Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PLATE HUM DISTAL 2H LT 85MM ST

Facility

$5,353.30

Service Code	HCPCS C1713
Hospital Charge Code	270684232
Hospital Revenue Code	278
Min. Negotiated Rate	$803.00
Max. Negotiated Rate	$1,295.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,070.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,295.50
Rate for Payer: Qualcare PPO/HMO/WC	$803.00

PLATE HUM DISTAL 2H LT 85MM ST

Facility

$5,353.30

Service Code	HCPCS C1713
Hospital Charge Code	270684232
Hospital Revenue Code	278
Min. Negotiated Rate	$152.03
Max. Negotiated Rate	$2,676.65
Rate for Payer: Aetna Commercial	$2,034.25
Rate for Payer: Aetna Medicare Advantage	$1,605.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,365.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,365.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,070.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,365.09
Rate for Payer: Cigna Commercial	$2,676.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,295.50
Rate for Payer: Qualcare PPO/HMO/WC	$803.00
Rate for Payer: UnitedHealthcare Community & State	$169.16
Rate for Payer: Wellpoint Medicaid Managed Care	$152.03

PLATE HUM DISTAL 2H RT 82MM

Facility

$4,842.05

Hospital Charge Code	270677664
Hospital Revenue Code	278
Min. Negotiated Rate	$137.51
Max. Negotiated Rate	$2,421.03
Rate for Payer: Aetna Commercial	$1,839.98
Rate for Payer: Aetna Medicare Advantage	$1,452.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,234.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,234.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$968.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,234.72
Rate for Payer: Cigna Commercial	$2,421.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,171.78
Rate for Payer: Qualcare PPO/HMO/WC	$726.31
Rate for Payer: UnitedHealthcare Community & State	$153.01
Rate for Payer: Wellpoint Medicaid Managed Care	$137.51

PLATE HUM DISTAL 2H RT 82MM

Facility

$4,842.05

Hospital Charge Code	270677664
Hospital Revenue Code	278
Min. Negotiated Rate	$726.31
Max. Negotiated Rate	$1,171.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$968.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,171.78
Rate for Payer: Qualcare PPO/HMO/WC	$726.31

PLATE HUM DISTAL 2H RT 82MM ME

Facility

$5,049.05

Service Code	HCPCS C1713
Hospital Charge Code	270678411
Hospital Revenue Code	278
Min. Negotiated Rate	$757.36
Max. Negotiated Rate	$1,221.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,009.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,221.87
Rate for Payer: Qualcare PPO/HMO/WC	$757.36

PLATE HUM DISTAL 2H RT 82MM ME

Facility

$5,049.05

Service Code	HCPCS C1713
Hospital Charge Code	270678411
Hospital Revenue Code	278
Min. Negotiated Rate	$143.39
Max. Negotiated Rate	$2,524.53
Rate for Payer: Aetna Commercial	$1,918.64
Rate for Payer: Aetna Medicare Advantage	$1,514.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,287.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,287.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,009.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,287.51
Rate for Payer: Cigna Commercial	$2,524.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,221.87
Rate for Payer: Qualcare PPO/HMO/WC	$757.36
Rate for Payer: UnitedHealthcare Community & State	$159.55
Rate for Payer: Wellpoint Medicaid Managed Care	$143.39

PLATE HUM DISTAL 2H RT 85MM

Facility

$4,993.45

Hospital Charge Code	270677629
Hospital Revenue Code	278
Min. Negotiated Rate	$141.81
Max. Negotiated Rate	$2,496.72
Rate for Payer: Aetna Commercial	$1,897.51
Rate for Payer: Aetna Medicare Advantage	$1,498.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,273.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,273.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$998.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,273.33
Rate for Payer: Cigna Commercial	$2,496.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,208.41
Rate for Payer: Qualcare PPO/HMO/WC	$749.02
Rate for Payer: UnitedHealthcare Community & State	$157.79
Rate for Payer: Wellpoint Medicaid Managed Care	$141.81

PLATE HUM DISTAL 2H RT 85MM

Facility

$4,993.45

Hospital Charge Code	270677629
Hospital Revenue Code	278
Min. Negotiated Rate	$749.02
Max. Negotiated Rate	$1,208.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$998.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,208.41
Rate for Payer: Qualcare PPO/HMO/WC	$749.02

