Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PLATE PROX FEMUR 3.4/4.5 12H R

Facility

$16,640.95

Service Code	HCPCS C1713
Hospital Charge Code	270693776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,496.14
Max. Negotiated Rate	$4,027.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,328.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,027.11
Rate for Payer: Qualcare PPO/HMO/WC	$2,496.14

PLATE PROX FEMUR 3.4/4.5 12H R

Facility

$16,640.95

Service Code	HCPCS C1713
Hospital Charge Code	270693776
Hospital Revenue Code	278
Min. Negotiated Rate	$472.60
Max. Negotiated Rate	$8,320.48
Rate for Payer: Aetna Commercial	$6,323.56
Rate for Payer: Aetna Medicare Advantage	$4,992.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,243.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,243.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,328.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,243.44
Rate for Payer: Cigna Commercial	$8,320.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,027.11
Rate for Payer: Qualcare PPO/HMO/WC	$2,496.14
Rate for Payer: UnitedHealthcare Community & State	$525.85
Rate for Payer: Wellpoint Medicaid Managed Care	$472.60

PLATE PROXIMAL HUMERAL 4H9mm L

Facility

$6,865.00

Service Code	HCPCS C1713
Hospital Charge Code	270670779
Hospital Revenue Code	278
Min. Negotiated Rate	$1,029.75
Max. Negotiated Rate	$1,661.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,373.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,661.33
Rate for Payer: Qualcare PPO/HMO/WC	$1,029.75

PLATE PROXIMAL HUMERAL 4H9mm L

Facility

$6,865.00

Service Code	HCPCS C1713
Hospital Charge Code	270670779
Hospital Revenue Code	278
Min. Negotiated Rate	$194.97
Max. Negotiated Rate	$3,432.50
Rate for Payer: Aetna Commercial	$2,608.70
Rate for Payer: Aetna Medicare Advantage	$2,059.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,750.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,750.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,373.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,750.58
Rate for Payer: Cigna Commercial	$3,432.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,661.33
Rate for Payer: Qualcare PPO/HMO/WC	$1,029.75
Rate for Payer: UnitedHealthcare Community & State	$216.93
Rate for Payer: Wellpoint Medicaid Managed Care	$194.97

PLATE PROXIMAL TIBIA MEDIAL 3.

Facility

$6,220.15

Service Code	HCPCS C1713
Hospital Charge Code	270679035
Hospital Revenue Code	278
Min. Negotiated Rate	$933.02
Max. Negotiated Rate	$1,505.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,244.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,505.28
Rate for Payer: Qualcare PPO/HMO/WC	$933.02

PLATE PROXIMAL TIBIA MEDIAL 3.

Facility

$6,220.15

Service Code	HCPCS C1713
Hospital Charge Code	270679035
Hospital Revenue Code	278
Min. Negotiated Rate	$176.65
Max. Negotiated Rate	$3,110.07
Rate for Payer: Aetna Commercial	$2,363.66
Rate for Payer: Aetna Medicare Advantage	$1,866.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,586.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,586.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,244.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,586.14
Rate for Payer: Cigna Commercial	$3,110.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,505.28
Rate for Payer: Qualcare PPO/HMO/WC	$933.02
Rate for Payer: UnitedHealthcare Community & State	$196.56
Rate for Payer: Wellpoint Medicaid Managed Care	$176.65

PLATE PROXIMAL ULNA 108MM RT

Facility

$8,970.00

Service Code	HCPCS C1713
Hospital Charge Code	270698965
Hospital Revenue Code	278
Min. Negotiated Rate	$1,345.50
Max. Negotiated Rate	$2,170.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,794.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,170.74
Rate for Payer: Qualcare PPO/HMO/WC	$1,345.50

PLATE PROXIMAL ULNA 108MM RT

Facility

$8,970.00

Service Code	HCPCS C1713
Hospital Charge Code	270698965
Hospital Revenue Code	278
Min. Negotiated Rate	$254.75
Max. Negotiated Rate	$4,485.00
Rate for Payer: Aetna Commercial	$3,408.60
Rate for Payer: Aetna Medicare Advantage	$2,691.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,287.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,287.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,794.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,287.35
Rate for Payer: Cigna Commercial	$4,485.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,170.74
Rate for Payer: Qualcare PPO/HMO/WC	$1,345.50
Rate for Payer: UnitedHealthcare Community & State	$283.45
Rate for Payer: Wellpoint Medicaid Managed Care	$254.75

