Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PLATE TIBIA 6HOLE 123MM LEFT

Facility

$9,671.00

Service Code	HCPCS C1713
Hospital Charge Code	270675653
Hospital Revenue Code	278
Min. Negotiated Rate	$274.66
Max. Negotiated Rate	$4,835.50
Rate for Payer: Aetna Commercial	$3,674.98
Rate for Payer: Aetna Medicare Advantage	$2,901.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,466.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,466.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,934.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,466.11
Rate for Payer: Cigna Commercial	$4,835.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,340.38
Rate for Payer: Qualcare PPO/HMO/WC	$1,450.65
Rate for Payer: UnitedHealthcare Community & State	$305.60
Rate for Payer: Wellpoint Medicaid Managed Care	$274.66

PLATE TIBIAL 3.5LCP 10HOLES

Facility

$6,448.85

Service Code	HCPCS C1713
Hospital Charge Code	270645819
Hospital Revenue Code	278
Min. Negotiated Rate	$967.33
Max. Negotiated Rate	$1,560.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.62
Rate for Payer: Qualcare PPO/HMO/WC	$967.33

PLATE TIBIAL 3.5LCP 10HOLES

Facility

$6,448.85

Service Code	HCPCS C1713
Hospital Charge Code	270645819
Hospital Revenue Code	278
Min. Negotiated Rate	$183.15
Max. Negotiated Rate	$3,224.43
Rate for Payer: Aetna Commercial	$2,450.56
Rate for Payer: Aetna Medicare Advantage	$1,934.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,644.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,644.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,644.46
Rate for Payer: Cigna Commercial	$3,224.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.62
Rate for Payer: Qualcare PPO/HMO/WC	$967.33
Rate for Payer: UnitedHealthcare Community & State	$203.78
Rate for Payer: Wellpoint Medicaid Managed Care	$183.15

PLATE TIBIAL 67 OSS 150420

Facility

$12,480.00

Service Code	HCPCS C1713
Hospital Charge Code	270638563
Hospital Revenue Code	278
Min. Negotiated Rate	$354.43
Max. Negotiated Rate	$6,240.00
Rate for Payer: Aetna Commercial	$4,742.40
Rate for Payer: Aetna Medicare Advantage	$3,744.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,182.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,182.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,496.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,182.40
Rate for Payer: Cigna Commercial	$6,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,020.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,872.00
Rate for Payer: UnitedHealthcare Community & State	$394.37
Rate for Payer: Wellpoint Medicaid Managed Care	$354.43

PLATE TIBIAL 67 OSS 150420

Facility

$12,480.00

Service Code	HCPCS C1713
Hospital Charge Code	270638563
Hospital Revenue Code	278
Min. Negotiated Rate	$1,872.00
Max. Negotiated Rate	$3,020.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,496.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,020.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,872.00

PLATE TIBIAL 75mm CRU T 141234

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270636752
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 TIBIAL 75mm CRU T 141234

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270636752
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 TIBIAL BEARING 12x71/75

Facility

$5,135.00

Service Code	HCPCS C1713
Hospital Charge Code	270638582
Hospital Revenue Code	278
Min. Negotiated Rate	$770.25
Max. Negotiated Rate	$1,242.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,027.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,242.67
Rate for Payer: Qualcare PPO/HMO/WC	$770.25

PLATE TIBIAL BEARING 12x71/75

Facility

$5,135.00

Service Code	HCPCS C1713
Hospital Charge Code	270638582
Hospital Revenue Code	278
Min. Negotiated Rate	$145.83
Max. Negotiated Rate	$2,567.50
Rate for Payer: Aetna Commercial	$1,951.30
Rate for Payer: Aetna Medicare Advantage	$1,540.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,309.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,309.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,027.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,309.42
Rate for Payer: Cigna Commercial	$2,567.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,242.67
Rate for Payer: Qualcare PPO/HMO/WC	$770.25
Rate for Payer: UnitedHealthcare Community & State	$162.27
Rate for Payer: Wellpoint Medicaid Managed Care	$145.83

PLATE TIBIAL CRUCIATE 71mm

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270639680
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 TIBIAL CRUCIATE 71mm

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270639680
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 TIBIA LF 2 HOLE 95MM

Facility

$12,236.15

Service Code	HCPCS C1713
Hospital Charge Code	270699118
Hospital Revenue Code	278
Min. Negotiated Rate	$347.51
Max. Negotiated Rate	$6,118.07
Rate for Payer: Aetna Commercial	$4,649.74
Rate for Payer: Aetna Medicare Advantage	$3,670.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,120.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,120.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,447.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,120.22
Rate for Payer: Cigna Commercial	$6,118.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,961.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,835.42
Rate for Payer: UnitedHealthcare Community & State	$386.66
Rate for Payer: Wellpoint Medicaid Managed Care	$347.51

PLATE TIBIA LF 2 HOLE 95MM

Facility

$12,236.15

Service Code	HCPCS C1713
Hospital Charge Code	270699118
Hospital Revenue Code	278
Min. Negotiated Rate	$1,835.42
Max. Negotiated Rate	$2,961.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,447.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,961.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,835.42

