Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PLATE OLECRANON 10 HOLE SMALL

Facility

$6,050.00

Hospital Charge Code	270701882
Hospital Revenue Code	278
Min. Negotiated Rate	$907.50
Max. Negotiated Rate	$1,464.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,464.10
Rate for Payer: Qualcare PPO/HMO/WC	$907.50

PLATE OLECRANON 10 HOLE SMALL

Facility

$6,050.00

Hospital Charge Code	270701882
Hospital Revenue Code	278
Min. Negotiated Rate	$171.82
Max. Negotiated Rate	$3,025.00
Rate for Payer: Aetna Commercial	$2,299.00
Rate for Payer: Aetna Medicare Advantage	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,542.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,542.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,542.75
Rate for Payer: Cigna Commercial	$3,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,464.10
Rate for Payer: Qualcare PPO/HMO/WC	$907.50
Rate for Payer: UnitedHealthcare Community & State	$191.18
Rate for Payer: Wellpoint Medicaid Managed Care	$171.82

PLATE OLECRANON 13H LARGE

Facility

$6,770.00

Hospital Charge Code	270669272
Hospital Revenue Code	278
Min. Negotiated Rate	$1,015.50
Max. Negotiated Rate	$1,638.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,354.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,638.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,015.50

PLATE OLECRANON 13H LARGE

Facility

$6,770.00

Hospital Charge Code	270669272
Hospital Revenue Code	278
Min. Negotiated Rate	$192.27
Max. Negotiated Rate	$3,385.00
Rate for Payer: Aetna Commercial	$2,572.60
Rate for Payer: Aetna Medicare Advantage	$2,031.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,726.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,726.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,354.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,726.35
Rate for Payer: Cigna Commercial	$3,385.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,638.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,015.50
Rate for Payer: UnitedHealthcare Community & State	$213.93
Rate for Payer: Wellpoint Medicaid Managed Care	$192.27

PLATE OLECRANON 3.5x138 6H RT

Facility

$4,217.85

Service Code	HCPCS C1713
Hospital Charge Code	270641314
Hospital Revenue Code	278
Min. Negotiated Rate	$119.79
Max. Negotiated Rate	$2,108.93
Rate for Payer: Aetna Commercial	$1,602.78
Rate for Payer: Aetna Medicare Advantage	$1,265.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,075.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,075.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$843.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,075.55
Rate for Payer: Cigna Commercial	$2,108.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,020.72
Rate for Payer: Qualcare PPO/HMO/WC	$632.68
Rate for Payer: UnitedHealthcare Community & State	$133.28
Rate for Payer: Wellpoint Medicaid Managed Care	$119.79

PLATE OLECRANON 3.5x138 6H RT

Facility

$4,217.85

Service Code	HCPCS C1713
Hospital Charge Code	270641314
Hospital Revenue Code	278
Min. Negotiated Rate	$632.68
Max. Negotiated Rate	$1,020.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$843.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,020.72
Rate for Payer: Qualcare PPO/HMO/WC	$632.68

PLATE OLECRAN STD 11 HOLE LEFT

Facility

$11,155.00

Service Code	HCPCS C1713
Hospital Charge Code	270697231
Hospital Revenue Code	278
Min. Negotiated Rate	$1,673.25
Max. Negotiated Rate	$2,699.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,231.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,699.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,673.25

PLATE OLECRAN STD 11 HOLE LEFT

Facility

$11,155.00

Service Code	HCPCS C1713
Hospital Charge Code	270697231
Hospital Revenue Code	278
Min. Negotiated Rate	$316.80
Max. Negotiated Rate	$5,577.50
Rate for Payer: Aetna Commercial	$4,238.90
Rate for Payer: Aetna Medicare Advantage	$3,346.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,844.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,844.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,231.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,844.53
Rate for Payer: Cigna Commercial	$5,577.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,699.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,673.25
Rate for Payer: UnitedHealthcare Community & State	$352.50
Rate for Payer: Wellpoint Medicaid Managed Care	$316.80

PLATE ONE-THIRD TU 3HOLE 3.5mm

Facility

$1,081.50

Service Code	HCPCS C1713
Hospital Charge Code	270678636
Hospital Revenue Code	278
Min. Negotiated Rate	$30.71
Max. Negotiated Rate	$540.75
Rate for Payer: Aetna Commercial	$410.97
Rate for Payer: Aetna Medicare Advantage	$324.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$275.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$275.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$216.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$275.78
Rate for Payer: Cigna Commercial	$540.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$261.72
Rate for Payer: Qualcare PPO/HMO/WC	$162.22
Rate for Payer: UnitedHealthcare Community & State	$34.18
Rate for Payer: Wellpoint Medicaid Managed Care	$30.71

PLATE ONE-THIRD TU 3HOLE 3.5mm

Facility

$1,081.50

Service Code	HCPCS C1713
Hospital Charge Code	270678636
Hospital Revenue Code	278
Min. Negotiated Rate	$162.22
Max. Negotiated Rate	$261.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$216.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$261.72
Rate for Payer: Qualcare PPO/HMO/WC	$162.22

PLATE OPENING WEDGE 0 MM

Facility

$6,930.00

Service Code	HCPCS C1713
Hospital Charge Code	270679185
Hospital Revenue Code	278
Min. Negotiated Rate	$1,039.50
Max. Negotiated Rate	$1,677.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,386.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,677.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,039.50

PLATE OPENING WEDGE 0 MM

Facility

$6,930.00

Service Code	HCPCS C1713
Hospital Charge Code	270679185
Hospital Revenue Code	278
Min. Negotiated Rate	$196.81
Max. Negotiated Rate	$3,465.00
Rate for Payer: Aetna Commercial	$2,633.40
Rate for Payer: Aetna Medicare Advantage	$2,079.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,767.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,767.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,767.15
Rate for Payer: Cigna Commercial	$3,465.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,677.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,039.50
Rate for Payer: UnitedHealthcare Community & State	$218.99
Rate for Payer: Wellpoint Medicaid Managed Care	$196.81

