Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PLATE 2.0mm TITAN CHON 6HOLE L

Facility

$1,288.55

Service Code	HCPCS C1713
Hospital Charge Code	270604099
Hospital Revenue Code	278
Min. Negotiated Rate	$36.59
Max. Negotiated Rate	$644.27
Rate for Payer: Aetna Commercial	$489.65
Rate for Payer: Aetna Medicare Advantage	$386.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$328.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$328.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$257.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$328.58
Rate for Payer: Cigna Commercial	$644.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$311.83
Rate for Payer: Qualcare PPO/HMO/WC	$193.28
Rate for Payer: UnitedHealthcare Community & State	$40.72
Rate for Payer: Wellpoint Medicaid Managed Care	$36.59

PLATE 2.0mm TITAN CHON 6HOLE R

Facility

$1,288.55

Service Code	HCPCS C1713
Hospital Charge Code	270604100
Hospital Revenue Code	278
Min. Negotiated Rate	$193.28
Max. Negotiated Rate	$311.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$257.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$311.83
Rate for Payer: Qualcare PPO/HMO/WC	$193.28

PLATE 2.0mm TITAN CHON 6HOLE R

Facility

$1,288.55

Service Code	HCPCS C1713
Hospital Charge Code	270604100
Hospital Revenue Code	278
Min. Negotiated Rate	$36.59
Max. Negotiated Rate	$644.27
Rate for Payer: Aetna Commercial	$489.65
Rate for Payer: Aetna Medicare Advantage	$386.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$328.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$328.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$257.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$328.58
Rate for Payer: Cigna Commercial	$644.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$311.83
Rate for Payer: Qualcare PPO/HMO/WC	$193.28
Rate for Payer: UnitedHealthcare Community & State	$40.72
Rate for Payer: Wellpoint Medicaid Managed Care	$36.59

PLATE 2.0mm TITAN DCP 4HOLE

Facility

$545.00

Service Code	HCPCS C1713
Hospital Charge Code	270604092
Hospital Revenue Code	278
Min. Negotiated Rate	$81.75
Max. Negotiated Rate	$131.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$109.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.89
Rate for Payer: Qualcare PPO/HMO/WC	$81.75

PLATE 2.0mm TITAN DCP 4HOLE

Facility

$545.00

Service Code	HCPCS C1713
Hospital Charge Code	270604092
Hospital Revenue Code	278
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$272.50
Rate for Payer: Aetna Commercial	$207.10
Rate for Payer: Aetna Medicare Advantage	$163.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$138.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$138.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$109.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$138.97
Rate for Payer: Cigna Commercial	$272.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.89
Rate for Payer: Qualcare PPO/HMO/WC	$81.75
Rate for Payer: UnitedHealthcare Community & State	$17.22
Rate for Payer: Wellpoint Medicaid Managed Care	$15.48

PLATE 2.0mm TITAN DCP 6HOLE

Facility

$1,146.40

Service Code	HCPCS C1713
Hospital Charge Code	270604094
Hospital Revenue Code	278
Min. Negotiated Rate	$32.56
Max. Negotiated Rate	$573.20
Rate for Payer: Aetna Commercial	$435.63
Rate for Payer: Aetna Medicare Advantage	$343.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$292.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$292.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$229.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$292.33
Rate for Payer: Cigna Commercial	$573.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$277.43
Rate for Payer: Qualcare PPO/HMO/WC	$171.96
Rate for Payer: UnitedHealthcare Community & State	$36.23
Rate for Payer: Wellpoint Medicaid Managed Care	$32.56

PLATE 2.0mm TITAN DCP 6HOLE

Facility

$1,146.40

Service Code	HCPCS C1713
Hospital Charge Code	270604094
Hospital Revenue Code	278
Min. Negotiated Rate	$171.96
Max. Negotiated Rate	$277.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$229.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$277.43
Rate for Payer: Qualcare PPO/HMO/WC	$171.96