PLATE TIBIAL LCP 3.5 8HOLE LT

Facility

$7,464.00

Hospital Charge Code	270671109
Hospital Revenue Code	278
Min. Negotiated Rate	$211.98
Max. Negotiated Rate	$3,732.00
Rate for Payer: Aetna Commercial	$2,836.32
Rate for Payer: Aetna Medicare Advantage	$2,239.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,903.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,903.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,492.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,903.32
Rate for Payer: Cigna Commercial	$3,732.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,806.29
Rate for Payer: Qualcare PPO/HMO/WC	$1,119.60
Rate for Payer: UnitedHealthcare Community & State	$235.86
Rate for Payer: Wellpoint Medicaid Managed Care	$211.98

PLATE TIBIAL LCP 3.5 8HOLE LT

Facility

$7,464.00

Hospital Charge Code	270671109
Hospital Revenue Code	278
Min. Negotiated Rate	$1,119.60
Max. Negotiated Rate	$1,806.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,492.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,806.29
Rate for Payer: Qualcare PPO/HMO/WC	$1,119.60

PLATE TIBIAL STEMMED 67mm

Facility

$15,430.00

Service Code	HCPCS C1713
Hospital Charge Code	270638752
Hospital Revenue Code	278
Min. Negotiated Rate	$2,314.50
Max. Negotiated Rate	$3,734.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,086.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,734.06
Rate for Payer: Qualcare PPO/HMO/WC	$2,314.50

PLATE TIBIAL STEMMED 67mm

Facility

$15,430.00

Service Code	HCPCS C1713
Hospital Charge Code	270638752
Hospital Revenue Code	278
Min. Negotiated Rate	$438.21
Max. Negotiated Rate	$7,715.00
Rate for Payer: Aetna Commercial	$5,863.40
Rate for Payer: Aetna Medicare Advantage	$4,629.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,934.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,934.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,086.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,934.65
Rate for Payer: Cigna Commercial	$7,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,734.06
Rate for Payer: Qualcare PPO/HMO/WC	$2,314.50
Rate for Payer: UnitedHealthcare Community & State	$487.59
Rate for Payer: Wellpoint Medicaid Managed Care	$438.21

PLATE TIBIAL STEMMED 83mm

Facility

$15,430.00

Hospital Charge Code	270669904
Hospital Revenue Code	278
Min. Negotiated Rate	$438.21
Max. Negotiated Rate	$7,715.00
Rate for Payer: Aetna Commercial	$5,863.40
Rate for Payer: Aetna Medicare Advantage	$4,629.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,934.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,934.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,086.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,934.65
Rate for Payer: Cigna Commercial	$7,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,734.06
Rate for Payer: Qualcare PPO/HMO/WC	$2,314.50
Rate for Payer: UnitedHealthcare Community & State	$487.59
Rate for Payer: Wellpoint Medicaid Managed Care	$438.21

PLATE TIBIAL STEMMED 83mm

Facility

$15,430.00

Hospital Charge Code	270669904
Hospital Revenue Code	278
Min. Negotiated Rate	$2,314.50
Max. Negotiated Rate	$3,734.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,086.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,734.06
Rate for Payer: Qualcare PPO/HMO/WC	$2,314.50

PLATE TIBIA MED DIST SS LT 6H

Facility

$9,425.00

Service Code	HCPCS C1713
Hospital Charge Code	270699402
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 TIBIA MED DIST SS LT 6H

Facility

$9,425.00

Service Code	HCPCS C1713
Hospital Charge Code	270699402
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 TIBIA PROX 3.5x119 6H RT

Facility

$6,489.50

Service Code	HCPCS C1713
Hospital Charge Code	270681562
Hospital Revenue Code	278
Min. Negotiated Rate	$184.30
Max. Negotiated Rate	$3,244.75
Rate for Payer: Aetna Commercial	$2,466.01
Rate for Payer: Aetna Medicare Advantage	$1,946.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,654.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,654.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,297.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,654.82
Rate for Payer: Cigna Commercial	$3,244.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,570.46
Rate for Payer: Qualcare PPO/HMO/WC	$973.42
Rate for Payer: UnitedHealthcare Community & State	$205.07
Rate for Payer: Wellpoint Medicaid Managed Care	$184.30

PLATE TIBIA PROX 3.5x119 6H RT

Facility

$6,489.50

Service Code	HCPCS C1713
Hospital Charge Code	270681562
Hospital Revenue Code	278
Min. Negotiated Rate	$973.42
Max. Negotiated Rate	$1,570.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,297.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,570.46
Rate for Payer: Qualcare PPO/HMO/WC	$973.42

PLATE TIBIA PROX VA-LCP 3.5MM

Facility

$6,912.85

Service Code	HCPCS C1713
Hospital Charge Code	270681178
Hospital Revenue Code	278
Min. Negotiated Rate	$1,036.93
Max. Negotiated Rate	$1,672.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,382.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,672.91
Rate for Payer: Qualcare PPO/HMO/WC	$1,036.93

PLATE TIBIA PROX VA-LCP 3.5MM

Facility

$6,912.85

Service Code	HCPCS C1713
Hospital Charge Code	270681178
Hospital Revenue Code	278
Min. Negotiated Rate	$196.32
Max. Negotiated Rate	$3,456.43
Rate for Payer: Aetna Commercial	$2,626.88
Rate for Payer: Aetna Medicare Advantage	$2,073.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,762.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,762.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,382.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,762.78
Rate for Payer: Cigna Commercial	$3,456.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,672.91
Rate for Payer: Qualcare PPO/HMO/WC	$1,036.93
Rate for Payer: UnitedHealthcare Community & State	$218.45
Rate for Payer: Wellpoint Medicaid Managed Care	$196.32

Know your out-of-pocket cost for care.

All Charges