Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PLATE METAPHYSEAL 6H 3.5x86MM

Facility

$3,902.00

Service Code	HCPCS C1713
Hospital Charge Code	270660390
Hospital Revenue Code	278
Min. Negotiated Rate	$585.30
Max. Negotiated Rate	$944.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$780.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$944.28
Rate for Payer: Qualcare PPO/HMO/WC	$585.30

PLATE METAPHYSEAL 6H 3.5x86MM

Facility

$3,902.00

Service Code	HCPCS C1713
Hospital Charge Code	270660390
Hospital Revenue Code	278
Min. Negotiated Rate	$110.82
Max. Negotiated Rate	$1,951.00
Rate for Payer: Aetna Commercial	$1,482.76
Rate for Payer: Aetna Medicare Advantage	$1,170.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$995.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$995.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$780.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$995.01
Rate for Payer: Cigna Commercial	$1,951.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$944.28
Rate for Payer: Qualcare PPO/HMO/WC	$585.30
Rate for Payer: UnitedHealthcare Community & State	$123.30
Rate for Payer: Wellpoint Medicaid Managed Care	$110.82

PLATE METATARSAL 4H STRAIGHT

Facility

$3,900.00

Service Code	HCPCS C1713
Hospital Charge Code	270697018
Hospital Revenue Code	278
Min. Negotiated Rate	$110.76
Max. Negotiated Rate	$1,950.00
Rate for Payer: Aetna Commercial	$1,482.00
Rate for Payer: Aetna Medicare Advantage	$1,170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$994.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$994.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$780.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$994.50
Rate for Payer: Cigna Commercial	$1,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$943.80
Rate for Payer: Qualcare PPO/HMO/WC	$585.00
Rate for Payer: UnitedHealthcare Community & State	$123.24
Rate for Payer: Wellpoint Medicaid Managed Care	$110.76

PLATE METATARSAL 4H STRAIGHT

Facility

$3,900.00

Service Code	HCPCS C1713
Hospital Charge Code	270697018
Hospital Revenue Code	278
Min. Negotiated Rate	$585.00
Max. Negotiated Rate	$943.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$780.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$943.80
Rate for Payer: Qualcare PPO/HMO/WC	$585.00

PLATE METATASAL WEDG 2MM LEFT

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270678717
Hospital Revenue Code	278
Min. Negotiated Rate	$596.25
Max. Negotiated Rate	$961.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

PLATE METATASAL WEDG 2MM LEFT

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270678717
Hospital Revenue Code	278
Min. Negotiated Rate	$112.89
Max. Negotiated Rate	$1,987.50
Rate for Payer: Aetna Commercial	$1,510.50
Rate for Payer: Aetna Medicare Advantage	$1,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,013.62
Rate for Payer: Cigna Commercial	$1,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25
Rate for Payer: UnitedHealthcare Community & State	$125.61
Rate for Payer: Wellpoint Medicaid Managed Care	$112.89

PLATE MINI LOCKED LEFT 24x43MM

Facility

$5,720.00

Service Code	HCPCS C1713
Hospital Charge Code	270673610
Hospital Revenue Code	278
Min. Negotiated Rate	$858.00
Max. Negotiated Rate	$1,384.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,144.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,384.24
Rate for Payer: Qualcare PPO/HMO/WC	$858.00

PLATE MINI LOCKED LEFT 24x43MM

Facility

$5,720.00

Service Code	HCPCS C1713
Hospital Charge Code	270673610
Hospital Revenue Code	278
Min. Negotiated Rate	$162.45
Max. Negotiated Rate	$2,860.00
Rate for Payer: Aetna Commercial	$2,173.60
Rate for Payer: Aetna Medicare Advantage	$1,716.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,458.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,458.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,458.60
Rate for Payer: Cigna Commercial	$2,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,384.24
Rate for Payer: Qualcare PPO/HMO/WC	$858.00
Rate for Payer: UnitedHealthcare Community & State	$180.75
Rate for Payer: Wellpoint Medicaid Managed Care	$162.45