PLATE OPENING WEDGE 5MM

Facility

$6,930.00

Service Code	HCPCS C1713
Hospital Charge Code	270663146
Hospital Revenue Code	278
Min. Negotiated Rate	$1,039.50
Max. Negotiated Rate	$1,677.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,386.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,677.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,039.50

PLATE OPENING WEDGE 5MM

Facility

$6,930.00

Service Code	HCPCS C1713
Hospital Charge Code	270663146
Hospital Revenue Code	278
Min. Negotiated Rate	$196.81
Max. Negotiated Rate	$3,465.00
Rate for Payer: Aetna Commercial	$2,633.40
Rate for Payer: Aetna Medicare Advantage	$2,079.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,767.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,767.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,767.15
Rate for Payer: Cigna Commercial	$3,465.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,677.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,039.50
Rate for Payer: UnitedHealthcare Community & State	$218.99
Rate for Payer: Wellpoint Medicaid Managed Care	$196.81

PLATE OPEN WEDGE 3MM

Facility

$8,540.00

Service Code	HCPCS C1713
Hospital Charge Code	270700341
Hospital Revenue Code	278
Min. Negotiated Rate	$1,281.00
Max. Negotiated Rate	$2,066.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,708.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,066.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,281.00

PLATE OPEN WEDGE 3MM

Facility

$8,540.00

Service Code	HCPCS C1713
Hospital Charge Code	270700341
Hospital Revenue Code	278
Min. Negotiated Rate	$242.54
Max. Negotiated Rate	$4,270.00
Rate for Payer: Aetna Commercial	$3,245.20
Rate for Payer: Aetna Medicare Advantage	$2,562.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,177.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,177.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,708.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,177.70
Rate for Payer: Cigna Commercial	$4,270.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,066.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,281.00
Rate for Payer: UnitedHealthcare Community & State	$269.86
Rate for Payer: Wellpoint Medicaid Managed Care	$242.54

PLATE OPEN WEDGE 4.5

Facility

$4,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270679764
Hospital Revenue Code	278
Min. Negotiated Rate	$671.25
Max. Negotiated Rate	$1,082.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: Qualcare PPO/HMO/WC	$671.25

PLATE OPEN WEDGE 4.5

Facility

$4,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270679764
Hospital Revenue Code	278
Min. Negotiated Rate	$127.09
Max. Negotiated Rate	$2,237.50
Rate for Payer: Aetna Commercial	$1,700.50
Rate for Payer: Aetna Medicare Advantage	$1,342.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,141.12
Rate for Payer: Cigna Commercial	$2,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: Qualcare PPO/HMO/WC	$671.25
Rate for Payer: UnitedHealthcare Community & State	$141.41
Rate for Payer: Wellpoint Medicaid Managed Care	$127.09

PLATE OPEN WEDGE 4.5MM LEFT

Facility

$5,680.00

Service Code	HCPCS C1713
Hospital Charge Code	270656537
Hospital Revenue Code	278
Min. Negotiated Rate	$852.00
Max. Negotiated Rate	$1,374.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,136.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,374.56
Rate for Payer: Qualcare PPO/HMO/WC	$852.00

PLATE OPEN WEDGE 4.5MM LEFT

Facility

$5,680.00

Service Code	HCPCS C1713
Hospital Charge Code	270656537
Hospital Revenue Code	278
Min. Negotiated Rate	$161.31
Max. Negotiated Rate	$2,840.00
Rate for Payer: Aetna Commercial	$2,158.40
Rate for Payer: Aetna Medicare Advantage	$1,704.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,448.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,448.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,136.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,448.40
Rate for Payer: Cigna Commercial	$2,840.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,374.56
Rate for Payer: Qualcare PPO/HMO/WC	$852.00
Rate for Payer: UnitedHealthcare Community & State	$179.49
Rate for Payer: Wellpoint Medicaid Managed Care	$161.31

PLATE OPEN WEDGE 4MM LEFT

Facility

$5,680.00

Service Code	HCPCS C1713
Hospital Charge Code	270653100
Hospital Revenue Code	278
Min. Negotiated Rate	$161.31
Max. Negotiated Rate	$2,840.00
Rate for Payer: Aetna Commercial	$2,158.40
Rate for Payer: Aetna Medicare Advantage	$1,704.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,448.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,448.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,136.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,448.40
Rate for Payer: Cigna Commercial	$2,840.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,374.56
Rate for Payer: Qualcare PPO/HMO/WC	$852.00
Rate for Payer: UnitedHealthcare Community & State	$179.49
Rate for Payer: Wellpoint Medicaid Managed Care	$161.31

PLATE OPEN WEDGE 4MM LEFT

Facility

$5,680.00

Service Code	HCPCS C1713
Hospital Charge Code	270653100
Hospital Revenue Code	278
Min. Negotiated Rate	$852.00
Max. Negotiated Rate	$1,374.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,136.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,374.56
Rate for Payer: Qualcare PPO/HMO/WC	$852.00

PLATE OPEN WEDGE 5mm RIGHT

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270679885
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 OPEN WEDGE 5mm RIGHT

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270679885
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 ORTHO 6 CALC SLIDE

Facility

$7,490.00

Hospital Charge Code	270677101
Hospital Revenue Code	278
Min. Negotiated Rate	$1,123.50
Max. Negotiated Rate	$1,812.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,498.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,812.58
Rate for Payer: Qualcare PPO/HMO/WC	$1,123.50

Know your out-of-pocket cost for care.

All Charges