Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PLATE LAT 2H SZ12 17.25X31.5MM

Facility

$19,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270694488
Hospital Revenue Code	278
Min. Negotiated Rate	$2,996.25
Max. Negotiated Rate	$4,833.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,833.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,996.25

PLATE LAT 2H SZ12 17.25X31.5MM

Facility

$19,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270694488
Hospital Revenue Code	278
Min. Negotiated Rate	$567.29
Max. Negotiated Rate	$9,987.50
Rate for Payer: Aetna Commercial	$7,590.50
Rate for Payer: Aetna Medicare Advantage	$5,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,093.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,093.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,093.62
Rate for Payer: Cigna Commercial	$9,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,833.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,996.25
Rate for Payer: UnitedHealthcare Community & State	$631.21
Rate for Payer: Wellpoint Medicaid Managed Care	$567.29

PLATE LAT 2HSZ16 17.X25X35.5MM

Facility

$19,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270694456
Hospital Revenue Code	278
Min. Negotiated Rate	$2,996.25
Max. Negotiated Rate	$4,833.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,833.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,996.25

PLATE LAT 2HSZ16 17.X25X35.5MM

Facility

$19,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270694456
Hospital Revenue Code	278
Min. Negotiated Rate	$567.29
Max. Negotiated Rate	$9,987.50
Rate for Payer: Aetna Commercial	$7,590.50
Rate for Payer: Aetna Medicare Advantage	$5,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,093.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,093.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,093.62
Rate for Payer: Cigna Commercial	$9,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,833.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,996.25
Rate for Payer: UnitedHealthcare Community & State	$631.21
Rate for Payer: Wellpoint Medicaid Managed Care	$567.29

PLATE LAT 2SCREW OFFSET 15MM

Facility

$20,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270696342
Hospital Revenue Code	278
Min. Negotiated Rate	$589.30
Max. Negotiated Rate	$10,375.00
Rate for Payer: Aetna Commercial	$7,885.00
Rate for Payer: Aetna Medicare Advantage	$6,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,291.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,291.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,291.25
Rate for Payer: Cigna Commercial	$10,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,021.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,112.50
Rate for Payer: UnitedHealthcare Community & State	$655.70
Rate for Payer: Wellpoint Medicaid Managed Care	$589.30

PLATE LAT 2SCREW OFFSET 15MM

Facility

$20,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270696342
Hospital Revenue Code	278
Min. Negotiated Rate	$3,112.50
Max. Negotiated Rate	$5,021.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,021.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,112.50

PLATE LAT DIATAL FEMR 9H-227MM

Facility

$7,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270670423
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

PLATE LAT DIATAL FEMR 9H-227MM

Facility

$7,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270670423
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

PLATE LAT DISTAL FEMR 12H-281m

Facility

$7,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270671594
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

PLATE LAT DISTAL FEMR 12H-281m

Facility

$7,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270671594
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

PLATE LAT DIST TIB TI RT 4H

Facility

$7,016.75

Service Code	HCPCS C1713
Hospital Charge Code	270699067
Hospital Revenue Code	278
Min. Negotiated Rate	$1,052.51
Max. Negotiated Rate	$1,698.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,403.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,698.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,052.51

PLATE LAT DIST TIB TI RT 4H

Facility

$7,016.75

Service Code	HCPCS C1713
Hospital Charge Code	270699067
Hospital Revenue Code	278
Min. Negotiated Rate	$199.28
Max. Negotiated Rate	$3,508.38
Rate for Payer: Aetna Commercial	$2,666.36
Rate for Payer: Aetna Medicare Advantage	$2,105.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,789.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,789.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,403.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,789.27
Rate for Payer: Cigna Commercial	$3,508.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,698.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,052.51
Rate for Payer: UnitedHealthcare Community & State	$221.73
Rate for Payer: Wellpoint Medicaid Managed Care	$199.28

