Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TRIATHLON TBI CS SZ1 11MM

Facility

$5,082.30

Service Code	HCPCS C1776
Hospital Charge Code	270696480
Hospital Revenue Code	278
Min. Negotiated Rate	$762.35
Max. Negotiated Rate	$1,229.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.92
Rate for Payer: Qualcare PPO/HMO/WC	$762.35

TRIATHLON TBI CS SZ1 11MM

Facility

$5,082.30

Service Code	HCPCS C1776
Hospital Charge Code	270696480
Hospital Revenue Code	278
Min. Negotiated Rate	$144.34
Max. Negotiated Rate	$2,541.15
Rate for Payer: Aetna Commercial	$1,931.27
Rate for Payer: Aetna Medicare Advantage	$1,524.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,295.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,295.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,295.99
Rate for Payer: Cigna Commercial	$2,541.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.92
Rate for Payer: Qualcare PPO/HMO/WC	$762.35
Rate for Payer: UnitedHealthcare Community & State	$160.60
Rate for Payer: Wellpoint Medicaid Managed Care	$144.34

TRIATHLON TBI CS SZ3 12.0MM

Facility

$5,082.20

Service Code	HCPCS C1776
Hospital Charge Code	270698668
Hospital Revenue Code	278
Min. Negotiated Rate	$762.33
Max. Negotiated Rate	$1,229.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.89
Rate for Payer: Qualcare PPO/HMO/WC	$762.33

TRIATHLON TBI CS SZ3 12.0MM

Facility

$5,082.20

Service Code	HCPCS C1776
Hospital Charge Code	270698668
Hospital Revenue Code	278
Min. Negotiated Rate	$144.33
Max. Negotiated Rate	$2,541.10
Rate for Payer: Aetna Commercial	$1,931.24
Rate for Payer: Aetna Medicare Advantage	$1,524.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,295.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,295.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,295.96
Rate for Payer: Cigna Commercial	$2,541.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.89
Rate for Payer: Qualcare PPO/HMO/WC	$762.33
Rate for Payer: UnitedHealthcare Community & State	$160.60
Rate for Payer: Wellpoint Medicaid Managed Care	$144.33

TRIATHLON TBI CS X3 SZ6 10MM

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270697357
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 TBI CS X3 SZ6 10MM

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270697357
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 TIBIA COMP SZ 1

Facility

$6,924.60

Service Code	HCPCS C1776
Hospital Charge Code	270696522
Hospital Revenue Code	278
Min. Negotiated Rate	$1,038.69
Max. Negotiated Rate	$1,675.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,384.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,675.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,038.69

TRIATHLON TIBIA COMP SZ 1

Facility

$6,924.60

Service Code	HCPCS C1776
Hospital Charge Code	270696522
Hospital Revenue Code	278
Min. Negotiated Rate	$196.66
Max. Negotiated Rate	$3,462.30
Rate for Payer: Aetna Commercial	$2,631.35
Rate for Payer: Aetna Medicare Advantage	$2,077.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,765.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,765.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,384.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,765.77
Rate for Payer: Cigna Commercial	$3,462.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,675.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,038.69
Rate for Payer: UnitedHealthcare Community & State	$218.82
Rate for Payer: Wellpoint Medicaid Managed Care	$196.66

TRIATHLON TIBIAL BEAR INSERT S

Facility

$5,659.60

Service Code	HCPCS C1713
Hospital Charge Code	270704894
Hospital Revenue Code	278
Min. Negotiated Rate	$848.94
Max. Negotiated Rate	$1,369.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,131.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,369.62
Rate for Payer: Qualcare PPO/HMO/WC	$848.94

TRIATHLON TIBIAL BEAR INSERT S

Facility

$5,659.60

Service Code	HCPCS C1713
Hospital Charge Code	270704894
Hospital Revenue Code	278
Min. Negotiated Rate	$160.73
Max. Negotiated Rate	$2,829.80
Rate for Payer: Aetna Commercial	$2,150.65
Rate for Payer: Aetna Medicare Advantage	$1,697.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,443.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,443.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,131.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,443.20
Rate for Payer: Cigna Commercial	$2,829.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,369.62
Rate for Payer: Qualcare PPO/HMO/WC	$848.94
Rate for Payer: UnitedHealthcare Community & State	$178.84
Rate for Payer: Wellpoint Medicaid Managed Care	$160.73

TRIATHLON TIBIA SZ 8

Facility

$6,837.70

Service Code	HCPCS C1776
Hospital Charge Code	270695713
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 TIBIA SZ 8

Facility

$6,837.70

Service Code	HCPCS C1776
Hospital Charge Code	270695713
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 TK UNIV TIB BASEPLT

Facility

$5,986.15

Service Code	HCPCS C1776
Hospital Charge Code	270691169
Hospital Revenue Code	278
Min. Negotiated Rate	$897.92
Max. Negotiated Rate	$1,448.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,197.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,448.65
Rate for Payer: Qualcare PPO/HMO/WC	$897.92

