Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SMALL 11MM 8 DEG PLATE

Facility

$15,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704097
Hospital Revenue Code	278
Min. Negotiated Rate	$426.00
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$5,700.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00
Rate for Payer: UnitedHealthcare Community & State	$474.00
Rate for Payer: Wellpoint Medicaid Managed Care	$426.00

SMALL BONE FIXATION SYSTEM

Facility

$2,030.00

Hospital Charge Code	270339479
Hospital Revenue Code	278
Min. Negotiated Rate	$304.50
Max. Negotiated Rate	$491.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$406.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$491.26
Rate for Payer: Qualcare PPO/HMO/WC	$304.50

SMALL BONE FIXATION SYSTEM

Facility

$625.00

Hospital Charge Code	270661291
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$151.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

SMALL BONE FIXATION SYSTEM

Facility

$625.00

Hospital Charge Code	270661291
Hospital Revenue Code	278
Min. Negotiated Rate	$17.75
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Community & State	$19.75
Rate for Payer: Wellpoint Medicaid Managed Care	$17.75

SMALL BONE FIXATION SYSTEM

Facility

$2,030.00

Hospital Charge Code	270339479
Hospital Revenue Code	278
Min. Negotiated Rate	$57.65
Max. Negotiated Rate	$1,015.00
Rate for Payer: Aetna Commercial	$771.40
Rate for Payer: Aetna Medicare Advantage	$609.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$517.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$517.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$406.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$517.65
Rate for Payer: Cigna Commercial	$1,015.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$491.26
Rate for Payer: Qualcare PPO/HMO/WC	$304.50
Rate for Payer: UnitedHealthcare Community & State	$64.15
Rate for Payer: Wellpoint Medicaid Managed Care	$57.65

SMALL EX-FIX COMB CLAMMR COND

Facility

$1,629.55

Hospital Charge Code	270666874
Hospital Revenue Code	272
Min. Negotiated Rate	$46.28
Max. Negotiated Rate	$814.77
Rate for Payer: Aetna Commercial	$619.23
Rate for Payer: Aetna Medicare Advantage	$488.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$415.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$415.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$415.54
Rate for Payer: Cigna Commercial	$814.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.68
Rate for Payer: Oxford Commercial	$325.91
Rate for Payer: Qualcare PPO/HMO/WC	$244.43
Rate for Payer: UnitedHealthcare Commercial	$325.91
Rate for Payer: UnitedHealthcare Community & State	$51.49
Rate for Payer: Wellpoint Medicaid Managed Care	$46.28

SMALL EX-FIX COMB CLAMMR COND

Facility

$1,629.55

Hospital Charge Code	270666874
Hospital Revenue Code	272
Min. Negotiated Rate	$244.43
Max. Negotiated Rate	$244.43
Rate for Payer: Qualcare PPO/HMO/WC	$244.43

SMALL FRAGMENT PLATES

Facility

$249.00

Hospital Charge Code	270335005
Hospital Revenue Code	278
Min. Negotiated Rate	$7.07
Max. Negotiated Rate	$124.50
Rate for Payer: Aetna Commercial	$94.62
Rate for Payer: Aetna Medicare Advantage	$74.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.49
Rate for Payer: Cigna Commercial	$124.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.26
Rate for Payer: Qualcare PPO/HMO/WC	$37.35
Rate for Payer: UnitedHealthcare Community & State	$7.87
Rate for Payer: Wellpoint Medicaid Managed Care	$7.07

SMALL FRAGMENT PLATES

Facility

$249.00

Hospital Charge Code	270335005
Hospital Revenue Code	278
Min. Negotiated Rate	$37.35
Max. Negotiated Rate	$60.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.26
Rate for Payer: Qualcare PPO/HMO/WC	$37.35

SMALL FRAGMENT SCREWS

Facility

$137.00

Hospital Charge Code	270335003
Hospital Revenue Code	278
Min. Negotiated Rate	$3.89
Max. Negotiated Rate	$68.50
Rate for Payer: Aetna Commercial	$52.06
Rate for Payer: Aetna Medicare Advantage	$41.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.94
Rate for Payer: Cigna Commercial	$68.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.15
Rate for Payer: Qualcare PPO/HMO/WC	$20.55
Rate for Payer: UnitedHealthcare Community & State	$4.33
Rate for Payer: Wellpoint Medicaid Managed Care	$3.89

SMALL FRAGMENT SCREWS

Facility

$137.00

Hospital Charge Code	270335003
Hospital Revenue Code	278
Min. Negotiated Rate	$20.55
Max. Negotiated Rate	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.15
Rate for Payer: Qualcare PPO/HMO/WC	$20.55

SMALL IMPACT TIP

Facility

$182.30

Hospital Charge Code	270652409
Hospital Revenue Code	272
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$91.15
Rate for Payer: Aetna Commercial	$69.27
Rate for Payer: Aetna Medicare Advantage	$54.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.49
Rate for Payer: Cigna Commercial	$91.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.40
Rate for Payer: Oxford Commercial	$36.46
Rate for Payer: Qualcare PPO/HMO/WC	$27.34
Rate for Payer: UnitedHealthcare Commercial	$36.46
Rate for Payer: UnitedHealthcare Community & State	$5.76
Rate for Payer: Wellpoint Medicaid Managed Care	$5.18

SMALL IMPACT TIP

Facility

$182.30

Hospital Charge Code	270652409
Hospital Revenue Code	272
Min. Negotiated Rate	$27.34
Max. Negotiated Rate	$27.34
Rate for Payer: Qualcare PPO/HMO/WC	$27.34