PLATE 2.0mm TITAN DCP 7HOLE

Facility

$1,242.20

Service Code	HCPCS C1713
Hospital Charge Code	270604095
Hospital Revenue Code	278
Min. Negotiated Rate	$186.33
Max. Negotiated Rate	$300.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$248.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$300.61
Rate for Payer: Qualcare PPO/HMO/WC	$186.33

PLATE 2.0mm TITAN DCP 7HOLE

Facility

$1,242.20

Service Code	HCPCS C1713
Hospital Charge Code	270604095
Hospital Revenue Code	278
Min. Negotiated Rate	$35.28
Max. Negotiated Rate	$621.10
Rate for Payer: Aetna Commercial	$472.04
Rate for Payer: Aetna Medicare Advantage	$372.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$316.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$316.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$248.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$316.76
Rate for Payer: Cigna Commercial	$621.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$300.61
Rate for Payer: Qualcare PPO/HMO/WC	$186.33
Rate for Payer: UnitedHealthcare Community & State	$39.25
Rate for Payer: Wellpoint Medicaid Managed Care	$35.28

PLATE 2.0mm TITAN T H3-S9HOLE

Facility

$911.55

Service Code	HCPCS C1713
Hospital Charge Code	270603542
Hospital Revenue Code	278
Min. Negotiated Rate	$136.73
Max. Negotiated Rate	$220.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$182.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$220.60
Rate for Payer: Qualcare PPO/HMO/WC	$136.73

PLATE 2.0mm TITAN T H3-S9HOLE

Facility

$911.55

Service Code	HCPCS C1713
Hospital Charge Code	270603542
Hospital Revenue Code	278
Min. Negotiated Rate	$25.89
Max. Negotiated Rate	$455.77
Rate for Payer: Aetna Commercial	$346.39
Rate for Payer: Aetna Medicare Advantage	$273.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$232.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$232.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$182.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$232.45
Rate for Payer: Cigna Commercial	$455.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$220.60
Rate for Payer: Qualcare PPO/HMO/WC	$136.73
Rate for Payer: UnitedHealthcare Community & State	$28.80
Rate for Payer: Wellpoint Medicaid Managed Care	$25.89

PLATE 2.0mm TITAN T H4-S9HOLE

Facility

$985.70

Service Code	HCPCS C1713
Hospital Charge Code	270603543
Hospital Revenue Code	278
Min. Negotiated Rate	$27.99
Max. Negotiated Rate	$492.85
Rate for Payer: Aetna Commercial	$374.57
Rate for Payer: Aetna Medicare Advantage	$295.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$251.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$251.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$197.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$251.35
Rate for Payer: Cigna Commercial	$492.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.54
Rate for Payer: Qualcare PPO/HMO/WC	$147.85
Rate for Payer: UnitedHealthcare Community & State	$31.15
Rate for Payer: Wellpoint Medicaid Managed Care	$27.99

PLATE 2.0mm TITAN T H4-S9HOLE

Facility

$985.70

Service Code	HCPCS C1713
Hospital Charge Code	270603543
Hospital Revenue Code	278
Min. Negotiated Rate	$147.85
Max. Negotiated Rate	$238.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$197.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.54
Rate for Payer: Qualcare PPO/HMO/WC	$147.85

PLATE 2.4/2.7 MM LCP FUS

Facility

$6,216.10

Service Code	HCPCS C1776
Hospital Charge Code	270689384
Hospital Revenue Code	278
Min. Negotiated Rate	$176.54
Max. Negotiated Rate	$3,108.05
Rate for Payer: Aetna Commercial	$2,362.12
Rate for Payer: Aetna Medicare Advantage	$1,864.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,585.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,585.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,243.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,585.11
Rate for Payer: Cigna Commercial	$3,108.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,504.30
Rate for Payer: Qualcare PPO/HMO/WC	$932.41
Rate for Payer: UnitedHealthcare Community & State	$196.43
Rate for Payer: Wellpoint Medicaid Managed Care	$176.54