TRIATHLON TK UNIV TIB BASEPLT

Facility

$5,986.15

Service Code	HCPCS C1776
Hospital Charge Code	270691169
Hospital Revenue Code	278
Min. Negotiated Rate	$170.01
Max. Negotiated Rate	$2,993.07
Rate for Payer: Aetna Commercial	$2,274.74
Rate for Payer: Aetna Medicare Advantage	$1,795.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,526.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,526.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,197.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,526.47
Rate for Payer: Cigna Commercial	$2,993.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,448.65
Rate for Payer: Qualcare PPO/HMO/WC	$897.92
Rate for Payer: UnitedHealthcare Community & State	$189.16
Rate for Payer: Wellpoint Medicaid Managed Care	$170.01

TRIATHLONTRIANASYMPATELLA32X10

Facility

$2,550.50

Service Code	HCPCS C1776
Hospital Charge Code	270691186
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

TRIATHLONTRIANASYMPATELLA32X10

Facility

$2,550.50

Service Code	HCPCS C1776
Hospital Charge Code	270691186
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 TRITAN ASYMPAT 10X35

Facility

$2,550.50

Service Code	HCPCS C1776
Hospital Charge Code	270691179
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 TRITAN ASYMPAT 10X35

Facility

$2,550.50

Service Code	HCPCS C1776
Hospital Charge Code	270691179
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 TRITAN TIBIAL COMP S

Facility

$7,614.20

Service Code	HCPCS C1713
Hospital Charge Code	270704893
Hospital Revenue Code	278
Min. Negotiated Rate	$1,142.13
Max. Negotiated Rate	$1,842.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,522.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,842.64
Rate for Payer: Qualcare PPO/HMO/WC	$1,142.13

TRIATHLON TRITAN TIBIAL COMP S

Facility

$7,614.20

Service Code	HCPCS C1713
Hospital Charge Code	270704893
Hospital Revenue Code	278
Min. Negotiated Rate	$216.24
Max. Negotiated Rate	$3,807.10
Rate for Payer: Aetna Commercial	$2,893.40
Rate for Payer: Aetna Medicare Advantage	$2,284.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,941.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,941.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,522.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,941.62
Rate for Payer: Cigna Commercial	$3,807.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,842.64
Rate for Payer: Qualcare PPO/HMO/WC	$1,142.13
Rate for Payer: UnitedHealthcare Community & State	$240.61
Rate for Payer: Wellpoint Medicaid Managed Care	$216.24

TRIATHLON X3 ASYMETRIC PATELLA

Facility

$2,473.40

Service Code	HCPCS C1776
Hospital Charge Code	270691170
Hospital Revenue Code	278
Min. Negotiated Rate	$371.01
Max. Negotiated Rate	$598.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$494.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.56
Rate for Payer: Qualcare PPO/HMO/WC	$371.01

TRIATHLON X3 ASYMETRIC PATELLA

Facility

$2,473.40

Service Code	HCPCS C1776
Hospital Charge Code	270691170
Hospital Revenue Code	278
Min. Negotiated Rate	$70.24
Max. Negotiated Rate	$1,236.70
Rate for Payer: Aetna Commercial	$939.89
Rate for Payer: Aetna Medicare Advantage	$742.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$630.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$630.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$494.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$630.72
Rate for Payer: Cigna Commercial	$1,236.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.56
Rate for Payer: Qualcare PPO/HMO/WC	$371.01
Rate for Payer: UnitedHealthcare Community & State	$78.16
Rate for Payer: Wellpoint Medicaid Managed Care	$70.24

TRIATHLON X3 CS INSERT #7 9MM

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270692855
Hospital Revenue Code	278
Min. Negotiated Rate	$762.35
Max. Negotiated Rate	$1,229.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: Qualcare PPO/HMO/WC	$762.35

TRIATHLON X3 CS INSERT #7 9MM

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270692855
Hospital Revenue Code	278
Min. Negotiated Rate	$144.34
Max. Negotiated Rate	$2,541.18
Rate for Payer: Aetna Commercial	$1,931.29
Rate for Payer: Aetna Medicare Advantage	$1,524.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,296.00
Rate for Payer: Cigna Commercial	$2,541.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: Qualcare PPO/HMO/WC	$762.35
Rate for Payer: UnitedHealthcare Community & State	$160.60
Rate for Payer: Wellpoint Medicaid Managed Care	$144.34

TRIATHLONX3TBICSSZTYPCS11ST

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270691184
Hospital Revenue Code	278
Min. Negotiated Rate	$762.35
Max. Negotiated Rate	$1,229.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: Qualcare PPO/HMO/WC	$762.35

Know your out-of-pocket cost for care.

All Charges