PLATE PROX LATERAL 4H 121MM

Facility

$11,785.90

Service Code	HCPCS C1713
Hospital Charge Code	270692171
Hospital Revenue Code	278
Min. Negotiated Rate	$334.72
Max. Negotiated Rate	$5,892.95
Rate for Payer: Aetna Commercial	$4,478.64
Rate for Payer: Aetna Medicare Advantage	$3,535.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,005.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,005.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,357.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,005.40
Rate for Payer: Cigna Commercial	$5,892.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,852.19
Rate for Payer: Qualcare PPO/HMO/WC	$1,767.88
Rate for Payer: UnitedHealthcare Community & State	$372.43
Rate for Payer: Wellpoint Medicaid Managed Care	$334.72

PLATE PROX LATERAL 4H 121MM

Facility

$11,785.90

Service Code	HCPCS C1713
Hospital Charge Code	270692171
Hospital Revenue Code	278
Min. Negotiated Rate	$1,767.88
Max. Negotiated Rate	$2,852.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,357.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,852.19
Rate for Payer: Qualcare PPO/HMO/WC	$1,767.88

PLATE PSLT DHP LAT SUP 3H

Facility

$6,780.70

Service Code	HCPCS C1713
Hospital Charge Code	270693064
Hospital Revenue Code	278
Min. Negotiated Rate	$192.57
Max. Negotiated Rate	$3,390.35
Rate for Payer: Aetna Commercial	$2,576.67
Rate for Payer: Aetna Medicare Advantage	$2,034.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,729.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,729.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,356.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,729.08
Rate for Payer: Cigna Commercial	$3,390.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,640.93
Rate for Payer: Qualcare PPO/HMO/WC	$1,017.11
Rate for Payer: UnitedHealthcare Community & State	$214.27
Rate for Payer: Wellpoint Medicaid Managed Care	$192.57

PLATE PSLT DHP LAT SUP 3H

Facility

$6,780.70

Service Code	HCPCS C1713
Hospital Charge Code	270693064
Hospital Revenue Code	278
Min. Negotiated Rate	$1,017.11
Max. Negotiated Rate	$1,640.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,356.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,640.93
Rate for Payer: Qualcare PPO/HMO/WC	$1,017.11

PLATE PYRENEES LVL 1 18MM

Facility

$6,520.00

Hospital Charge Code	270670285
Hospital Revenue Code	278
Min. Negotiated Rate	$185.17
Max. Negotiated Rate	$3,260.00
Rate for Payer: Aetna Commercial	$2,477.60
Rate for Payer: Aetna Medicare Advantage	$1,956.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,662.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,662.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,304.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,662.60
Rate for Payer: Cigna Commercial	$3,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,577.84
Rate for Payer: Qualcare PPO/HMO/WC	$978.00
Rate for Payer: UnitedHealthcare Community & State	$206.03
Rate for Payer: Wellpoint Medicaid Managed Care	$185.17

PLATE PYRENEES LVL 1 18MM

Facility

$6,520.00

Hospital Charge Code	270670285
Hospital Revenue Code	278
Min. Negotiated Rate	$978.00
Max. Negotiated Rate	$1,577.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,304.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,577.84
Rate for Payer: Qualcare PPO/HMO/WC	$978.00

PLATE PYRENEES LVL 1 20MM

Facility

$6,520.00

Hospital Charge Code	270670286
Hospital Revenue Code	278
Min. Negotiated Rate	$185.17
Max. Negotiated Rate	$3,260.00
Rate for Payer: Aetna Commercial	$2,477.60
Rate for Payer: Aetna Medicare Advantage	$1,956.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,662.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,662.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,304.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,662.60
Rate for Payer: Cigna Commercial	$3,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,577.84
Rate for Payer: Qualcare PPO/HMO/WC	$978.00
Rate for Payer: UnitedHealthcare Community & State	$206.03
Rate for Payer: Wellpoint Medicaid Managed Care	$185.17

PLATE PYRENEES LVL 1 20MM

Facility

$6,520.00

Hospital Charge Code	270670286
Hospital Revenue Code	278
Min. Negotiated Rate	$978.00
Max. Negotiated Rate	$1,577.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,304.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,577.84
Rate for Payer: Qualcare PPO/HMO/WC	$978.00

