Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PLATE CALCANEAL LCKG MINI-RT

Facility

$3,411.35

Hospital Charge Code	270668527
Hospital Revenue Code	278
Min. Negotiated Rate	$511.70
Max. Negotiated Rate	$825.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$682.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$825.55
Rate for Payer: Qualcare PPO/HMO/WC	$511.70

PLATE CALCANEAL LCKG SHORT LF

Facility

$2,926.25

Service Code	HCPCS C1713
Hospital Charge Code	270651713
Hospital Revenue Code	278
Min. Negotiated Rate	$438.94
Max. Negotiated Rate	$708.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$585.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$708.15
Rate for Payer: Qualcare PPO/HMO/WC	$438.94

PLATE CALCANEAL LCKG SHORT LF

Facility

$2,926.25

Service Code	HCPCS C1713
Hospital Charge Code	270651713
Hospital Revenue Code	278
Min. Negotiated Rate	$83.11
Max. Negotiated Rate	$1,463.12
Rate for Payer: Aetna Commercial	$1,111.97
Rate for Payer: Aetna Medicare Advantage	$877.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$746.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$746.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$585.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$746.19
Rate for Payer: Cigna Commercial	$1,463.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$708.15
Rate for Payer: Qualcare PPO/HMO/WC	$438.94
Rate for Payer: UnitedHealthcare Community & State	$92.47
Rate for Payer: Wellpoint Medicaid Managed Care	$83.11

PLATE CALCANEAL M8 HOLE

Facility

$10,570.00

Service Code	HCPCS C1713
Hospital Charge Code	270701152
Hospital Revenue Code	278
Min. Negotiated Rate	$300.19
Max. Negotiated Rate	$5,285.00
Rate for Payer: Aetna Commercial	$4,016.60
Rate for Payer: Aetna Medicare Advantage	$3,171.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,695.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,695.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,114.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,695.35
Rate for Payer: Cigna Commercial	$5,285.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,557.94
Rate for Payer: Qualcare PPO/HMO/WC	$1,585.50
Rate for Payer: UnitedHealthcare Community & State	$334.01
Rate for Payer: Wellpoint Medicaid Managed Care	$300.19

PLATE CALCANEAL M8 HOLE

Facility

$10,570.00

Service Code	HCPCS C1713
Hospital Charge Code	270701152
Hospital Revenue Code	278
Min. Negotiated Rate	$1,585.50
Max. Negotiated Rate	$2,557.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,114.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,557.94
Rate for Payer: Qualcare PPO/HMO/WC	$1,585.50

PLATE CALCANEAL RT SM 58MM STR

Facility

$4,512.00

Service Code	HCPCS C1713
Hospital Charge Code	270675823
Hospital Revenue Code	278
Min. Negotiated Rate	$676.80
Max. Negotiated Rate	$1,091.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$902.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,091.90
Rate for Payer: Qualcare PPO/HMO/WC	$676.80

PLATE CALCANEAL RT SM 58MM STR

Facility

$4,512.00

Service Code	HCPCS C1713
Hospital Charge Code	270675823
Hospital Revenue Code	278
Min. Negotiated Rate	$128.14
Max. Negotiated Rate	$2,256.00
Rate for Payer: Aetna Commercial	$1,714.56
Rate for Payer: Aetna Medicare Advantage	$1,353.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,150.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,150.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$902.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,150.56
Rate for Payer: Cigna Commercial	$2,256.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,091.90
Rate for Payer: Qualcare PPO/HMO/WC	$676.80
Rate for Payer: UnitedHealthcare Community & State	$142.58
Rate for Payer: Wellpoint Medicaid Managed Care	$128.14

PLATE CALCANEUS STEP 5MM

Facility

$4,900.00

Service Code	HCPCS C1713
Hospital Charge Code	270669480
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 CALCANEUS STEP 5MM

Facility

$4,900.00

Service Code	HCPCS C1713
Hospital Charge Code	270669480
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 CALCANEUS STEP 7.5MM

Facility

$4,900.00

Service Code	HCPCS C1713
Hospital Charge Code	270668407
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 CALCANEUS STEP 7.5MM

Facility

$4,900.00

Service Code	HCPCS C1713
Hospital Charge Code	270668407
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 CALCAN PERIMETERPLATE SM

Facility

$5,980.00

Service Code	HCPCS C1713
Hospital Charge Code	270701269
Hospital Revenue Code	278
Min. Negotiated Rate	$897.00
Max. Negotiated Rate	$1,447.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,196.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,447.16
Rate for Payer: Qualcare PPO/HMO/WC	$897.00

PLATE CALCAN PERIMETERPLATE SM

Facility

$5,980.00

Service Code	HCPCS C1713
Hospital Charge Code	270701269
Hospital Revenue Code	278
Min. Negotiated Rate	$169.83
Max. Negotiated Rate	$2,990.00
Rate for Payer: Aetna Commercial	$2,272.40
Rate for Payer: Aetna Medicare Advantage	$1,794.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,524.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,524.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,196.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,524.90
Rate for Payer: Cigna Commercial	$2,990.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,447.16
Rate for Payer: Qualcare PPO/HMO/WC	$897.00
Rate for Payer: UnitedHealthcare Community & State	$188.97
Rate for Payer: Wellpoint Medicaid Managed Care	$169.83

