Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PLATE MONO PYRENEES 42 MM

Facility

$6,535.00

Service Code	HCPCS C1713
Hospital Charge Code	270698871
Hospital Revenue Code	278
Min. Negotiated Rate	$980.25
Max. Negotiated Rate	$1,581.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,307.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,581.47
Rate for Payer: Qualcare PPO/HMO/WC	$980.25

PLATE MPJ 1ST 7D SMALL RIGHT

Facility

$9,155.00

Service Code	HCPCS C1713
Hospital Charge Code	270694684
Hospital Revenue Code	278
Min. Negotiated Rate	$260.00
Max. Negotiated Rate	$4,577.50
Rate for Payer: Aetna Commercial	$3,478.90
Rate for Payer: Aetna Medicare Advantage	$2,746.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,334.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,334.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,831.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,334.53
Rate for Payer: Cigna Commercial	$4,577.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,215.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,373.25
Rate for Payer: UnitedHealthcare Community & State	$289.30
Rate for Payer: Wellpoint Medicaid Managed Care	$260.00

PLATE MPJ 1ST 7D SMALL RIGHT

Facility

$9,155.00

Service Code	HCPCS C1713
Hospital Charge Code	270694684
Hospital Revenue Code	278
Min. Negotiated Rate	$1,373.25
Max. Negotiated Rate	$2,215.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,831.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,215.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,373.25

PLATE MPJ SMALL LT 0DEG

Facility

$9,425.00

Service Code	HCPCS C1713
Hospital Charge Code	270693322
Hospital Revenue Code	278
Min. Negotiated Rate	$267.67
Max. Negotiated Rate	$4,712.50
Rate for Payer: Aetna Commercial	$3,581.50
Rate for Payer: Aetna Medicare Advantage	$2,827.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,403.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,403.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,885.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,403.38
Rate for Payer: Cigna Commercial	$4,712.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,280.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,413.75
Rate for Payer: UnitedHealthcare Community & State	$297.83
Rate for Payer: Wellpoint Medicaid Managed Care	$267.67

PLATE MPJ SMALL LT 0DEG

Facility

$9,425.00

Service Code	HCPCS C1713
Hospital Charge Code	270693322
Hospital Revenue Code	278
Min. Negotiated Rate	$1,413.75
Max. Negotiated Rate	$2,280.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,885.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,280.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,413.75

PLATE MTP 5 DEG MED LT

Facility

$6,503.75

Service Code	HCPCS C1713
Hospital Charge Code	270701184
Hospital Revenue Code	278
Min. Negotiated Rate	$975.56
Max. Negotiated Rate	$1,573.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.91
Rate for Payer: Qualcare PPO/HMO/WC	$975.56

PLATE MTP 5 DEG MED LT

Facility

$6,503.75

Service Code	HCPCS C1713
Hospital Charge Code	270701184
Hospital Revenue Code	278
Min. Negotiated Rate	$184.71
Max. Negotiated Rate	$3,251.88
Rate for Payer: Aetna Commercial	$2,471.43
Rate for Payer: Aetna Medicare Advantage	$1,951.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,658.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,658.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,658.46
Rate for Payer: Cigna Commercial	$3,251.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.91
Rate for Payer: Qualcare PPO/HMO/WC	$975.56
Rate for Payer: UnitedHealthcare Community & State	$205.52
Rate for Payer: Wellpoint Medicaid Managed Care	$184.71

PLATE MTP CP, RIGHT

Facility

$10,270.00

Hospital Charge Code	270667537
Hospital Revenue Code	278
Min. Negotiated Rate	$291.67
Max. Negotiated Rate	$5,135.00
Rate for Payer: Aetna Commercial	$3,902.60
Rate for Payer: Aetna Medicare Advantage	$3,081.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,618.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,618.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,054.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,618.85
Rate for Payer: Cigna Commercial	$5,135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,485.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,540.50
Rate for Payer: UnitedHealthcare Community & State	$324.53
Rate for Payer: Wellpoint Medicaid Managed Care	$291.67