PLATE PYRENEES LVL 1 22MM

Facility

$6,520.00

Hospital Charge Code	270670287
Hospital Revenue Code	278
Min. Negotiated Rate	$978.00
Max. Negotiated Rate	$1,577.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,304.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,577.84
Rate for Payer: Qualcare PPO/HMO/WC	$978.00

PLATE PYRENEES LVL 1 22MM

Facility

$6,520.00

Hospital Charge Code	270670287
Hospital Revenue Code	278
Min. Negotiated Rate	$185.17
Max. Negotiated Rate	$3,260.00
Rate for Payer: Aetna Commercial	$2,477.60
Rate for Payer: Aetna Medicare Advantage	$1,956.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,662.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,662.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,304.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,662.60
Rate for Payer: Cigna Commercial	$3,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,577.84
Rate for Payer: Qualcare PPO/HMO/WC	$978.00
Rate for Payer: UnitedHealthcare Community & State	$206.03
Rate for Payer: Wellpoint Medicaid Managed Care	$185.17

PLATE PYRENEES LVL 1 24MM

Facility

$6,520.00

Service Code	HCPCS C1713
Hospital Charge Code	270700542
Hospital Revenue Code	278
Min. Negotiated Rate	$185.17
Max. Negotiated Rate	$3,260.00
Rate for Payer: Aetna Commercial	$2,477.60
Rate for Payer: Aetna Medicare Advantage	$1,956.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,662.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,662.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,304.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,662.60
Rate for Payer: Cigna Commercial	$3,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,577.84
Rate for Payer: Qualcare PPO/HMO/WC	$978.00
Rate for Payer: UnitedHealthcare Community & State	$206.03
Rate for Payer: Wellpoint Medicaid Managed Care	$185.17

PLATE PYRENEES LVL 1 24MM

Facility

$6,520.00

Hospital Charge Code	270657248
Hospital Revenue Code	278
Min. Negotiated Rate	$978.00
Max. Negotiated Rate	$1,577.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,304.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,577.84
Rate for Payer: Qualcare PPO/HMO/WC	$978.00

PLATE PYRENEES LVL 1 24MM

Facility

$6,520.00

Service Code	HCPCS C1713
Hospital Charge Code	270700542
Hospital Revenue Code	278
Min. Negotiated Rate	$978.00
Max. Negotiated Rate	$1,577.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,304.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,577.84
Rate for Payer: Qualcare PPO/HMO/WC	$978.00

PLATE PYRENEES LVL 1 24MM

Facility

$6,520.00

Hospital Charge Code	270657248
Hospital Revenue Code	278
Min. Negotiated Rate	$185.17
Max. Negotiated Rate	$3,260.00
Rate for Payer: Aetna Commercial	$2,477.60
Rate for Payer: Aetna Medicare Advantage	$1,956.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,662.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,662.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,304.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,662.60
Rate for Payer: Cigna Commercial	$3,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,577.84
Rate for Payer: Qualcare PPO/HMO/WC	$978.00
Rate for Payer: UnitedHealthcare Community & State	$206.03
Rate for Payer: Wellpoint Medicaid Managed Care	$185.17

PLATE PYRENEES LVL 1 26MM

Facility

$6,520.00

Hospital Charge Code	270670288
Hospital Revenue Code	278
Min. Negotiated Rate	$978.00
Max. Negotiated Rate	$1,577.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,304.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,577.84
Rate for Payer: Qualcare PPO/HMO/WC	$978.00

PLATE PYRENEES LVL 1 26MM

Facility

$6,520.00

Hospital Charge Code	270670288
Hospital Revenue Code	278
Min. Negotiated Rate	$185.17
Max. Negotiated Rate	$3,260.00
Rate for Payer: Aetna Commercial	$2,477.60
Rate for Payer: Aetna Medicare Advantage	$1,956.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,662.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,662.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,304.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,662.60
Rate for Payer: Cigna Commercial	$3,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,577.84
Rate for Payer: Qualcare PPO/HMO/WC	$978.00
Rate for Payer: UnitedHealthcare Community & State	$206.03
Rate for Payer: Wellpoint Medicaid Managed Care	$185.17

PLATE PYRENEES LVL 1 28MM

Facility

$6,520.00

Hospital Charge Code	270670289
Hospital Revenue Code	278
Min. Negotiated Rate	$978.00
Max. Negotiated Rate	$1,577.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,304.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,577.84
Rate for Payer: Qualcare PPO/HMO/WC	$978.00

Know your out-of-pocket cost for care.

All Charges