Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PLATE ZEVO 35MM 2 LVL

Facility

$12,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270698646
Hospital Revenue Code	278
Min. Negotiated Rate	$1,875.00
Max. Negotiated Rate	$3,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.00

PLATE ZEVO 39MM 2 LVL

Facility

$11,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270698146
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.50
Max. Negotiated Rate	$2,722.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50

PLATE ZEVO 39MM 2 LVL

Facility

$11,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270698146
Hospital Revenue Code	278
Min. Negotiated Rate	$319.50
Max. Negotiated Rate	$5,625.00
Rate for Payer: Aetna Commercial	$4,275.00
Rate for Payer: Aetna Medicare Advantage	$3,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,868.75
Rate for Payer: Cigna Commercial	$5,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50
Rate for Payer: UnitedHealthcare Community & State	$355.50
Rate for Payer: Wellpoint Medicaid Managed Care	$319.50

PLATE ZEVO 3 LEVEL 57MM

Facility

$11,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270697834
Hospital Revenue Code	278
Min. Negotiated Rate	$319.50
Max. Negotiated Rate	$5,625.00
Rate for Payer: Aetna Commercial	$4,275.00
Rate for Payer: Aetna Medicare Advantage	$3,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,868.75
Rate for Payer: Cigna Commercial	$5,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50
Rate for Payer: UnitedHealthcare Community & State	$355.50
Rate for Payer: Wellpoint Medicaid Managed Care	$319.50

PLATE ZEVO 3 LEVEL 57MM

Facility

$11,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270697834
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.50
Max. Negotiated Rate	$2,722.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50

PLATE ZEVO 78MM 4 LEVEL

Facility

$12,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270697821
Hospital Revenue Code	278
Min. Negotiated Rate	$1,912.50
Max. Negotiated Rate	$3,085.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,085.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.50

PLATE ZEVO 78MM 4 LEVEL

Facility

$12,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270697821
Hospital Revenue Code	278
Min. Negotiated Rate	$362.10
Max. Negotiated Rate	$6,375.00
Rate for Payer: Aetna Commercial	$4,845.00
Rate for Payer: Aetna Medicare Advantage	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,251.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,251.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,251.25
Rate for Payer: Cigna Commercial	$6,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,085.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.50
Rate for Payer: UnitedHealthcare Community & State	$402.90
Rate for Payer: Wellpoint Medicaid Managed Care	$362.10

PLATE ZEVO ANT CERV LEV3 53MM

Facility

$13,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695967
Hospital Revenue Code	278
Min. Negotiated Rate	$2,062.50
Max. Negotiated Rate	$3,327.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50

PLATE ZEVO ANT CERV LEV3 53MM

Facility

$13,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695967
Hospital Revenue Code	278
Min. Negotiated Rate	$390.50
Max. Negotiated Rate	$6,875.00
Rate for Payer: Aetna Commercial	$5,225.00
Rate for Payer: Aetna Medicare Advantage	$4,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,506.25
Rate for Payer: Cigna Commercial	$6,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50
Rate for Payer: UnitedHealthcare Community & State	$434.50
Rate for Payer: Wellpoint Medicaid Managed Care	$390.50

PLATE ZIM FRL 4H 135 118113504

Facility

$1,585.05

Service Code	HCPCS C1713
Hospital Charge Code	270601785
Hospital Revenue Code	278
Min. Negotiated Rate	$237.76
Max. Negotiated Rate	$383.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$317.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$383.58
Rate for Payer: Qualcare PPO/HMO/WC	$237.76

PLATE ZIM FRL 4H 135 118113504

Facility

$1,585.05

Service Code	HCPCS C1713
Hospital Charge Code	270601785
Hospital Revenue Code	278
Min. Negotiated Rate	$45.02
Max. Negotiated Rate	$792.52
Rate for Payer: Aetna Commercial	$602.32
Rate for Payer: Aetna Medicare Advantage	$475.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$404.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$404.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$317.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$404.19
Rate for Payer: Cigna Commercial	$792.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$383.58
Rate for Payer: Qualcare PPO/HMO/WC	$237.76
Rate for Payer: UnitedHealthcare Community & State	$50.09
Rate for Payer: Wellpoint Medicaid Managed Care	$45.02

PLATE ZIM FRL 4H 140 118114004

Facility

$1,473.90

Service Code	HCPCS C1713
Hospital Charge Code	270601395
Hospital Revenue Code	278
Min. Negotiated Rate	$41.86
Max. Negotiated Rate	$736.95
Rate for Payer: Aetna Commercial	$560.08
Rate for Payer: Aetna Medicare Advantage	$442.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$375.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$375.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$294.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$375.84
Rate for Payer: Cigna Commercial	$736.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.68
Rate for Payer: Qualcare PPO/HMO/WC	$221.09
Rate for Payer: UnitedHealthcare Community & State	$46.58
Rate for Payer: Wellpoint Medicaid Managed Care	$41.86

PLATE ZIM FRL 4H 140 118114004

Facility

$1,473.90

Service Code	HCPCS C1713
Hospital Charge Code	270601395
Hospital Revenue Code	278
Min. Negotiated Rate	$221.09
Max. Negotiated Rate	$356.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$294.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.68
Rate for Payer: Qualcare PPO/HMO/WC	$221.09

PLATING FUSION SM 3DI SYSTEM

Facility

$7,050.00

Hospital Charge Code	270702877
Hospital Revenue Code	278
Min. Negotiated Rate	$1,057.50
Max. Negotiated Rate	$1,706.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50