PLATE MTP CP, RIGHT

Facility

$10,270.00

Hospital Charge Code	270667537
Hospital Revenue Code	278
Min. Negotiated Rate	$1,540.50
Max. Negotiated Rate	$2,485.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,054.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,485.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,540.50

PLATE MTP FUSION 10 MM

Facility

$5,465.20

Service Code	HCPCS C1713
Hospital Charge Code	270689910
Hospital Revenue Code	278
Min. Negotiated Rate	$155.21
Max. Negotiated Rate	$2,732.60
Rate for Payer: Aetna Commercial	$2,076.78
Rate for Payer: Aetna Medicare Advantage	$1,639.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,393.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,393.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,093.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,393.63
Rate for Payer: Cigna Commercial	$2,732.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,322.58
Rate for Payer: Qualcare PPO/HMO/WC	$819.78
Rate for Payer: UnitedHealthcare Community & State	$172.70
Rate for Payer: Wellpoint Medicaid Managed Care	$155.21

PLATE MTP FUSION 10 MM

Facility

$5,465.20

Service Code	HCPCS C1713
Hospital Charge Code	270689910
Hospital Revenue Code	278
Min. Negotiated Rate	$819.78
Max. Negotiated Rate	$1,322.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,093.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,322.58
Rate for Payer: Qualcare PPO/HMO/WC	$819.78

PLATE MTP FUSION LG/5 DEG/LEFT

Facility

$4,839.00

Service Code	HCPCS C1713
Hospital Charge Code	270676586
Hospital Revenue Code	278
Min. Negotiated Rate	$137.43
Max. Negotiated Rate	$2,419.50
Rate for Payer: Aetna Commercial	$1,838.82
Rate for Payer: Aetna Medicare Advantage	$1,451.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,233.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,233.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$967.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,233.94
Rate for Payer: Cigna Commercial	$2,419.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,171.04
Rate for Payer: Qualcare PPO/HMO/WC	$725.85
Rate for Payer: UnitedHealthcare Community & State	$152.91
Rate for Payer: Wellpoint Medicaid Managed Care	$137.43

PLATE MTP FUSION LG/5 DEG/LEFT

Facility

$4,839.00

Service Code	HCPCS C1713
Hospital Charge Code	270676586
Hospital Revenue Code	278
Min. Negotiated Rate	$725.85
Max. Negotiated Rate	$1,171.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$967.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,171.04
Rate for Payer: Qualcare PPO/HMO/WC	$725.85

PLATE MTP FUSION RIGHT

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270682558
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

PLATE MTP FUSION RIGHT

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270682558
Hospital Revenue Code	278
Min. Negotiated Rate	$113.60
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$126.40
Rate for Payer: Wellpoint Medicaid Managed Care	$113.60

PLATE MTP FUSION SM/0 DEG/LT S

Facility

$4,281.00

Service Code	HCPCS C1713
Hospital Charge Code	270675950
Hospital Revenue Code	278
Min. Negotiated Rate	$121.58
Max. Negotiated Rate	$2,140.50
Rate for Payer: Aetna Commercial	$1,626.78
Rate for Payer: Aetna Medicare Advantage	$1,284.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,091.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,091.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$856.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,091.65
Rate for Payer: Cigna Commercial	$2,140.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.00
Rate for Payer: Qualcare PPO/HMO/WC	$642.15
Rate for Payer: UnitedHealthcare Community & State	$135.28
Rate for Payer: Wellpoint Medicaid Managed Care	$121.58

PLATE MTP FUSION SM/0 DEG/LT S

Facility

$4,281.00

Service Code	HCPCS C1713
Hospital Charge Code	270675950
Hospital Revenue Code	278
Min. Negotiated Rate	$642.15
Max. Negotiated Rate	$1,036.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$856.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.00
Rate for Payer: Qualcare PPO/HMO/WC	$642.15