PLATE MNTR H/H X-CONN 28MM

Facility

$5,180.00

Service Code	HCPCS C1713
Hospital Charge Code	270663780
Hospital Revenue Code	278
Min. Negotiated Rate	$777.00
Max. Negotiated Rate	$1,253.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,036.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,253.56
Rate for Payer: Qualcare PPO/HMO/WC	$777.00

PLATE MNTR H/H X-CONN 28MM

Facility

$5,180.00

Service Code	HCPCS C1713
Hospital Charge Code	270663780
Hospital Revenue Code	278
Min. Negotiated Rate	$147.11
Max. Negotiated Rate	$2,590.00
Rate for Payer: Aetna Commercial	$1,968.40
Rate for Payer: Aetna Medicare Advantage	$1,554.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,320.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,320.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,036.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,320.90
Rate for Payer: Cigna Commercial	$2,590.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,253.56
Rate for Payer: Qualcare PPO/HMO/WC	$777.00
Rate for Payer: UnitedHealthcare Community & State	$163.69
Rate for Payer: Wellpoint Medicaid Managed Care	$147.11

PLATE MNTR H/H X-CONN 35MM

Facility

$5,180.00

Hospital Charge Code	270663784
Hospital Revenue Code	278
Min. Negotiated Rate	$777.00
Max. Negotiated Rate	$1,253.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,036.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,253.56
Rate for Payer: Qualcare PPO/HMO/WC	$777.00

PLATE MNTR H/H X-CONN 35MM

Facility

$5,180.00

Hospital Charge Code	270663784
Hospital Revenue Code	278
Min. Negotiated Rate	$147.11
Max. Negotiated Rate	$2,590.00
Rate for Payer: Aetna Commercial	$1,968.40
Rate for Payer: Aetna Medicare Advantage	$1,554.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,320.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,320.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,036.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,320.90
Rate for Payer: Cigna Commercial	$2,590.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,253.56
Rate for Payer: Qualcare PPO/HMO/WC	$777.00
Rate for Payer: UnitedHealthcare Community & State	$163.69
Rate for Payer: Wellpoint Medicaid Managed Care	$147.11

PLATE MNTR OC SMALL

Facility

$15,990.00

Service Code	HCPCS C1713
Hospital Charge Code	270677388
Hospital Revenue Code	278
Min. Negotiated Rate	$454.12
Max. Negotiated Rate	$7,995.00
Rate for Payer: Aetna Commercial	$6,076.20
Rate for Payer: Aetna Medicare Advantage	$4,797.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,077.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,077.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,198.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,077.45
Rate for Payer: Cigna Commercial	$7,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,869.58
Rate for Payer: Qualcare PPO/HMO/WC	$2,398.50
Rate for Payer: UnitedHealthcare Community & State	$505.28
Rate for Payer: Wellpoint Medicaid Managed Care	$454.12

PLATE MNTR OC SMALL

Facility

$15,990.00

Service Code	HCPCS C1713
Hospital Charge Code	270677388
Hospital Revenue Code	278
Min. Negotiated Rate	$2,398.50
Max. Negotiated Rate	$3,869.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,198.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,869.58
Rate for Payer: Qualcare PPO/HMO/WC	$2,398.50

PLATE MODULUS XLIF DS 10MM

Facility

$15,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270697064
Hospital Revenue Code	278
Min. Negotiated Rate	$447.30
Max. Negotiated Rate	$7,875.00
Rate for Payer: Aetna Commercial	$5,985.00
Rate for Payer: Aetna Medicare Advantage	$4,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,016.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,016.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,016.25
Rate for Payer: Cigna Commercial	$7,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,811.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,362.50
Rate for Payer: UnitedHealthcare Community & State	$497.70
Rate for Payer: Wellpoint Medicaid Managed Care	$447.30

PLATE MODULUS XLIF DS 10MM

Facility

$15,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270697064
Hospital Revenue Code	278
Min. Negotiated Rate	$2,362.50
Max. Negotiated Rate	$3,811.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,811.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,362.50