PLATE LATERAL 2H SZ10 NEXXT

Facility

$19,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270693627
Hospital Revenue Code	278
Min. Negotiated Rate	$567.29
Max. Negotiated Rate	$9,987.50
Rate for Payer: Aetna Commercial	$7,590.50
Rate for Payer: Aetna Medicare Advantage	$5,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,093.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,093.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,093.62
Rate for Payer: Cigna Commercial	$9,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,833.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,996.25
Rate for Payer: UnitedHealthcare Community & State	$631.21
Rate for Payer: Wellpoint Medicaid Managed Care	$567.29

PLATE LATERAL 2H SZ10 NEXXT

Facility

$19,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270693627
Hospital Revenue Code	278
Min. Negotiated Rate	$2,996.25
Max. Negotiated Rate	$4,833.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,833.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,996.25

PLATE LATERAL FIBULA 3H 77MM

Facility

$4,940.00

Service Code	HCPCS C1713
Hospital Charge Code	270662554
Hospital Revenue Code	278
Min. Negotiated Rate	$741.00
Max. Negotiated Rate	$1,195.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$988.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,195.48
Rate for Payer: Qualcare PPO/HMO/WC	$741.00

PLATE LATERAL FIBULA 3H 77MM

Facility

$4,940.00

Service Code	HCPCS C1713
Hospital Charge Code	270662554
Hospital Revenue Code	278
Min. Negotiated Rate	$140.30
Max. Negotiated Rate	$2,470.00
Rate for Payer: Aetna Commercial	$1,877.20
Rate for Payer: Aetna Medicare Advantage	$1,482.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,259.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,259.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$988.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,259.70
Rate for Payer: Cigna Commercial	$2,470.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,195.48
Rate for Payer: Qualcare PPO/HMO/WC	$741.00
Rate for Payer: UnitedHealthcare Community & State	$156.10
Rate for Payer: Wellpoint Medicaid Managed Care	$140.30

PLATE LATERAL HOOK LOCK SS 3H

Facility

$3,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270671907
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

PLATE LATERAL HOOK LOCK SS 3H

Facility

$3,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270671907
Hospital Revenue Code	278
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$110.60
Rate for Payer: Wellpoint Medicaid Managed Care	$99.40

PLATE LATERAL HOOK LOCK SS 5H

Facility

$3,500.00

Hospital Charge Code	270656473
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

PLATE LATERAL HOOK LOCK SS 5H

Facility

$3,500.00

Hospital Charge Code	270656473
Hospital Revenue Code	278
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$110.60
Rate for Payer: Wellpoint Medicaid Managed Care	$99.40

PLATE LATERAL HOOK LOCK SS 7H

Facility

$3,500.00

Hospital Charge Code	270656475
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

PLATE LATERAL HOOK LOCK SS 7H

Facility

$3,500.00

Hospital Charge Code	270656475
Hospital Revenue Code	278
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$110.60
Rate for Payer: Wellpoint Medicaid Managed Care	$99.40

PLATE LATERAL STRUXXURE 14MM2H

Facility

$19,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270693947
Hospital Revenue Code	278
Min. Negotiated Rate	$2,996.25
Max. Negotiated Rate	$4,833.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,833.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,996.25

PLATE LATERAL STRUXXURE 14MM2H

Facility

$19,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270693947
Hospital Revenue Code	278
Min. Negotiated Rate	$567.29
Max. Negotiated Rate	$9,987.50
Rate for Payer: Aetna Commercial	$7,590.50
Rate for Payer: Aetna Medicare Advantage	$5,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,093.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,093.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,093.62
Rate for Payer: Cigna Commercial	$9,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,833.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,996.25
Rate for Payer: UnitedHealthcare Community & State	$631.21
Rate for Payer: Wellpoint Medicaid Managed Care	$567.29

PLATE LATERAL TIBIA 2H 95MM RT

Facility

$13,170.00

Service Code	HCPCS C1713
Hospital Charge Code	270673957
Hospital Revenue Code	278
Min. Negotiated Rate	$1,975.50
Max. Negotiated Rate	$3,187.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,634.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,187.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,975.50

Know your out-of-pocket cost for care.

All Charges