rate	$72.43
Max. Negotiated Rate	$1,275.25
Rate for Payer: Aetna Commercial	$969.19
Rate for Payer: Aetna Medicare Advantage	$765.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$650.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$650.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$510.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$650.38
Rate for Payer: Cigna Commercial	$1,275.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$617.22
Rate for Payer: Qualcare PPO/HMO/WC	$382.57
Rate for Payer: UnitedHealthcare Community & State	$80.60
Rate for Payer: Wellpoint Medicaid Managed Care	$72.43

TRIATHLON PATELLA SZ 3 PS LT

Facility

$2,100.65

Service Code	HCPCS C1776
Hospital Charge Code	270697928
Hospital Revenue Code	278
Min. Negotiated Rate	$315.10
Max. Negotiated Rate	$508.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$420.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$508.36
Rate for Payer: Qualcare PPO/HMO/WC	$315.10

TRIATHLON PATELLA SZ 3 PS LT

Facility

$2,100.65

Service Code	HCPCS C1776
Hospital Charge Code	270697928
Hospital Revenue Code	278
Min. Negotiated Rate	$59.66
Max. Negotiated Rate	$1,050.33
Rate for Payer: Aetna Commercial	$798.25
Rate for Payer: Aetna Medicare Advantage	$630.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$535.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$535.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$420.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$535.67
Rate for Payer: Cigna Commercial	$1,050.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$508.36
Rate for Payer: Qualcare PPO/HMO/WC	$315.10
Rate for Payer: UnitedHealthcare Community & State	$66.38
Rate for Payer: Wellpoint Medicaid Managed Care	$59.66

TRIATHLON PS FEM COMP LT SZ3

Facility

$10,774.35

Service Code	HCPCS C1776
Hospital Charge Code	270694445
Hospital Revenue Code	278
Min. Negotiated Rate	$1,616.15
Max. Negotiated Rate	$2,607.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,154.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,607.39
Rate for Payer: Qualcare PPO/HMO/WC	$1,616.15

TRIATHLON PS FEM COMP LT SZ3

Facility

$10,774.35

Service Code	HCPCS C1776
Hospital Charge Code	270694445
Hospital Revenue Code	278
Min. Negotiated Rate	$305.99
Max. Negotiated Rate	$5,387.18
Rate for Payer: Aetna Commercial	$4,094.25
Rate for Payer: Aetna Medicare Advantage	$3,232.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,747.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,747.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,154.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,747.46
Rate for Payer: Cigna Commercial	$5,387.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,607.39
Rate for Payer: Qualcare PPO/HMO/WC	$1,616.15
Rate for Payer: UnitedHealthcare Community & State	$340.47
Rate for Payer: Wellpoint Medicaid Managed Care	$305.99

TRIATHLON PS FEM COMPON LT PS7

Facility

$7,237.90

Service Code	HCPCS C1776
Hospital Charge Code	270691996
Hospital Revenue Code	278
Min. Negotiated Rate	$1,085.68
Max. Negotiated Rate	$1,751.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,447.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,751.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,085.68

TRIATHLON PS FEM COMPON LT PS7

Facility

$7,237.90

Service Code	HCPCS C1776
Hospital Charge Code	270691996
Hospital Revenue Code	278
Min. Negotiated Rate	$205.56
Max. Negotiated Rate	$3,618.95
Rate for Payer: Aetna Commercial	$2,750.40
Rate for Payer: Aetna Medicare Advantage	$2,171.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,845.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,845.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,447.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,845.66
Rate for Payer: Cigna Commercial	$3,618.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,751.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,085.68
Rate for Payer: UnitedHealthcare Community & State	$228.72
Rate for Payer: Wellpoint Medicaid Managed Care	$205.56

TRIATHLON PSF PS RT SZ7

Facility

$10,774.35

Service Code	HCPCS C1776
Hospital Charge Code	270697091
Hospital Revenue Code	278
Min. Negotiated Rate	$1,616.15
Max. Negotiated Rate	$2,607.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,154.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,607.39
Rate for Payer: Qualcare PPO/HMO/WC	$1,616.15

TRIATHLON PSF PS RT SZ7

Facility

$10,774.35

Service Code	HCPCS C1776
Hospital Charge Code	270697091
Hospital Revenue Code	278
Min. Negotiated Rate	$305.99
Max. Negotiated Rate	$5,387.18
Rate for Payer: Aetna Commercial	$4,094.25
Rate for Payer: Aetna Medicare Advantage	$3,232.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,747.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,747.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,154.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,747.46
Rate for Payer: Cigna Commercial	$5,387.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,607.39
Rate for Payer: Qualcare PPO/HMO/WC	$1,616.15
Rate for Payer: UnitedHealthcare Community & State	$340.47
Rate for Payer: Wellpoint Medicaid Managed Care	$305.99

Know your out-of-pocket cost for care.

All Charges