PLATEMODULUSXLIFDUALSIDE 8MM

Facility

$15,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270697554
Hospital Revenue Code	278
Min. Negotiated Rate	$447.30
Max. Negotiated Rate	$7,875.00
Rate for Payer: Aetna Commercial	$5,985.00
Rate for Payer: Aetna Medicare Advantage	$4,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,016.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,016.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,016.25
Rate for Payer: Cigna Commercial	$7,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,811.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,362.50
Rate for Payer: UnitedHealthcare Community & State	$497.70
Rate for Payer: Wellpoint Medicaid Managed Care	$447.30

PLATEMODULUSXLIFDUALSIDE 8MM

Facility

$15,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270697554
Hospital Revenue Code	278
Min. Negotiated Rate	$2,362.50
Max. Negotiated Rate	$3,811.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,811.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,362.50

PLATE MODULUS XLIF MOD 12MM

Facility

$15,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695492
Hospital Revenue Code	278
Min. Negotiated Rate	$2,362.50
Max. Negotiated Rate	$3,811.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,811.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,362.50

PLATE MODULUS XLIF MOD 12MM

Facility

$15,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695492
Hospital Revenue Code	278
Min. Negotiated Rate	$447.30
Max. Negotiated Rate	$7,875.00
Rate for Payer: Aetna Commercial	$5,985.00
Rate for Payer: Aetna Medicare Advantage	$4,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,016.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,016.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,016.25
Rate for Payer: Cigna Commercial	$7,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,811.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,362.50
Rate for Payer: UnitedHealthcare Community & State	$497.70
Rate for Payer: Wellpoint Medicaid Managed Care	$447.30

PLATEMONET4HWIDEEXTRA7MM$$N/C

Facility

$9,450.00

Service Code	HCPCS C1713
Hospital Charge Code	270696627
Hospital Revenue Code	278
Min. Negotiated Rate	$268.38
Max. Negotiated Rate	$4,725.00
Rate for Payer: Aetna Commercial	$3,591.00
Rate for Payer: Aetna Medicare Advantage	$2,835.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,409.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,409.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,409.75
Rate for Payer: Cigna Commercial	$4,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,286.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,417.50
Rate for Payer: UnitedHealthcare Community & State	$298.62
Rate for Payer: Wellpoint Medicaid Managed Care	$268.38

PLATEMONET4HWIDEEXTRA7MM$$N/C

Facility

$9,450.00

Service Code	HCPCS C1713
Hospital Charge Code	270696627
Hospital Revenue Code	278
Min. Negotiated Rate	$1,417.50
Max. Negotiated Rate	$2,286.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,890.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,286.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,417.50

PLATE MONEY XWIDE 4H 8MM

Facility

$9,450.00

Service Code	HCPCS C1889
Hospital Charge Code	270697689
Hospital Revenue Code	278
Min. Negotiated Rate	$268.38
Max. Negotiated Rate	$4,725.00
Rate for Payer: Aetna Commercial	$3,591.00
Rate for Payer: Aetna Medicare Advantage	$2,835.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,409.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,409.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,409.75
Rate for Payer: Cigna Commercial	$4,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,286.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,417.50
Rate for Payer: UnitedHealthcare Community & State	$298.62
Rate for Payer: Wellpoint Medicaid Managed Care	$268.38

PLATE MONEY XWIDE 4H 8MM

Facility

$9,450.00

Service Code	HCPCS C1889
Hospital Charge Code	270697689
Hospital Revenue Code	278
Min. Negotiated Rate	$1,417.50
Max. Negotiated Rate	$2,286.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,890.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,286.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,417.50

PLATE MONO PYRENEES 42 MM

Facility

$6,535.00

Service Code	HCPCS C1713
Hospital Charge Code	270698871
Hospital Revenue Code	278
Min. Negotiated Rate	$185.59
Max. Negotiated Rate	$3,267.50
Rate for Payer: Aetna Commercial	$2,483.30
Rate for Payer: Aetna Medicare Advantage	$1,960.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,666.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,666.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,307.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,666.42
Rate for Payer: Cigna Commercial	$3,267.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,581.47
Rate for Payer: Qualcare PPO/HMO/WC	$980.25
Rate for Payer: UnitedHealthcare Community & State	$206.51
Rate for Payer: Wellpoint Medicaid Managed Care	$185.59

Know your out-of-pocket cost for care.

All Charges