PLATE HUM DISTAL 3H LT 75MM

Facility

$4,842.05

Service Code	HCPCS C1713
Hospital Charge Code	270676237
Hospital Revenue Code	278
Min. Negotiated Rate	$137.51
Max. Negotiated Rate	$2,421.03
Rate for Payer: Aetna Commercial	$1,839.98
Rate for Payer: Aetna Medicare Advantage	$1,452.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,234.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,234.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$968.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,234.72
Rate for Payer: Cigna Commercial	$2,421.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,171.78
Rate for Payer: Qualcare PPO/HMO/WC	$726.31
Rate for Payer: UnitedHealthcare Community & State	$153.01
Rate for Payer: Wellpoint Medicaid Managed Care	$137.51

PLATE HUM DISTAL 3H LT 75MM

Facility

$4,842.05

Service Code	HCPCS C1713
Hospital Charge Code	270676237
Hospital Revenue Code	278
Min. Negotiated Rate	$726.31
Max. Negotiated Rate	$1,171.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$968.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,171.78
Rate for Payer: Qualcare PPO/HMO/WC	$726.31

PLATE HUM DISTAL 3H LT 75MM ST

Facility

$5,049.05

Service Code	HCPCS C1713
Hospital Charge Code	270676911
Hospital Revenue Code	278
Min. Negotiated Rate	$143.39
Max. Negotiated Rate	$2,524.53
Rate for Payer: Aetna Commercial	$1,918.64
Rate for Payer: Aetna Medicare Advantage	$1,514.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,287.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,287.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,009.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,287.51
Rate for Payer: Cigna Commercial	$2,524.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,221.87
Rate for Payer: Qualcare PPO/HMO/WC	$757.36
Rate for Payer: UnitedHealthcare Community & State	$159.55
Rate for Payer: Wellpoint Medicaid Managed Care	$143.39

PLATE HUM DISTAL 3H LT 75MM ST

Facility

$5,049.05

Service Code	HCPCS C1713
Hospital Charge Code	270676911
Hospital Revenue Code	278
Min. Negotiated Rate	$757.36
Max. Negotiated Rate	$1,221.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,009.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,221.87
Rate for Payer: Qualcare PPO/HMO/WC	$757.36

PLATE HUM DISTAL 3H RT 75MM

Facility

$4,842.05

Hospital Charge Code	270677635
Hospital Revenue Code	278
Min. Negotiated Rate	$137.51
Max. Negotiated Rate	$2,421.03
Rate for Payer: Aetna Commercial	$1,839.98
Rate for Payer: Aetna Medicare Advantage	$1,452.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,234.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,234.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$968.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,234.72
Rate for Payer: Cigna Commercial	$2,421.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,171.78
Rate for Payer: Qualcare PPO/HMO/WC	$726.31
Rate for Payer: UnitedHealthcare Community & State	$153.01
Rate for Payer: Wellpoint Medicaid Managed Care	$137.51

PLATE HUM DISTAL 3H RT 75MM

Facility

$4,842.05

Hospital Charge Code	270677635
Hospital Revenue Code	278
Min. Negotiated Rate	$726.31
Max. Negotiated Rate	$1,171.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$968.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,171.78
Rate for Payer: Qualcare PPO/HMO/WC	$726.31

PLATE HUM DISTAL 4H LT 111MM

Facility

$4,993.45

Hospital Charge Code	270677633
Hospital Revenue Code	278
Min. Negotiated Rate	$141.81
Max. Negotiated Rate	$2,496.72
Rate for Payer: Aetna Commercial	$1,897.51
Rate for Payer: Aetna Medicare Advantage	$1,498.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,273.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,273.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$998.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,273.33
Rate for Payer: Cigna Commercial	$2,496.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,208.41
Rate for Payer: Qualcare PPO/HMO/WC	$749.02
Rate for Payer: UnitedHealthcare Community & State	$157.79
Rate for Payer: Wellpoint Medicaid Managed Care	$141.81

PLATE HUM DISTAL 4H LT 111MM

Facility

$4,993.45

Hospital Charge Code	270677633
Hospital Revenue Code	278
Min. Negotiated Rate	$749.02
Max. Negotiated Rate	$1,208.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$998.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,208.41
Rate for Payer: Qualcare PPO/HMO/WC	$749.02