SMALL JOINT KIT ARTHREX

Facility

$895.00

Hospital Charge Code	270339532
Hospital Revenue Code	278
Min. Negotiated Rate	$25.42
Max. Negotiated Rate	$447.50
Rate for Payer: Aetna Commercial	$340.10
Rate for Payer: Aetna Medicare Advantage	$268.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$228.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$228.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$179.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$228.22
Rate for Payer: Cigna Commercial	$447.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.59
Rate for Payer: Qualcare PPO/HMO/WC	$134.25
Rate for Payer: UnitedHealthcare Community & State	$28.28
Rate for Payer: Wellpoint Medicaid Managed Care	$25.42

SMALL JOINT KIT ARTHREX

Facility

$895.00

Hospital Charge Code	270339532
Hospital Revenue Code	278
Min. Negotiated Rate	$134.25
Max. Negotiated Rate	$216.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$179.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.59
Rate for Payer: Qualcare PPO/HMO/WC	$134.25

SMALL JOINT KIT DISP

Facility

$725.00

Hospital Charge Code	270656577
Hospital Revenue Code	272
Min. Negotiated Rate	$108.75
Max. Negotiated Rate	$108.75
Rate for Payer: Qualcare PPO/HMO/WC	$108.75

SMALL JOINT KIT DISP

Facility

$725.00

Hospital Charge Code	270656577
Hospital Revenue Code	272
Min. Negotiated Rate	$20.59
Max. Negotiated Rate	$362.50
Rate for Payer: Aetna Commercial	$275.50
Rate for Payer: Aetna Medicare Advantage	$217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.88
Rate for Payer: Cigna Commercial	$362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.50
Rate for Payer: Oxford Commercial	$145.00
Rate for Payer: Qualcare PPO/HMO/WC	$108.75
Rate for Payer: UnitedHealthcare Commercial	$145.00
Rate for Payer: UnitedHealthcare Community & State	$22.91
Rate for Payer: Wellpoint Medicaid Managed Care	$20.59

SMALL JOINT OATS KIT 8MM

Facility

$3,900.00

Hospital Charge Code	270689468
Hospital Revenue Code	270
Min. Negotiated Rate	$110.76
Max. Negotiated Rate	$1,950.00
Rate for Payer: Aetna Commercial	$1,482.00
Rate for Payer: Aetna Medicare Advantage	$1,170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$994.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$994.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$994.50
Rate for Payer: Cigna Commercial	$1,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,014.00
Rate for Payer: Oxford Commercial	$780.00
Rate for Payer: Qualcare PPO/HMO/WC	$585.00
Rate for Payer: UnitedHealthcare Commercial	$780.00
Rate for Payer: UnitedHealthcare Community & State	$123.24
Rate for Payer: Wellpoint Medicaid Managed Care	$110.76

SMALL JOINT OATS KIT 8MM

Facility

$3,900.00

Hospital Charge Code	270689468
Hospital Revenue Code	270
Min. Negotiated Rate	$585.00
Max. Negotiated Rate	$585.00
Rate for Payer: Qualcare PPO/HMO/WC	$585.00

SMALL PLATE LARGE

Facility

$5,014.65

Service Code	HCPCS C1713
Hospital Charge Code	270693997
Hospital Revenue Code	278
Min. Negotiated Rate	$142.42
Max. Negotiated Rate	$2,507.32
Rate for Payer: Aetna Commercial	$1,905.57
Rate for Payer: Aetna Medicare Advantage	$1,504.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,278.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,278.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,002.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,278.74
Rate for Payer: Cigna Commercial	$2,507.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,213.55
Rate for Payer: Qualcare PPO/HMO/WC	$752.20
Rate for Payer: UnitedHealthcare Community & State	$158.46
Rate for Payer: Wellpoint Medicaid Managed Care	$142.42

SMALL PLATE LARGE

Facility

$5,014.65

Service Code	HCPCS C1713
Hospital Charge Code	270693997
Hospital Revenue Code	278
Min. Negotiated Rate	$752.20
Max. Negotiated Rate	$1,213.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,002.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,213.55
Rate for Payer: Qualcare PPO/HMO/WC	$752.20

Small shelve with three divide

Facility

$1,875.00

Hospital Charge Code	270665974
Hospital Revenue Code	270
Min. Negotiated Rate	$53.25
Max. Negotiated Rate	$937.50
Rate for Payer: Aetna Commercial	$712.50
Rate for Payer: Aetna Medicare Advantage	$562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$478.12
Rate for Payer: Cigna Commercial	$937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$487.50
Rate for Payer: Oxford Commercial	$375.00
Rate for Payer: Qualcare PPO/HMO/WC	$281.25
Rate for Payer: UnitedHealthcare Commercial	$375.00
Rate for Payer: UnitedHealthcare Community & State	$59.25
Rate for Payer: Wellpoint Medicaid Managed Care	$53.25

Small shelve with three divide

Facility

$1,875.00

Hospital Charge Code	270665974
Hospital Revenue Code	270
Min. Negotiated Rate	$281.25
Max. Negotiated Rate	$281.25
Rate for Payer: Qualcare PPO/HMO/WC	$281.25

SM AND SM/RNP AB I

Facility

$390.00

Service Code	HCPCS 8623591
Hospital Charge Code	39990080A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SM AND SM/RNP AB I

Facility

$390.00

Service Code	HCPCS 8623591
Hospital Charge Code	39990080A
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

Know your out-of-pocket cost for care.

All Charges