Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PLATE SLIM 3 LEVEL 52MM

Facility

$19,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270695652
Hospital Revenue Code	278
Min. Negotiated Rate	$2,887.50
Max. Negotiated Rate	$4,658.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,658.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,887.50

PLATE SLIM 3 LEVEL 52MM

Facility

$19,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270695652
Hospital Revenue Code	278
Min. Negotiated Rate	$546.70
Max. Negotiated Rate	$9,625.00
Rate for Payer: Aetna Commercial	$7,315.00
Rate for Payer: Aetna Medicare Advantage	$5,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,908.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,908.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,908.75
Rate for Payer: Cigna Commercial	$9,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,658.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,887.50
Rate for Payer: UnitedHealthcare Community & State	$608.30
Rate for Payer: Wellpoint Medicaid Managed Care	$546.70

PLATE SLIM MEDIAL 15H

Facility

$14,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270698469
Hospital Revenue Code	278
Min. Negotiated Rate	$408.96
Max. Negotiated Rate	$7,200.00
Rate for Payer: Aetna Commercial	$5,472.00
Rate for Payer: Aetna Medicare Advantage	$4,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,672.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,672.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,880.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,672.00
Rate for Payer: Cigna Commercial	$7,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,484.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,160.00
Rate for Payer: UnitedHealthcare Community & State	$455.04
Rate for Payer: Wellpoint Medicaid Managed Care	$408.96

PLATE SLIM MEDIAL 15H

Facility

$14,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270698469
Hospital Revenue Code	278
Min. Negotiated Rate	$2,160.00
Max. Negotiated Rate	$3,484.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,880.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,484.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,160.00

PLATE SMALL MEDAIL

Facility

$4,360.00

Service Code	HCPCS C1713
Hospital Charge Code	270686751
Hospital Revenue Code	278
Min. Negotiated Rate	$654.00
Max. Negotiated Rate	$1,055.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$872.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,055.12
Rate for Payer: Qualcare PPO/HMO/WC	$654.00

PLATE SMALL MEDAIL

Facility

$4,360.00

Service Code	HCPCS C1713
Hospital Charge Code	270686751
Hospital Revenue Code	278
Min. Negotiated Rate	$123.82
Max. Negotiated Rate	$2,180.00
Rate for Payer: Aetna Commercial	$1,656.80
Rate for Payer: Aetna Medicare Advantage	$1,308.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,111.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,111.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$872.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,111.80
Rate for Payer: Cigna Commercial	$2,180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,055.12
Rate for Payer: Qualcare PPO/HMO/WC	$654.00
Rate for Payer: UnitedHealthcare Community & State	$137.78
Rate for Payer: Wellpoint Medicaid Managed Care	$123.82

PLATE SMALL RT 3.5X4.5

Facility

$12,751.20

Service Code	HCPCS C1713
Hospital Charge Code	270693767
Hospital Revenue Code	278
Min. Negotiated Rate	$1,912.68
Max. Negotiated Rate	$3,085.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,550.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,085.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.68

PLATE SMALL RT 3.5X4.5

Facility

$12,751.20

Service Code	HCPCS C1713
Hospital Charge Code	270693767
Hospital Revenue Code	278
Min. Negotiated Rate	$362.13
Max. Negotiated Rate	$6,375.60
Rate for Payer: Aetna Commercial	$4,845.46
Rate for Payer: Aetna Medicare Advantage	$3,825.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,251.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,251.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,550.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,251.56
Rate for Payer: Cigna Commercial	$6,375.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,085.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.68
Rate for Payer: UnitedHealthcare Community & State	$402.94
Rate for Payer: Wellpoint Medicaid Managed Care	$362.13

PLATE SPINAL FIXAT 2LEVEL 34MM

Facility

$17,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270694320
Hospital Revenue Code	278
Min. Negotiated Rate	$2,587.50
Max. Negotiated Rate	$4,174.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,174.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,587.50

PLATE SPINAL FIXAT 2LEVEL 34MM

Facility

$17,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270694320
Hospital Revenue Code	278
Min. Negotiated Rate	$489.90
Max. Negotiated Rate	$8,625.00
Rate for Payer: Aetna Commercial	$6,555.00
Rate for Payer: Aetna Medicare Advantage	$5,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,398.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,398.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,398.75
Rate for Payer: Cigna Commercial	$8,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,174.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,587.50
Rate for Payer: UnitedHealthcare Community & State	$545.10
Rate for Payer: Wellpoint Medicaid Managed Care	$489.90