PLATE 2.4/2.7 MM LCP FUS

Facility

$6,216.10

Service Code	HCPCS C1776
Hospital Charge Code	270689384
Hospital Revenue Code	278
Min. Negotiated Rate	$932.41
Max. Negotiated Rate	$1,504.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,243.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,504.30
Rate for Payer: Qualcare PPO/HMO/WC	$932.41

PLATE 2.4/2.7 X-SMALL

Facility

$4,745.00

Service Code	HCPCS C1713
Hospital Charge Code	270689658
Hospital Revenue Code	278
Min. Negotiated Rate	$711.75
Max. Negotiated Rate	$1,148.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$949.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,148.29
Rate for Payer: Qualcare PPO/HMO/WC	$711.75

PLATE 2.4/2.7 X-SMALL

Facility

$4,745.00

Service Code	HCPCS C1713
Hospital Charge Code	270689658
Hospital Revenue Code	278
Min. Negotiated Rate	$134.76
Max. Negotiated Rate	$2,372.50
Rate for Payer: Aetna Commercial	$1,803.10
Rate for Payer: Aetna Medicare Advantage	$1,423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,209.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,209.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$949.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,209.97
Rate for Payer: Cigna Commercial	$2,372.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,148.29
Rate for Payer: Qualcare PPO/HMO/WC	$711.75
Rate for Payer: UnitedHealthcare Community & State	$149.94
Rate for Payer: Wellpoint Medicaid Managed Care	$134.76

PLATE 2.4 LCP

Facility

$8,982.00

Service Code	HCPCS C1713
Hospital Charge Code	270685708
Hospital Revenue Code	278
Min. Negotiated Rate	$1,347.30
Max. Negotiated Rate	$2,173.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,796.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,173.64
Rate for Payer: Qualcare PPO/HMO/WC	$1,347.30

PLATE 2.4 LCP

Facility

$8,982.00

Service Code	HCPCS C1713
Hospital Charge Code	270685708
Hospital Revenue Code	278
Min. Negotiated Rate	$255.09
Max. Negotiated Rate	$4,491.00
Rate for Payer: Aetna Commercial	$3,413.16
Rate for Payer: Aetna Medicare Advantage	$2,694.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,290.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,290.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,796.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,290.41
Rate for Payer: Cigna Commercial	$4,491.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,173.64
Rate for Payer: Qualcare PPO/HMO/WC	$1,347.30
Rate for Payer: UnitedHealthcare Community & State	$283.83
Rate for Payer: Wellpoint Medicaid Managed Care	$255.09

PLATE 24MM

Facility

$4,900.00

Hospital Charge Code	270702973
Hospital Revenue Code	278
Min. Negotiated Rate	$735.00
Max. Negotiated Rate	$1,185.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$980.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,185.80
Rate for Payer: Qualcare PPO/HMO/WC	$735.00

PLATE 24MM

Facility

$4,900.00

Hospital Charge Code	270702973
Hospital Revenue Code	278
Min. Negotiated Rate	$139.16
Max. Negotiated Rate	$2,450.00
Rate for Payer: Aetna Commercial	$1,862.00
Rate for Payer: Aetna Medicare Advantage	$1,470.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,249.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,249.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,249.50
Rate for Payer: Cigna Commercial	$2,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,185.80
Rate for Payer: Qualcare PPO/HMO/WC	$735.00
Rate for Payer: UnitedHealthcare Community & State	$154.84
Rate for Payer: Wellpoint Medicaid Managed Care	$139.16

PLATE 24MM

Facility

$10,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704672
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

PLATE 24MM

Facility

$10,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704672
Hospital Revenue Code	278
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$316.00
Rate for Payer: Wellpoint Medicaid Managed Care	$284.00

PLATE 24 MM 1 LEVEL ARCHON

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270693083
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

PLATE 24 MM 1 LEVEL ARCHON

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270693083
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

Know your out-of-pocket cost for care.

All Charges