PLATING FUSION SM 3DI SYSTEM

Facility

$7,050.00

Hospital Charge Code	270702877
Hospital Revenue Code	278
Min. Negotiated Rate	$200.22
Max. Negotiated Rate	$3,525.00
Rate for Payer: Aetna Commercial	$2,679.00
Rate for Payer: Aetna Medicare Advantage	$2,115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,797.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,797.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,797.75
Rate for Payer: Cigna Commercial	$3,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50
Rate for Payer: UnitedHealthcare Community & State	$222.78
Rate for Payer: Wellpoint Medicaid Managed Care	$200.22

PLATING ORTHOLOC 3DI MED RT

Facility

$7,445.00

Service Code	HCPCS C1713
Hospital Charge Code	270700804
Hospital Revenue Code	278
Min. Negotiated Rate	$211.44
Max. Negotiated Rate	$3,722.50
Rate for Payer: Aetna Commercial	$2,829.10
Rate for Payer: Aetna Medicare Advantage	$2,233.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,898.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,898.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,489.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,898.47
Rate for Payer: Cigna Commercial	$3,722.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,801.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,116.75
Rate for Payer: UnitedHealthcare Community & State	$235.26
Rate for Payer: Wellpoint Medicaid Managed Care	$211.44

PLATING ORTHOLOC 3DI MED RT

Facility

$7,445.00

Service Code	HCPCS C1713
Hospital Charge Code	270700804
Hospital Revenue Code	278
Min. Negotiated Rate	$1,116.75
Max. Negotiated Rate	$1,801.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,489.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,801.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,116.75

PLATING WEDGE OPEN 4MM RIGHT

Facility

$7,351.50

Service Code	HCPCS C1713
Hospital Charge Code	270680167
Hospital Revenue Code	278
Min. Negotiated Rate	$208.78
Max. Negotiated Rate	$3,675.75
Rate for Payer: Aetna Commercial	$2,793.57
Rate for Payer: Aetna Medicare Advantage	$2,205.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,874.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,874.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,470.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,874.63
Rate for Payer: Cigna Commercial	$3,675.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,779.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,102.72
Rate for Payer: UnitedHealthcare Community & State	$232.31
Rate for Payer: Wellpoint Medicaid Managed Care	$208.78

PLATING WEDGE OPEN 4MM RIGHT

Facility

$7,351.50

Service Code	HCPCS C1713
Hospital Charge Code	270680167
Hospital Revenue Code	278
Min. Negotiated Rate	$1,102.72
Max. Negotiated Rate	$1,779.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,470.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,779.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,102.72

PLAT VALCP COL-FUSN 2.7x78MM L

Facility

$5,920.45

Service Code	HCPCS C1713
Hospital Charge Code	270680262
Hospital Revenue Code	278
Min. Negotiated Rate	$888.07
Max. Negotiated Rate	$1,432.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,184.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,432.75
Rate for Payer: Qualcare PPO/HMO/WC	$888.07

PLAT VALCP COL-FUSN 2.7x78MM L

Facility

$5,920.45

Service Code	HCPCS C1713
Hospital Charge Code	270680262
Hospital Revenue Code	278
Min. Negotiated Rate	$168.14
Max. Negotiated Rate	$2,960.22
Rate for Payer: Aetna Commercial	$2,249.77
Rate for Payer: Aetna Medicare Advantage	$1,776.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,509.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,509.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,184.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,509.71
Rate for Payer: Cigna Commercial	$2,960.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,432.75
Rate for Payer: Qualcare PPO/HMO/WC	$888.07
Rate for Payer: UnitedHealthcare Community & State	$187.09
Rate for Payer: Wellpoint Medicaid Managed Care	$168.14

PLAT VA LKG CALC SM2.7x58MM LT

Facility

$4,341.45

Service Code	HCPCS C1713
Hospital Charge Code	270680302
Hospital Revenue Code	278
Min. Negotiated Rate	$651.22
Max. Negotiated Rate	$1,050.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$868.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.63
Rate for Payer: Qualcare PPO/HMO/WC	$651.22

PLAT VA LKG CALC SM2.7x58MM LT

Facility

$4,341.45

Service Code	HCPCS C1713
Hospital Charge Code	270680302
Hospital Revenue Code	278
Min. Negotiated Rate	$123.30
Max. Negotiated Rate	$2,170.72
Rate for Payer: Aetna Commercial	$1,649.75
Rate for Payer: Aetna Medicare Advantage	$1,302.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,107.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,107.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$868.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,107.07
Rate for Payer: Cigna Commercial	$2,170.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.63
Rate for Payer: Qualcare PPO/HMO/WC	$651.22
Rate for Payer: UnitedHealthcare Community & State	$137.19
Rate for Payer: Wellpoint Medicaid Managed Care	$123.30

PL CATH ART 2ND A/P-BI

Facility

$8,697.00

Service Code	HCPCS 3624650
Hospital Charge Code	3668362465
Hospital Revenue Code	361
Min. Negotiated Rate	$1,304.55
Max. Negotiated Rate	$1,304.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55

PL CATH ART 2ND A/P-BI

Facility

$8,697.00

Service Code	HCPCS 3624650
Hospital Charge Code	7411105
Hospital Revenue Code	361
Min. Negotiated Rate	$246.99
Max. Negotiated Rate	$4,348.50
Rate for Payer: Aetna Commercial	$3,304.86
Rate for Payer: Aetna Medicare Advantage	$2,609.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,217.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,217.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,217.74
Rate for Payer: Cigna Commercial	$4,348.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,261.22
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55
Rate for Payer: UnitedHealthcare Community & State	$274.83
Rate for Payer: Wellpoint Medicaid Managed Care	$246.99

Know your out-of-pocket cost for care.

All Charges