PLATE STANDARD 4 HOLE RIGHT

Facility

$4,475.00

Hospital Charge Code	270664369
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 STANDARD 4 HOLE RIGHT

Facility

$4,475.00

Hospital Charge Code	270664369
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 STANDARD LARGE

Facility

$5,287.75

Service Code	HCPCS C1713
Hospital Charge Code	270693998
Hospital Revenue Code	278
Min. Negotiated Rate	$150.17
Max. Negotiated Rate	$2,643.88
Rate for Payer: Aetna Commercial	$2,009.35
Rate for Payer: Aetna Medicare Advantage	$1,586.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,348.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,348.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,057.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,348.38
Rate for Payer: Cigna Commercial	$2,643.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,279.64
Rate for Payer: Qualcare PPO/HMO/WC	$793.16
Rate for Payer: UnitedHealthcare Community & State	$167.09
Rate for Payer: Wellpoint Medicaid Managed Care	$150.17

PLATE STANDARD LARGE

Facility

$5,287.75

Service Code	HCPCS C1713
Hospital Charge Code	270693998
Hospital Revenue Code	278
Min. Negotiated Rate	$793.16
Max. Negotiated Rate	$1,279.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,057.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,279.64
Rate for Payer: Qualcare PPO/HMO/WC	$793.16

PLATE START TIBIAL 2.5/ 3.5 MM

Facility

$16,600.00

Service Code	HCPCS C1713
Hospital Charge Code	270687281
Hospital Revenue Code	278
Min. Negotiated Rate	$2,490.00
Max. Negotiated Rate	$4,017.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,017.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,490.00

PLATE START TIBIAL 2.5/ 3.5 MM

Facility

$16,600.00

Service Code	HCPCS C1713
Hospital Charge Code	270687281
Hospital Revenue Code	278
Min. Negotiated Rate	$471.44
Max. Negotiated Rate	$8,300.00
Rate for Payer: Aetna Commercial	$6,308.00
Rate for Payer: Aetna Medicare Advantage	$4,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,233.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,233.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,233.00
Rate for Payer: Cigna Commercial	$8,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,017.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,490.00
Rate for Payer: UnitedHealthcare Community & State	$524.56
Rate for Payer: Wellpoint Medicaid Managed Care	$471.44

PLATE STR 1.6MM 10 HOLE

Facility

$4,094.25

Hospital Charge Code	270703048
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 STR 1.6MM 10 HOLE

Facility

$4,094.25

Hospital Charge Code	270703048
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 STR 1.6 MM 6 HOLE

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270689947
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 STR 1.6 MM 6 HOLE

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270689947
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 STR 2.0 MM 6 HOLE REIN

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270689950
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 STR 2.0 MM 6 HOLE REIN

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270689950
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 STR 2.0x17MM 3HOLE

Facility

$241.90

Service Code	HCPCS C1713
Hospital Charge Code	270651723
Hospital Revenue Code	278
Min. Negotiated Rate	$36.28
Max. Negotiated Rate	$58.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.54
Rate for Payer: Qualcare PPO/HMO/WC	$36.28

PLATE STR 2.0x17MM 3HOLE

Facility

$241.90

Service Code	HCPCS C1713
Hospital Charge Code	270651723
Hospital Revenue Code	278
Min. Negotiated Rate	$6.87
Max. Negotiated Rate	$120.95
Rate for Payer: Aetna Commercial	$91.92
Rate for Payer: Aetna Medicare Advantage	$72.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.68
Rate for Payer: Cigna Commercial	$120.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.54
Rate for Payer: Qualcare PPO/HMO/WC	$36.28
Rate for Payer: UnitedHealthcare Community & State	$7.64
Rate for Payer: Wellpoint Medicaid Managed Care	$6.87

PLATE STR 2.0x23MM 4HOLE

Facility

$258.00

Service Code	HCPCS C1713
Hospital Charge Code	270604328
Hospital Revenue Code	278
Min. Negotiated Rate	$7.33
Max. Negotiated Rate	$129.00
Rate for Payer: Aetna Commercial	$98.04
Rate for Payer: Aetna Medicare Advantage	$77.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.79
Rate for Payer: Cigna Commercial	$129.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.44
Rate for Payer: Qualcare PPO/HMO/WC	$38.70
Rate for Payer: UnitedHealthcare Community & State	$8.15
Rate for Payer: Wellpoint Medicaid Managed Care	$7.33

Know your out-of-pocket cost for care.

All Charges