Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PLATE DCP 10 HOLE 3.5x121MM

Facility

$769.40

Service Code	HCPCS C1713
Hospital Charge Code	270604402
Hospital Revenue Code	278
Min. Negotiated Rate	$115.41
Max. Negotiated Rate	$186.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$153.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.19
Rate for Payer: Qualcare PPO/HMO/WC	$115.41

PLATE DCP 10 HOLE 3.5x121MM

Facility

$769.40

Service Code	HCPCS C1713
Hospital Charge Code	270604402
Hospital Revenue Code	278
Min. Negotiated Rate	$21.85
Max. Negotiated Rate	$384.70
Rate for Payer: Aetna Commercial	$292.37
Rate for Payer: Aetna Medicare Advantage	$230.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$196.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$196.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$153.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$196.20
Rate for Payer: Cigna Commercial	$384.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.19
Rate for Payer: Qualcare PPO/HMO/WC	$115.41
Rate for Payer: UnitedHealthcare Community & State	$24.31
Rate for Payer: Wellpoint Medicaid Managed Care	$21.85

PLATE DCP 2.7MM 6HOLE 52MM

Facility

$707.60

Service Code	HCPCS C1713
Hospital Charge Code	270604361
Hospital Revenue Code	278
Min. Negotiated Rate	$20.10
Max. Negotiated Rate	$353.80
Rate for Payer: Aetna Commercial	$268.89
Rate for Payer: Aetna Medicare Advantage	$212.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$180.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$180.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$141.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$180.44
Rate for Payer: Cigna Commercial	$353.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$171.24
Rate for Payer: Qualcare PPO/HMO/WC	$106.14
Rate for Payer: UnitedHealthcare Community & State	$22.36
Rate for Payer: Wellpoint Medicaid Managed Care	$20.10

PLATE DCP 2.7MM 6HOLE 52MM

Facility

$707.60

Service Code	HCPCS C1713
Hospital Charge Code	270604361
Hospital Revenue Code	278
Min. Negotiated Rate	$106.14
Max. Negotiated Rate	$171.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$141.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$171.24
Rate for Payer: Qualcare PPO/HMO/WC	$106.14

PLATE DCP 6 HOLE 3.5x73MM

Facility

$645.00

Service Code	HCPCS C1713
Hospital Charge Code	270668575
Hospital Revenue Code	278
Min. Negotiated Rate	$96.75
Max. Negotiated Rate	$156.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$129.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.09
Rate for Payer: Qualcare PPO/HMO/WC	$96.75

PLATE DCP 6 HOLE 3.5x73MM

Facility

$645.00

Service Code	HCPCS C1713
Hospital Charge Code	270668575
Hospital Revenue Code	278
Min. Negotiated Rate	$18.32
Max. Negotiated Rate	$322.50
Rate for Payer: Aetna Commercial	$245.10
Rate for Payer: Aetna Medicare Advantage	$193.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$129.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$164.47
Rate for Payer: Cigna Commercial	$322.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.09
Rate for Payer: Qualcare PPO/HMO/WC	$96.75
Rate for Payer: UnitedHealthcare Community & State	$20.38
Rate for Payer: Wellpoint Medicaid Managed Care	$18.32

PLATE DCP NARROW 4H 4.5x71MM

Facility

$621.10

Service Code	HCPCS C1713
Hospital Charge Code	270651715
Hospital Revenue Code	278
Min. Negotiated Rate	$17.64
Max. Negotiated Rate	$310.55
Rate for Payer: Aetna Commercial	$236.02
Rate for Payer: Aetna Medicare Advantage	$186.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$158.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$158.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$158.38
Rate for Payer: Cigna Commercial	$310.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.31
Rate for Payer: Qualcare PPO/HMO/WC	$93.17
Rate for Payer: UnitedHealthcare Community & State	$19.63
Rate for Payer: Wellpoint Medicaid Managed Care	$17.64

PLATE DCP NARROW 4H 4.5x71MM

Facility

$621.10

Service Code	HCPCS C1713
Hospital Charge Code	270651715
Hospital Revenue Code	278
Min. Negotiated Rate	$93.17
Max. Negotiated Rate	$150.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.31
Rate for Payer: Qualcare PPO/HMO/WC	$93.17

PLATE DCP NARROW 5H 4.5x87MM

Facility

$621.10

Service Code	HCPCS C1713
Hospital Charge Code	270651716
Hospital Revenue Code	278
Min. Negotiated Rate	$93.17
Max. Negotiated Rate	$150.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.31
Rate for Payer: Qualcare PPO/HMO/WC	$93.17