PLATE HUM DISTAL 4H LT 111MM S

Facility

$5,197.40

Service Code	HCPCS C1713
Hospital Charge Code	270678881
Hospital Revenue Code	278
Min. Negotiated Rate	$147.61
Max. Negotiated Rate	$2,598.70
Rate for Payer: Aetna Commercial	$1,975.01
Rate for Payer: Aetna Medicare Advantage	$1,559.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,325.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,325.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,039.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,325.34
Rate for Payer: Cigna Commercial	$2,598.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,257.77
Rate for Payer: Qualcare PPO/HMO/WC	$779.61
Rate for Payer: UnitedHealthcare Community & State	$164.24
Rate for Payer: Wellpoint Medicaid Managed Care	$147.61

PLATE HUM DISTAL 4H LT 111MM S

Facility

$5,197.40

Service Code	HCPCS C1713
Hospital Charge Code	270678881
Hospital Revenue Code	278
Min. Negotiated Rate	$779.61
Max. Negotiated Rate	$1,257.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,039.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,257.77
Rate for Payer: Qualcare PPO/HMO/WC	$779.61

PLATE HUM DISTAL 4H LT 88MM

Facility

$4,842.05

Hospital Charge Code	270677639
Hospital Revenue Code	278
Min. Negotiated Rate	$726.31
Max. Negotiated Rate	$1,171.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$968.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,171.78
Rate for Payer: Qualcare PPO/HMO/WC	$726.31

PLATE HUM DISTAL 4H LT 88MM

Facility

$4,842.05

Hospital Charge Code	270677639
Hospital Revenue Code	278
Min. Negotiated Rate	$137.51
Max. Negotiated Rate	$2,421.03
Rate for Payer: Aetna Commercial	$1,839.98
Rate for Payer: Aetna Medicare Advantage	$1,452.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,234.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,234.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$968.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,234.72
Rate for Payer: Cigna Commercial	$2,421.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,171.78
Rate for Payer: Qualcare PPO/HMO/WC	$726.31
Rate for Payer: UnitedHealthcare Community & State	$153.01
Rate for Payer: Wellpoint Medicaid Managed Care	$137.51

PLATE HUM DISTAL 4H LT 88MM ST

Facility

$5,049.55

Hospital Charge Code	270678880
Hospital Revenue Code	272
Min. Negotiated Rate	$757.43
Max. Negotiated Rate	$757.43
Rate for Payer: Qualcare PPO/HMO/WC	$757.43

PLATE HUM DISTAL 4H LT 88MM ST

Facility

$5,049.55

Hospital Charge Code	270678880
Hospital Revenue Code	272
Min. Negotiated Rate	$143.41
Max. Negotiated Rate	$2,524.78
Rate for Payer: Aetna Commercial	$1,918.83
Rate for Payer: Aetna Medicare Advantage	$1,514.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,287.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,287.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,287.64
Rate for Payer: Cigna Commercial	$2,524.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,312.88
Rate for Payer: Oxford Commercial	$1,009.91
Rate for Payer: Qualcare PPO/HMO/WC	$757.43
Rate for Payer: UnitedHealthcare Commercial	$1,009.91
Rate for Payer: UnitedHealthcare Community & State	$159.57
Rate for Payer: Wellpoint Medicaid Managed Care	$143.41

PLATE HUM DISTAL 4H RT 88MM

Facility

$4,842.05

Hospital Charge Code	270677636
Hospital Revenue Code	278
Min. Negotiated Rate	$726.31
Max. Negotiated Rate	$1,171.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$968.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,171.78
Rate for Payer: Qualcare PPO/HMO/WC	$726.31

PLATE HUM DISTAL 4H RT 88MM

Facility

$4,842.05

Hospital Charge Code	270677636
Hospital Revenue Code	278
Min. Negotiated Rate	$137.51
Max. Negotiated Rate	$2,421.03
Rate for Payer: Aetna Commercial	$1,839.98
Rate for Payer: Aetna Medicare Advantage	$1,452.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,234.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,234.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$968.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,234.72
Rate for Payer: Cigna Commercial	$2,421.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,171.78
Rate for Payer: Qualcare PPO/HMO/WC	$726.31
Rate for Payer: UnitedHealthcare Community & State	$153.01
Rate for Payer: Wellpoint Medicaid Managed Care	$137.51

PLATE HUM DISTAL 5H LT 121MM

Facility

$4,842.05

Service Code	HCPCS C1713
Hospital Charge Code	270677669
Hospital Revenue Code	278
Min. Negotiated Rate	$726.31
Max. Negotiated Rate	$1,171.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$968.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,171.78
Rate for Payer: Qualcare PPO/HMO/WC	$726.31

Know your out-of-pocket cost for care.

All Charges