PLATE MTP FUSN 2.4/2.7 10DEG L

Facility

$4,281.00

Hospital Charge Code	270677392
Hospital Revenue Code	278
Min. Negotiated Rate	$121.58
Max. Negotiated Rate	$2,140.50
Rate for Payer: Aetna Commercial	$1,626.78
Rate for Payer: Aetna Medicare Advantage	$1,284.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,091.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,091.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$856.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,091.65
Rate for Payer: Cigna Commercial	$2,140.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.00
Rate for Payer: Qualcare PPO/HMO/WC	$642.15
Rate for Payer: UnitedHealthcare Community & State	$135.28
Rate for Payer: Wellpoint Medicaid Managed Care	$121.58

PLATE MTP FUSN 2.4/2.7 10DEG L

Facility

$4,281.00

Hospital Charge Code	270677392
Hospital Revenue Code	278
Min. Negotiated Rate	$642.15
Max. Negotiated Rate	$1,036.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$856.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.00
Rate for Payer: Qualcare PPO/HMO/WC	$642.15

PLATE MTP FUSN2.4/2.7 10DEG LT

Facility

$4,409.45

Service Code	HCPCS C1713
Hospital Charge Code	270679799
Hospital Revenue Code	278
Min. Negotiated Rate	$661.42
Max. Negotiated Rate	$1,067.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$881.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,067.09
Rate for Payer: Qualcare PPO/HMO/WC	$661.42

PLATE MTP FUSN2.4/2.7 10DEG LT

Facility

$4,409.45

Service Code	HCPCS C1713
Hospital Charge Code	270679799
Hospital Revenue Code	278
Min. Negotiated Rate	$125.23
Max. Negotiated Rate	$2,204.72
Rate for Payer: Aetna Commercial	$1,675.59
Rate for Payer: Aetna Medicare Advantage	$1,322.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,124.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,124.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$881.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,124.41
Rate for Payer: Cigna Commercial	$2,204.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,067.09
Rate for Payer: Qualcare PPO/HMO/WC	$661.42
Rate for Payer: UnitedHealthcare Community & State	$139.34
Rate for Payer: Wellpoint Medicaid Managed Care	$125.23

PLATE MTP FUSN 2.4/2.7 5DEG LT

Facility

$4,409.45

Service Code	HCPCS C1713
Hospital Charge Code	270679798
Hospital Revenue Code	278
Min. Negotiated Rate	$125.23
Max. Negotiated Rate	$2,204.72
Rate for Payer: Aetna Commercial	$1,675.59
Rate for Payer: Aetna Medicare Advantage	$1,322.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,124.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,124.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$881.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,124.41
Rate for Payer: Cigna Commercial	$2,204.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,067.09
Rate for Payer: Qualcare PPO/HMO/WC	$661.42
Rate for Payer: UnitedHealthcare Community & State	$139.34
Rate for Payer: Wellpoint Medicaid Managed Care	$125.23

PLATE MTP FUSN 2.4/2.7 5DEG LT

Facility

$4,409.45

Service Code	HCPCS C1713
Hospital Charge Code	270679798
Hospital Revenue Code	278
Min. Negotiated Rate	$661.42
Max. Negotiated Rate	$1,067.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$881.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,067.09
Rate for Payer: Qualcare PPO/HMO/WC	$661.42

PLATE MTP FUSN 2.4/2.7 LG

Facility

$4,328.45

Service Code	HCPCS C1713
Hospital Charge Code	270680180
Hospital Revenue Code	278
Min. Negotiated Rate	$649.27
Max. Negotiated Rate	$1,047.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$865.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,047.48
Rate for Payer: Qualcare PPO/HMO/WC	$649.27

PLATE MTP FUSN 2.4/2.7 LG

Facility

$4,328.45

Service Code	HCPCS C1713
Hospital Charge Code	270680180
Hospital Revenue Code	278
Min. Negotiated Rate	$122.93
Max. Negotiated Rate	$2,164.22
Rate for Payer: Aetna Commercial	$1,644.81
Rate for Payer: Aetna Medicare Advantage	$1,298.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$865.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,103.75
Rate for Payer: Cigna Commercial	$2,164.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,047.48
Rate for Payer: Qualcare PPO/HMO/WC	$649.27
Rate for Payer: UnitedHealthcare Community & State	$136.78
Rate for Payer: Wellpoint Medicaid Managed Care	$122.93

Know your out-of-pocket cost for care.

All Charges