PLATE DCP NARROW 5H 4.5x87MM

Facility

$621.10

Service Code	HCPCS C1713
Hospital Charge Code	270651716
Hospital Revenue Code	278
Min. Negotiated Rate	$17.64
Max. Negotiated Rate	$310.55
Rate for Payer: Aetna Commercial	$236.02
Rate for Payer: Aetna Medicare Advantage	$186.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$158.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$158.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$158.38
Rate for Payer: Cigna Commercial	$310.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.31
Rate for Payer: Qualcare PPO/HMO/WC	$93.17
Rate for Payer: UnitedHealthcare Community & State	$19.63
Rate for Payer: Wellpoint Medicaid Managed Care	$17.64

PLATE DCP NARROW 6H 103MM

Facility

$687.00

Hospital Charge Code	270671823
Hospital Revenue Code	278
Min. Negotiated Rate	$19.51
Max. Negotiated Rate	$343.50
Rate for Payer: Aetna Commercial	$261.06
Rate for Payer: Aetna Medicare Advantage	$206.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$175.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$175.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$137.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$175.19
Rate for Payer: Cigna Commercial	$343.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$166.25
Rate for Payer: Qualcare PPO/HMO/WC	$103.05
Rate for Payer: UnitedHealthcare Community & State	$21.71
Rate for Payer: Wellpoint Medicaid Managed Care	$19.51

PLATE DCP NARROW 6H 103MM

Facility

$687.00

Hospital Charge Code	270671823
Hospital Revenue Code	278
Min. Negotiated Rate	$103.05
Max. Negotiated Rate	$166.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$137.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$166.25
Rate for Payer: Qualcare PPO/HMO/WC	$103.05

PLATE DCP NARROW 8H 4.5x135MM

Facility

$707.60

Service Code	HCPCS C1713
Hospital Charge Code	270651717
Hospital Revenue Code	278
Min. Negotiated Rate	$20.10
Max. Negotiated Rate	$353.80
Rate for Payer: Aetna Commercial	$268.89
Rate for Payer: Aetna Medicare Advantage	$212.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$180.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$180.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$141.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$180.44
Rate for Payer: Cigna Commercial	$353.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$171.24
Rate for Payer: Qualcare PPO/HMO/WC	$106.14
Rate for Payer: UnitedHealthcare Community & State	$22.36
Rate for Payer: Wellpoint Medicaid Managed Care	$20.10

PLATE DCP NARROW 8H 4.5x135MM

Facility

$707.60

Service Code	HCPCS C1713
Hospital Charge Code	270651717
Hospital Revenue Code	278
Min. Negotiated Rate	$106.14
Max. Negotiated Rate	$171.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$141.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$171.24
Rate for Payer: Qualcare PPO/HMO/WC	$106.14

PLATE DHS 135 DEG 10H/174MM

Facility

$3,229.05

Service Code	HCPCS C1713
Hospital Charge Code	270651718
Hospital Revenue Code	278
Min. Negotiated Rate	$91.71
Max. Negotiated Rate	$1,614.53
Rate for Payer: Aetna Commercial	$1,227.04
Rate for Payer: Aetna Medicare Advantage	$968.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$823.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$823.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$645.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$823.41
Rate for Payer: Cigna Commercial	$1,614.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$781.43
Rate for Payer: Qualcare PPO/HMO/WC	$484.36
Rate for Payer: UnitedHealthcare Community & State	$102.04
Rate for Payer: Wellpoint Medicaid Managed Care	$91.71

PLATE DHS 135 DEG 10H/174MM

Facility

$3,229.05

Service Code	HCPCS C1713
Hospital Charge Code	270651718
Hospital Revenue Code	278
Min. Negotiated Rate	$484.36
Max. Negotiated Rate	$781.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$645.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$781.43
Rate for Payer: Qualcare PPO/HMO/WC	$484.36

PLATE DHS 135 DEG 4H/78MM

Facility

$2,274.25

Service Code	HCPCS C1713
Hospital Charge Code	270603833
Hospital Revenue Code	278
Min. Negotiated Rate	$64.59
Max. Negotiated Rate	$1,137.12
Rate for Payer: Aetna Commercial	$864.22
Rate for Payer: Aetna Medicare Advantage	$682.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$579.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$579.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$454.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$579.93
Rate for Payer: Cigna Commercial	$1,137.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$550.37
Rate for Payer: Qualcare PPO/HMO/WC	$341.14
Rate for Payer: UnitedHealthcare Community & State	$71.87
Rate for Payer: Wellpoint Medicaid Managed Care	$64.59

