Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PLATE WAISTED COMPR 8H 4x110MM

Facility

$1,315.00

Service Code	HCPCS C1713
Hospital Charge Code	270664730
Hospital Revenue Code	278
Min. Negotiated Rate	$197.25
Max. Negotiated Rate	$318.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$263.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$318.23
Rate for Payer: Qualcare PPO/HMO/WC	$197.25

PLATE WAISTED COMPR 8H 4x110MM

Facility

$1,315.00

Service Code	HCPCS C1713
Hospital Charge Code	270664730
Hospital Revenue Code	278
Min. Negotiated Rate	$37.35
Max. Negotiated Rate	$657.50
Rate for Payer: Aetna Commercial	$499.70
Rate for Payer: Aetna Medicare Advantage	$394.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$335.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$335.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$263.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$335.32
Rate for Payer: Cigna Commercial	$657.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$318.23
Rate for Payer: Qualcare PPO/HMO/WC	$197.25
Rate for Payer: UnitedHealthcare Community & State	$41.55
Rate for Payer: Wellpoint Medicaid Managed Care	$37.35

PLATE WAISTED NRW 2H 187MM

Facility

$1,485.00

Hospital Charge Code	270673797
Hospital Revenue Code	278
Min. Negotiated Rate	$222.75
Max. Negotiated Rate	$359.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$297.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$359.37
Rate for Payer: Qualcare PPO/HMO/WC	$222.75

PLATE WAISTED NRW 2H 187MM

Facility

$1,485.00

Hospital Charge Code	270673797
Hospital Revenue Code	278
Min. Negotiated Rate	$42.17
Max. Negotiated Rate	$742.50
Rate for Payer: Aetna Commercial	$564.30
Rate for Payer: Aetna Medicare Advantage	$445.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$378.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$378.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$297.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$378.68
Rate for Payer: Cigna Commercial	$742.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$359.37
Rate for Payer: Qualcare PPO/HMO/WC	$222.75
Rate for Payer: UnitedHealthcare Community & State	$46.93
Rate for Payer: Wellpoint Medicaid Managed Care	$42.17

PLATE WEDGE BASE OPEN 4MM

Facility

$4,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270677039
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 WEDGE BASE OPEN 4MM

Facility

$4,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270677039
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 WIDE LOCKED 28x56mm

Facility

$5,720.00

Service Code	HCPCS C1713
Hospital Charge Code	270672339
Hospital Revenue Code	278
Min. Negotiated Rate	$162.45
Max. Negotiated Rate	$2,860.00
Rate for Payer: Aetna Commercial	$2,173.60
Rate for Payer: Aetna Medicare Advantage	$1,716.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,458.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,458.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,458.60
Rate for Payer: Cigna Commercial	$2,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,384.24
Rate for Payer: Qualcare PPO/HMO/WC	$858.00
Rate for Payer: UnitedHealthcare Community & State	$180.75
Rate for Payer: Wellpoint Medicaid Managed Care	$162.45

PLATE WIDE LOCKED 28x56mm

Facility

$5,720.00

Service Code	HCPCS C1713
Hospital Charge Code	270672339
Hospital Revenue Code	278
Min. Negotiated Rate	$858.00
Max. Negotiated Rate	$1,384.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,144.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,384.24
Rate for Payer: Qualcare PPO/HMO/WC	$858.00

PLATE WIDE LOCKED RT 28x56MM

Facility

$4,575.00

Service Code	HCPCS C1713
Hospital Charge Code	270673691
Hospital Revenue Code	278
Min. Negotiated Rate	$129.93
Max. Negotiated Rate	$2,287.50
Rate for Payer: Aetna Commercial	$1,738.50
Rate for Payer: Aetna Medicare Advantage	$1,372.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,166.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,166.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$915.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,166.62
Rate for Payer: Cigna Commercial	$2,287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,107.15
Rate for Payer: Qualcare PPO/HMO/WC	$686.25
Rate for Payer: UnitedHealthcare Community & State	$144.57
Rate for Payer: Wellpoint Medicaid Managed Care	$129.93

PLATE WIDE LOCKED RT 28x56MM

Facility

$4,575.00

Service Code	HCPCS C1713
Hospital Charge Code	270673691
Hospital Revenue Code	278
Min. Negotiated Rate	$686.25
Max. Negotiated Rate	$1,107.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$915.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,107.15
Rate for Payer: Qualcare PPO/HMO/WC	$686.25

PLATE WITH BAR STRAIGHT 4 HOLE

Facility

$2,500.00

Hospital Charge Code	270669466
Hospital Revenue Code	278
Min. Negotiated Rate	$71.00
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$950.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Community & State	$79.00
Rate for Payer: Wellpoint Medicaid Managed Care	$71.00

PLATE WITH BAR STRAIGHT 4 HOLE

Facility

$2,500.00

Hospital Charge Code	270669466
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

PLATE X LORDTIR

Facility

$13,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270688431
Hospital Revenue Code	278
Min. Negotiated Rate	$1,987.50
Max. Negotiated Rate	$3,206.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,206.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,987.50

