Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PLATE ROI C ANCHORING 12 X 14X

Facility

$20,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270691010
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

PLATE ROI C ANCHORING 12 X 14X

Facility

$20,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270691010
Hospital Revenue Code	278
Min. Negotiated Rate	$568.00
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$7,600.00
Rate for Payer: Aetna Medicare Advantage	$6,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,100.00
Rate for Payer: Cigna Commercial	$10,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00
Rate for Payer: UnitedHealthcare Community & State	$632.00
Rate for Payer: Wellpoint Medicaid Managed Care	$568.00

PLATE ROT 2.0MM 5 HOLE

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270689901
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 ROT 2.0MM 5 HOLE

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270689901
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 ROTATION 1.6MM

Facility

$4,094.25

Hospital Charge Code	270703049
Hospital Revenue Code	278
Min. Negotiated Rate	$116.28
Max. Negotiated Rate	$2,047.12
Rate for Payer: Aetna Commercial	$1,555.82
Rate for Payer: Aetna Medicare Advantage	$1,228.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,044.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,044.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$818.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,044.03
Rate for Payer: Cigna Commercial	$2,047.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$990.81
Rate for Payer: Qualcare PPO/HMO/WC	$614.14
Rate for Payer: UnitedHealthcare Community & State	$129.38
Rate for Payer: Wellpoint Medicaid Managed Care	$116.28

PLATE ROTATION 1.6MM

Facility

$4,094.25

Hospital Charge Code	270703049
Hospital Revenue Code	278
Min. Negotiated Rate	$614.14
Max. Negotiated Rate	$990.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$818.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$990.81
Rate for Payer: Qualcare PPO/HMO/WC	$614.14

PLATE RT CLAVICLE W LATERA EXT

Facility

$4,660.05

Service Code	HCPCS C1776
Hospital Charge Code	270689729
Hospital Revenue Code	278
Min. Negotiated Rate	$699.01
Max. Negotiated Rate	$1,127.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$932.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,127.73
Rate for Payer: Qualcare PPO/HMO/WC	$699.01

PLATE RT CLAVICLE W LATERA EXT

Facility

$4,660.05

Service Code	HCPCS C1776
Hospital Charge Code	270689729
Hospital Revenue Code	278
Min. Negotiated Rate	$132.35
Max. Negotiated Rate	$2,330.03
Rate for Payer: Aetna Commercial	$1,770.82
Rate for Payer: Aetna Medicare Advantage	$1,398.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,188.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,188.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$932.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,188.31
Rate for Payer: Cigna Commercial	$2,330.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,127.73
Rate for Payer: Qualcare PPO/HMO/WC	$699.01
Rate for Payer: UnitedHealthcare Community & State	$147.26
Rate for Payer: Wellpoint Medicaid Managed Care	$132.35

PLATES ANGLE 2.4 2.7MM LEFT

Facility

$6,216.10

Service Code	HCPCS C1713
Hospital Charge Code	270693994
Hospital Revenue Code	278
Min. Negotiated Rate	$176.54
Max. Negotiated Rate	$3,108.05
Rate for Payer: Aetna Commercial	$2,362.12
Rate for Payer: Aetna Medicare Advantage	$1,864.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,585.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,585.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,243.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,585.11
Rate for Payer: Cigna Commercial	$3,108.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,504.30
Rate for Payer: Qualcare PPO/HMO/WC	$932.41
Rate for Payer: UnitedHealthcare Community & State	$196.43
Rate for Payer: Wellpoint Medicaid Managed Care	$176.54

PLATES ANGLE 2.4 2.7MM LEFT

Facility

$6,216.10

Service Code	HCPCS C1713
Hospital Charge Code	270693994
Hospital Revenue Code	278
Min. Negotiated Rate	$932.41
Max. Negotiated Rate	$1,504.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,243.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,504.30
Rate for Payer: Qualcare PPO/HMO/WC	$932.41

PLATE SAPPH XCERV SYS 1LEV 9MM

Facility

$8,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270694281
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

PLATE SAPPH XCERV SYS 1LEV 9MM

Facility

$8,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270694281
Hospital Revenue Code	278
Min. Negotiated Rate	$234.30
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Community & State	$260.70
Rate for Payer: Wellpoint Medicaid Managed Care	$234.30

PLATE SCREW 6.5X30MM

Facility

$6,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270697297
Hospital Revenue Code	278
Min. Negotiated Rate	$177.50
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$2,375.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Community & State	$197.50
Rate for Payer: Wellpoint Medicaid Managed Care	$177.50

PLATE SCREW 6.5X30MM

Facility

$6,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270697297
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

PLATE SKY 2 LEVEL TI 18MM

Facility

$6,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270676512
Hospital Revenue Code	278
Min. Negotiated Rate	$177.50
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$2,375.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Community & State	$197.50
Rate for Payer: Wellpoint Medicaid Managed Care	$177.50

PLATE SKY 2 LEVEL TI 18MM

Facility

$6,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270676512
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

PLATE SKY 2 LEVEL TI 20MM

Facility

$6,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270676511
Hospital Revenue Code	278
Min. Negotiated Rate	$177.50
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$2,375.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Community & State	$197.50
Rate for Payer: Wellpoint Medicaid Managed Care	$177.50

PLATE SKY 2 LEVEL TI 20MM

Facility

$6,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270676511
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

PLATE SKY 2 LEVEL TI 30MM

Facility

$6,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270679877
Hospital Revenue Code	278
Min. Negotiated Rate	$177.50
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$2,375.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Community & State	$197.50
Rate for Payer: Wellpoint Medicaid Managed Care	$177.50

PLATE SKY 2 LEVEL TI 30MM

Facility

$6,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270679877
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

PLATE SKY 2 LEVEL TI 38MM

Facility

$6,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270674901
Hospital Revenue Code	278
Min. Negotiated Rate	$191.70
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,565.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Community & State	$213.30
Rate for Payer: Wellpoint Medicaid Managed Care	$191.70

PLATE SKY 2 LEVEL TI 38MM

Facility

$6,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270674901
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

PLATE SKY 3 LEVEL TI 48MM

Facility

$7,250.00

Hospital Charge Code	270668252
Hospital Revenue Code	278
Min. Negotiated Rate	$205.90
Max. Negotiated Rate	$3,625.00
Rate for Payer: Aetna Commercial	$2,755.00
Rate for Payer: Aetna Medicare Advantage	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,848.75
Rate for Payer: Cigna Commercial	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50
Rate for Payer: UnitedHealthcare Community & State	$229.10
Rate for Payer: Wellpoint Medicaid Managed Care	$205.90

PLATE SKY 3 LEVEL TI 48MM

Facility

$7,250.00

Hospital Charge Code	270668252
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$1,754.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

PLATE SKY 3 LEVEL TI 51MM

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270666240
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$1,754.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

Know your out-of-pocket cost for care.

All Charges