PLATE DHS 135 DEG 4H/78MM

Facility

$2,274.25

Service Code	HCPCS C1713
Hospital Charge Code	270603833
Hospital Revenue Code	278
Min. Negotiated Rate	$341.14
Max. Negotiated Rate	$550.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$454.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$550.37
Rate for Payer: Qualcare PPO/HMO/WC	$341.14

PLATE DHS 135 DEG 5H/94MM

Facility

$2,274.25

Service Code	HCPCS C1713
Hospital Charge Code	270651719
Hospital Revenue Code	278
Min. Negotiated Rate	$64.59
Max. Negotiated Rate	$1,137.12
Rate for Payer: Aetna Commercial	$864.22
Rate for Payer: Aetna Medicare Advantage	$682.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$579.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$579.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$454.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$579.93
Rate for Payer: Cigna Commercial	$1,137.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$550.37
Rate for Payer: Qualcare PPO/HMO/WC	$341.14
Rate for Payer: UnitedHealthcare Community & State	$71.87
Rate for Payer: Wellpoint Medicaid Managed Care	$64.59

PLATE DHS 135 DEG 5H/94MM

Facility

$2,274.25

Service Code	HCPCS C1713
Hospital Charge Code	270651719
Hospital Revenue Code	278
Min. Negotiated Rate	$341.14
Max. Negotiated Rate	$550.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$454.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$550.37
Rate for Payer: Qualcare PPO/HMO/WC	$341.14

PLATE DHS 140 DEG 5H/94MM

Facility

$2,481.25

Service Code	HCPCS C1713
Hospital Charge Code	270603818
Hospital Revenue Code	278
Min. Negotiated Rate	$70.47
Max. Negotiated Rate	$1,240.62
Rate for Payer: Aetna Commercial	$942.88
Rate for Payer: Aetna Medicare Advantage	$744.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$632.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$632.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$496.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$632.72
Rate for Payer: Cigna Commercial	$1,240.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$600.46
Rate for Payer: Qualcare PPO/HMO/WC	$372.19
Rate for Payer: UnitedHealthcare Community & State	$78.41
Rate for Payer: Wellpoint Medicaid Managed Care	$70.47

PLATE DHS 140 DEG 5H/94MM

Facility

$2,481.25

Service Code	HCPCS C1713
Hospital Charge Code	270603818
Hospital Revenue Code	278
Min. Negotiated Rate	$372.19
Max. Negotiated Rate	$600.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$496.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$600.46
Rate for Payer: Qualcare PPO/HMO/WC	$372.19

PLATE DHS 2H/46mm 130 DEG

Facility

$2,409.00

Hospital Charge Code	270671816
Hospital Revenue Code	278
Min. Negotiated Rate	$68.42
Max. Negotiated Rate	$1,204.50
Rate for Payer: Aetna Commercial	$915.42
Rate for Payer: Aetna Medicare Advantage	$722.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$614.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$614.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$481.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$614.29
Rate for Payer: Cigna Commercial	$1,204.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$582.98
Rate for Payer: Qualcare PPO/HMO/WC	$361.35
Rate for Payer: UnitedHealthcare Community & State	$76.12
Rate for Payer: Wellpoint Medicaid Managed Care	$68.42

PLATE DHS 2H/46mm 130 DEG

Facility

$2,409.00

Hospital Charge Code	270671816
Hospital Revenue Code	278
Min. Negotiated Rate	$361.35
Max. Negotiated Rate	$582.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$481.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$582.98
Rate for Payer: Qualcare PPO/HMO/WC	$361.35

PLATE DHS 38mm 4HOLE 135

Facility

$2,208.00

Hospital Charge Code	270603807
Hospital Revenue Code	278
Min. Negotiated Rate	$62.71
Max. Negotiated Rate	$1,104.00
Rate for Payer: Aetna Commercial	$839.04
Rate for Payer: Aetna Medicare Advantage	$662.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$563.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$563.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$441.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$563.04
Rate for Payer: Cigna Commercial	$1,104.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$534.34
Rate for Payer: Qualcare PPO/HMO/WC	$331.20
Rate for Payer: UnitedHealthcare Community & State	$69.77
Rate for Payer: Wellpoint Medicaid Managed Care	$62.71

Know your out-of-pocket cost for care.

All Charges