PLATE X LORDTIR

Facility

$13,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270688431
Hospital Revenue Code	278
Min. Negotiated Rate	$376.30
Max. Negotiated Rate	$6,625.00
Rate for Payer: Aetna Commercial	$5,035.00
Rate for Payer: Aetna Medicare Advantage	$3,975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,378.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,378.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,378.75
Rate for Payer: Cigna Commercial	$6,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,206.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,987.50
Rate for Payer: UnitedHealthcare Community & State	$418.70
Rate for Payer: Wellpoint Medicaid Managed Care	$376.30

PLATE X MED TI 3.0MM

Facility

$4,285.50

Service Code	HCPCS C1713
Hospital Charge Code	270698367
Hospital Revenue Code	278
Min. Negotiated Rate	$121.71
Max. Negotiated Rate	$2,142.75
Rate for Payer: Aetna Commercial	$1,628.49
Rate for Payer: Aetna Medicare Advantage	$1,285.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,092.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,092.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$857.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,092.80
Rate for Payer: Cigna Commercial	$2,142.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,037.09
Rate for Payer: Qualcare PPO/HMO/WC	$642.83
Rate for Payer: UnitedHealthcare Community & State	$135.42
Rate for Payer: Wellpoint Medicaid Managed Care	$121.71

PLATE X MED TI 3.0MM

Facility

$4,285.50

Service Code	HCPCS C1713
Hospital Charge Code	270698367
Hospital Revenue Code	278
Min. Negotiated Rate	$642.83
Max. Negotiated Rate	$1,037.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$857.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,037.09
Rate for Payer: Qualcare PPO/HMO/WC	$642.83

PLATE Y LONG 5HOLE

Facility

$1,680.00

Hospital Charge Code	270677109
Hospital Revenue Code	278
Min. Negotiated Rate	$47.71
Max. Negotiated Rate	$840.00
Rate for Payer: Aetna Commercial	$638.40
Rate for Payer: Aetna Medicare Advantage	$504.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$428.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$428.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$336.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$428.40
Rate for Payer: Cigna Commercial	$840.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$406.56
Rate for Payer: Qualcare PPO/HMO/WC	$252.00
Rate for Payer: UnitedHealthcare Community & State	$53.09
Rate for Payer: Wellpoint Medicaid Managed Care	$47.71

PLATE Y LONG 5HOLE

Facility

$1,680.00

Hospital Charge Code	270677109
Hospital Revenue Code	278
Min. Negotiated Rate	$252.00
Max. Negotiated Rate	$406.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$336.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$406.56
Rate for Payer: Qualcare PPO/HMO/WC	$252.00

PLATE Y LONG DBL 6HOLE

Facility

$1,700.00

Hospital Charge Code	270677108
Hospital Revenue Code	278
Min. Negotiated Rate	$48.28
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$646.00
Rate for Payer: Aetna Medicare Advantage	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$340.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$433.50
Rate for Payer: Cigna Commercial	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$411.40
Rate for Payer: Qualcare PPO/HMO/WC	$255.00
Rate for Payer: UnitedHealthcare Community & State	$53.72
Rate for Payer: Wellpoint Medicaid Managed Care	$48.28

PLATE Y LONG DBL 6HOLE

Facility

$1,700.00

Hospital Charge Code	270677108
Hospital Revenue Code	278
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$411.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$411.40
Rate for Payer: Qualcare PPO/HMO/WC	$255.00

PLATE ZAVATION 2MM

Facility

$13,000.00

Hospital Charge Code	270675884
Hospital Revenue Code	278
Min. Negotiated Rate	$369.20
Max. Negotiated Rate	$6,500.00
Rate for Payer: Aetna Commercial	$4,940.00
Rate for Payer: Aetna Medicare Advantage	$3,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,315.00
Rate for Payer: Cigna Commercial	$6,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,146.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,950.00
Rate for Payer: UnitedHealthcare Community & State	$410.80
Rate for Payer: Wellpoint Medicaid Managed Care	$369.20

PLATE ZAVATION 2MM

Facility

$13,000.00

Hospital Charge Code	270675884
Hospital Revenue Code	278
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$3,146.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,146.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,950.00

PLATE ZAVATION CERV 2LEVEL26MM

Facility

$17,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270698829
Hospital Revenue Code	278
Min. Negotiated Rate	$497.00
Max. Negotiated Rate	$8,750.00
Rate for Payer: Aetna Commercial	$6,650.00
Rate for Payer: Aetna Medicare Advantage	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,462.50
Rate for Payer: Cigna Commercial	$8,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00
Rate for Payer: UnitedHealthcare Community & State	$553.00
Rate for Payer: Wellpoint Medicaid Managed Care	$497.00

PLATE ZAVATION CERV 2LEVEL26MM

Facility

$17,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270698829
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$4,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

PLATE ZEVO 35MM 2 LVL

Facility

$12,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270698646
Hospital Revenue Code	278
Min. Negotiated Rate	$355.00
Max. Negotiated Rate	$6,250.00
Rate for Payer: Aetna Commercial	$4,750.00
Rate for Payer: Aetna Medicare Advantage	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,187.50
Rate for Payer: Cigna Commercial	$6,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.00
Rate for Payer: UnitedHealthcare Community & State	$395.00
Rate for Payer: Wellpoint Medicaid Managed Care	$355.00

Know your out-of-pocket cost for care.

All Charges