Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BIOLOX CERAMIC HEAD

Facility

$13,493.90

Service Code	HCPCS C1776
Hospital Charge Code	270656964
Hospital Revenue Code	278
Min. Negotiated Rate	$2,024.09
Max. Negotiated Rate	$3,265.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,698.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,265.52
Rate for Payer: Qualcare PPO/HMO/WC	$2,024.09

BIOLOX DELTA CERAMIC FE

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270688885
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

BIOLOX DELTA CERAMIC FE

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270688885
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

BIOLOX DELTA CERAMIC HEAD +8.5

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690556
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

BIOLOX DELTA CERAMIC HEAD +8.5

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690556
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

BIOLOXDELTA FEM HEAD36MM-3.5MM

Facility

$13,493.90

Hospital Charge Code	270663139
Hospital Revenue Code	278
Min. Negotiated Rate	$383.23
Max. Negotiated Rate	$6,746.95
Rate for Payer: Aetna Commercial	$5,127.68
Rate for Payer: Aetna Medicare Advantage	$4,048.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,440.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,440.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,698.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,440.94
Rate for Payer: Cigna Commercial	$6,746.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,265.52
Rate for Payer: Qualcare PPO/HMO/WC	$2,024.09
Rate for Payer: UnitedHealthcare Community & State	$426.41
Rate for Payer: Wellpoint Medicaid Managed Care	$383.23

BIOLOXDELTA FEM HEAD36MM-3.5MM

Facility

$13,493.90

Hospital Charge Code	270663139
Hospital Revenue Code	278
Min. Negotiated Rate	$2,024.09
Max. Negotiated Rate	$3,265.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,698.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,265.52
Rate for Payer: Qualcare PPO/HMO/WC	$2,024.09

BIOLOX DELTA TA FEM HEAD 36

Facility

$7,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270667178
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

BIOLOX DELTA TA FEM HEAD 36

Facility

$7,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270667178
Hospital Revenue Code	278
Min. Negotiated Rate	$213.00
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00
Rate for Payer: UnitedHealthcare Community & State	$237.00
Rate for Payer: Wellpoint Medicaid Managed Care	$213.00

BIOLOX MOD CERAMIC HEAD36MM

Facility

$1,949.00

Service Code	HCPCS C1713
Hospital Charge Code	270702515
Hospital Revenue Code	278
Min. Negotiated Rate	$55.35
Max. Negotiated Rate	$974.50
Rate for Payer: Aetna Commercial	$740.62
Rate for Payer: Aetna Medicare Advantage	$584.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$497.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$497.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$389.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$497.00
Rate for Payer: Cigna Commercial	$974.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$471.66
Rate for Payer: Qualcare PPO/HMO/WC	$292.35
Rate for Payer: UnitedHealthcare Community & State	$61.59
Rate for Payer: Wellpoint Medicaid Managed Care	$55.35

BIOLOX MOD CERAMIC HEAD36MM

Facility

$1,949.00

Service Code	HCPCS C1713
Hospital Charge Code	270702515
Hospital Revenue Code	278
Min. Negotiated Rate	$292.35
Max. Negotiated Rate	$471.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$389.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$471.66
Rate for Payer: Qualcare PPO/HMO/WC	$292.35

BIOLOX MODULAR CERAMIC HEAD 36

Facility

$5,995.00

Service Code	HCPCS C1713
Hospital Charge Code	270702514
Hospital Revenue Code	278
Min. Negotiated Rate	$170.26
Max. Negotiated Rate	$2,997.50
Rate for Payer: Aetna Commercial	$2,278.10
Rate for Payer: Aetna Medicare Advantage	$1,798.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,528.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,528.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,199.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,528.72
Rate for Payer: Cigna Commercial	$2,997.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,450.79
Rate for Payer: Qualcare PPO/HMO/WC	$899.25
Rate for Payer: UnitedHealthcare Community & State	$189.44
Rate for Payer: Wellpoint Medicaid Managed Care	$170.26

BIOLOX MODULAR CERAMIC HEAD 36

Facility

$5,995.00

Service Code	HCPCS C1713
Hospital Charge Code	270702514
Hospital Revenue Code	278
Min. Negotiated Rate	$899.25
Max. Negotiated Rate	$1,450.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,199.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,450.79
Rate for Payer: Qualcare PPO/HMO/WC	$899.25

BIOMET END CAP OFFSET 5MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	270645062
Hospital Revenue Code	278
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$345.00
Rate for Payer: Aetna Commercial	$262.20
Rate for Payer: Aetna Medicare Advantage	$207.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$175.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$175.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$138.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$175.95
Rate for Payer: Cigna Commercial	$345.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$166.98
Rate for Payer: Qualcare PPO/HMO/WC	$103.50
Rate for Payer: UnitedHealthcare Community & State	$21.80
Rate for Payer: Wellpoint Medicaid Managed Care	$19.60

BIOMET END CAP OFFSET 5MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	270645062
Hospital Revenue Code	278
Min. Negotiated Rate	$103.50
Max. Negotiated Rate	$166.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$138.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$166.98
Rate for Payer: Qualcare PPO/HMO/WC	$103.50