PLATE CALC SLIDE

Facility

$7,837.50

Service Code	HCPCS C1713
Hospital Charge Code	270701423
Hospital Revenue Code	278
Min. Negotiated Rate	$222.59
Max. Negotiated Rate	$3,918.75
Rate for Payer: Aetna Commercial	$2,978.25
Rate for Payer: Aetna Medicare Advantage	$2,351.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,998.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,998.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,567.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,998.56
Rate for Payer: Cigna Commercial	$3,918.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,896.67
Rate for Payer: Qualcare PPO/HMO/WC	$1,175.62
Rate for Payer: UnitedHealthcare Community & State	$247.66
Rate for Payer: Wellpoint Medicaid Managed Care	$222.59

PLATE CALC SLIDE

Facility

$7,837.50

Service Code	HCPCS C1713
Hospital Charge Code	270701423
Hospital Revenue Code	278
Min. Negotiated Rate	$1,175.62
Max. Negotiated Rate	$1,896.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,567.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,896.67
Rate for Payer: Qualcare PPO/HMO/WC	$1,175.62

PLATE CAL LEFT

Facility

$5,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270684029
Hospital Revenue Code	278
Min. Negotiated Rate	$821.25
Max. Negotiated Rate	$1,324.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,095.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.95
Rate for Payer: Qualcare PPO/HMO/WC	$821.25

PLATE CAL LEFT

Facility

$5,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270684029
Hospital Revenue Code	278
Min. Negotiated Rate	$155.49
Max. Negotiated Rate	$2,737.50
Rate for Payer: Aetna Commercial	$2,080.50
Rate for Payer: Aetna Medicare Advantage	$1,642.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,396.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,396.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,095.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,396.12
Rate for Payer: Cigna Commercial	$2,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.95
Rate for Payer: Qualcare PPO/HMO/WC	$821.25
Rate for Payer: UnitedHealthcare Community & State	$173.01
Rate for Payer: Wellpoint Medicaid Managed Care	$155.49

PLATE CASE TRI SZ 6

Facility

$6,303.45

Service Code	HCPCS C1776
Hospital Charge Code	270691999
Hospital Revenue Code	278
Min. Negotiated Rate	$179.02
Max. Negotiated Rate	$3,151.72
Rate for Payer: Aetna Commercial	$2,395.31
Rate for Payer: Aetna Medicare Advantage	$1,891.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,607.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,607.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,260.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,607.38
Rate for Payer: Cigna Commercial	$3,151.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,525.43
Rate for Payer: Qualcare PPO/HMO/WC	$945.52
Rate for Payer: UnitedHealthcare Community & State	$199.19
Rate for Payer: Wellpoint Medicaid Managed Care	$179.02

PLATE CASE TRI SZ 6

Facility

$6,303.45

Service Code	HCPCS C1776
Hospital Charge Code	270691999
Hospital Revenue Code	278
Min. Negotiated Rate	$945.52
Max. Negotiated Rate	$1,525.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,260.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,525.43
Rate for Payer: Qualcare PPO/HMO/WC	$945.52

PLATE CAYMAN UNITED 1H 18MM LT

Facility

$17,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270698868
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$4,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

PLATE CAYMAN UNITED 1H 18MM LT

Facility

$17,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270698868
Hospital Revenue Code	278
Min. Negotiated Rate	$497.00
Max. Negotiated Rate	$8,750.00
Rate for Payer: Aetna Commercial	$6,650.00
Rate for Payer: Aetna Medicare Advantage	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,462.50
Rate for Payer: Cigna Commercial	$8,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00
Rate for Payer: UnitedHealthcare Community & State	$553.00
Rate for Payer: Wellpoint Medicaid Managed Care	$497.00

PLATE CERES 2 LEVEL 40MM

Facility

$4,800.00

Service Code	HCPCS C1713
Hospital Charge Code	270697054
Hospital Revenue Code	278
Min. Negotiated Rate	$720.00
Max. Negotiated Rate	$1,161.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$960.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.60
Rate for Payer: Qualcare PPO/HMO/WC	$720.00

PLATE CERES 2 LEVEL 40MM

Facility

$4,800.00

Service Code	HCPCS C1713
Hospital Charge Code	270697054
Hospital Revenue Code	278
Min. Negotiated Rate	$136.32
Max. Negotiated Rate	$2,400.00
Rate for Payer: Aetna Commercial	$1,824.00
Rate for Payer: Aetna Medicare Advantage	$1,440.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,224.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,224.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$960.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,224.00
Rate for Payer: Cigna Commercial	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.60
Rate for Payer: Qualcare PPO/HMO/WC	$720.00
Rate for Payer: UnitedHealthcare Community & State	$151.68
Rate for Payer: Wellpoint Medicaid Managed Care	$136.32

PLATE CERES 3 LEVEL 39MM

Facility

$4,800.00

Service Code	HCPCS C1713
Hospital Charge Code	270695467
Hospital Revenue Code	278
Min. Negotiated Rate	$136.32
Max. Negotiated Rate	$2,400.00
Rate for Payer: Aetna Commercial	$1,824.00
Rate for Payer: Aetna Medicare Advantage	$1,440.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,224.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,224.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$960.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,224.00
Rate for Payer: Cigna Commercial	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.60
Rate for Payer: Qualcare PPO/HMO/WC	$720.00
Rate for Payer: UnitedHealthcare Community & State	$151.68
Rate for Payer: Wellpoint Medicaid Managed Care	$136.32

PLATE CERES 3 LEVEL 39MM

Facility

$4,800.00

Service Code	HCPCS C1713
Hospital Charge Code	270695467
Hospital Revenue Code	278
Min. Negotiated Rate	$720.00
Max. Negotiated Rate	$1,161.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$960.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.60
Rate for Payer: Qualcare PPO/HMO/WC	$720.00

Know your out-of-pocket cost for care.

All Charges