BIOMET ILOK STEM TIB TRAY 75MM

Facility

$10,416.65

Service Code	HCPCS C1776
Hospital Charge Code	270685140
Hospital Revenue Code	278
Min. Negotiated Rate	$1,562.50
Max. Negotiated Rate	$2,520.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,083.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,520.83
Rate for Payer: Qualcare PPO/HMO/WC	$1,562.50

BIOMET ILOK STEM TIB TRAY 75MM

Facility

$10,416.65

Service Code	HCPCS C1776
Hospital Charge Code	270685140
Hospital Revenue Code	278
Min. Negotiated Rate	$295.83
Max. Negotiated Rate	$5,208.32
Rate for Payer: Aetna Commercial	$3,958.33
Rate for Payer: Aetna Medicare Advantage	$3,124.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,656.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,656.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,083.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,656.25
Rate for Payer: Cigna Commercial	$5,208.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,520.83
Rate for Payer: Qualcare PPO/HMO/WC	$1,562.50
Rate for Payer: UnitedHealthcare Community & State	$329.17
Rate for Payer: Wellpoint Medicaid Managed Care	$295.83

BIOMET ILOK STEM TIB TRAY 79MM

Facility

$14,160.00

Service Code	HCPCS C1776
Hospital Charge Code	270681757
Hospital Revenue Code	278
Min. Negotiated Rate	$2,124.00
Max. Negotiated Rate	$3,426.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,832.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,426.72
Rate for Payer: Qualcare PPO/HMO/WC	$2,124.00

BIOMET ILOK STEM TIB TRAY 79MM

Facility

$14,160.00

Service Code	HCPCS C1776
Hospital Charge Code	270681757
Hospital Revenue Code	278
Min. Negotiated Rate	$402.14
Max. Negotiated Rate	$7,080.00
Rate for Payer: Aetna Commercial	$5,380.80
Rate for Payer: Aetna Medicare Advantage	$4,248.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,610.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,610.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,832.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,610.80
Rate for Payer: Cigna Commercial	$7,080.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,426.72
Rate for Payer: Qualcare PPO/HMO/WC	$2,124.00
Rate for Payer: UnitedHealthcare Community & State	$447.46
Rate for Payer: Wellpoint Medicaid Managed Care	$402.14

BIOMET PHOENIX NAIL

Facility

$9,800.00

Hospital Charge Code	270339470
Hospital Revenue Code	278
Min. Negotiated Rate	$1,470.00
Max. Negotiated Rate	$2,371.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,960.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,371.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,470.00

BIOMET PHOENIX NAIL

Facility

$9,800.00

Hospital Charge Code	270339470
Hospital Revenue Code	278
Min. Negotiated Rate	$278.32
Max. Negotiated Rate	$4,900.00
Rate for Payer: Aetna Commercial	$3,724.00
Rate for Payer: Aetna Medicare Advantage	$2,940.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,499.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,499.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,960.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,499.00
Rate for Payer: Cigna Commercial	$4,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,371.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,470.00
Rate for Payer: UnitedHealthcare Community & State	$309.68
Rate for Payer: Wellpoint Medicaid Managed Care	$278.32

BIOMET TIB BLOCK 6MM 71

Facility

$5,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270688653
Hospital Revenue Code	278
Min. Negotiated Rate	$832.50
Max. Negotiated Rate	$1,343.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,343.10
Rate for Payer: Qualcare PPO/HMO/WC	$832.50

BIOMET TIB BLOCK 6MM 71

Facility

$5,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270688653
Hospital Revenue Code	278
Min. Negotiated Rate	$157.62
Max. Negotiated Rate	$2,775.00
Rate for Payer: Aetna Commercial	$2,109.00
Rate for Payer: Aetna Medicare Advantage	$1,665.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,415.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,415.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,415.25
Rate for Payer: Cigna Commercial	$2,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,343.10
Rate for Payer: Qualcare PPO/HMO/WC	$832.50
Rate for Payer: UnitedHealthcare Community & State	$175.38
Rate for Payer: Wellpoint Medicaid Managed Care	$157.62

BIOPATCH BLUE 1 IN DISK W/7MM

Facility

$34.98

Hospital Charge Code	270671184
Hospital Revenue Code	272
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$5.25
Rate for Payer: Qualcare PPO/HMO/WC	$5.25

BIOPATCH BLUE 1 IN DISK W/7MM

Facility

$34.98

Hospital Charge Code	270671184
Hospital Revenue Code	272
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$17.49
Rate for Payer: Aetna Commercial	$13.29
Rate for Payer: Aetna Medicare Advantage	$10.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.92
Rate for Payer: Cigna Commercial	$17.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.09
Rate for Payer: Oxford Commercial	$7.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.25
Rate for Payer: UnitedHealthcare Commercial	$7.00
Rate for Payer: UnitedHealthcare Community & State	$1.11
Rate for Payer: Wellpoint Medicaid Managed Care	$0.99

Know your out-of-pocket cost for care.

All Charges