Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PLATE 2 HOLE 9MM

Facility

$7,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270693821
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

PLATE 2 HOLE 9MM

Facility

$7,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270693821
Hospital Revenue Code	278
Min. Negotiated Rate	$213.00
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00
Rate for Payer: UnitedHealthcare Community & State	$237.00
Rate for Payer: Wellpoint Medicaid Managed Care	$213.00

PLATE 2 HOLE AR-8958-02

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270697225
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 2 HOLE AR-8958-02

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270697225
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 2 HPLE DBL COMP 20MM

Facility

$4,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270687447
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 2 HPLE DBL COMP 20MM

Facility

$4,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270687447
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 2 LCP 2.7MM 3HOLES SHAF

Facility

$3,150.85

Service Code	HCPCS C1713
Hospital Charge Code	270684225
Hospital Revenue Code	278
Min. Negotiated Rate	$472.63
Max. Negotiated Rate	$762.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$630.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$762.51
Rate for Payer: Qualcare PPO/HMO/WC	$472.63

PLATE 2 LCP 2.7MM 3HOLES SHAF

Facility

$3,150.85

Service Code	HCPCS C1713
Hospital Charge Code	270684225
Hospital Revenue Code	278
Min. Negotiated Rate	$89.48
Max. Negotiated Rate	$1,575.42
Rate for Payer: Aetna Commercial	$1,197.32
Rate for Payer: Aetna Medicare Advantage	$945.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$803.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$803.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$630.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$803.47
Rate for Payer: Cigna Commercial	$1,575.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$762.51
Rate for Payer: Qualcare PPO/HMO/WC	$472.63
Rate for Payer: UnitedHealthcare Community & State	$99.57
Rate for Payer: Wellpoint Medicaid Managed Care	$89.48

PLATE 2-LEVEL - 29MM

Facility

$4,500.00

Hospital Charge Code	270703080
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

PLATE 2-LEVEL - 29MM

Facility

$4,500.00

Hospital Charge Code	270703080
Hospital Revenue Code	278
Min. Negotiated Rate	$127.80
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Community & State	$142.20
Rate for Payer: Wellpoint Medicaid Managed Care	$127.80

PLATE 30MM

Facility

$0.01

Service Code	HCPCS C1713
Hospital Charge Code	270689969
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

PLATE 30MM

Facility

$0.01

Service Code	HCPCS C1713
Hospital Charge Code	270689969
Hospital Revenue Code	278
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

PLATE 30MM

Facility

$16,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270688412
Hospital Revenue Code	278
Min. Negotiated Rate	$2,400.00
Max. Negotiated Rate	$3,872.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,872.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,400.00

PLATE 30MM

Facility

$16,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270688412
Hospital Revenue Code	278
Min. Negotiated Rate	$454.40
Max. Negotiated Rate	$8,000.00
Rate for Payer: Aetna Commercial	$6,080.00
Rate for Payer: Aetna Medicare Advantage	$4,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,080.00
Rate for Payer: Cigna Commercial	$8,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,872.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,400.00
Rate for Payer: UnitedHealthcare Community & State	$505.60
Rate for Payer: Wellpoint Medicaid Managed Care	$454.40

PLATE 31MM 2-LEVEL

Facility

$0.01

Service Code	HCPCS C1713
Hospital Charge Code	270694165
Hospital Revenue Code	278
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

PLATE 31MM 2-LEVEL

Facility

$0.01

Service Code	HCPCS C1713
Hospital Charge Code	270694165
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

PLATE 32MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705061
Hospital Revenue Code	278
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

PLATE 32MM

Facility

$16,341.90

Service Code	HCPCS C1713
Hospital Charge Code	270703885
Hospital Revenue Code	278
Min. Negotiated Rate	$464.11
Max. Negotiated Rate	$8,170.95
Rate for Payer: Aetna Commercial	$6,209.92
Rate for Payer: Aetna Medicare Advantage	$4,902.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,167.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,167.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,268.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,167.18
Rate for Payer: Cigna Commercial	$8,170.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,954.74
Rate for Payer: Qualcare PPO/HMO/WC	$2,451.28
Rate for Payer: UnitedHealthcare Community & State	$516.40
Rate for Payer: Wellpoint Medicaid Managed Care	$464.11

PLATE 32MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705061
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

PLATE 32MM

Facility

$16,341.90

Service Code	HCPCS C1713
Hospital Charge Code	270703885
Hospital Revenue Code	278
Min. Negotiated Rate	$2,451.28
Max. Negotiated Rate	$3,954.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,268.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,954.74
Rate for Payer: Qualcare PPO/HMO/WC	$2,451.28

PLATE 32MM 2 LEVEL

Facility

$13,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270688897
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 32MM 2 LEVEL

Facility

$13,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270688897
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 32MM 2 LEVEL ARCHON

Facility

$6,050.00

Service Code	HCPCS C1713
Hospital Charge Code	270693072
Hospital Revenue Code	278
Min. Negotiated Rate	$171.82
Max. Negotiated Rate	$3,025.00
Rate for Payer: Aetna Commercial	$2,299.00
Rate for Payer: Aetna Medicare Advantage	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,542.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,542.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,542.75
Rate for Payer: Cigna Commercial	$3,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,464.10
Rate for Payer: Qualcare PPO/HMO/WC	$907.50
Rate for Payer: UnitedHealthcare Community & State	$191.18
Rate for Payer: Wellpoint Medicaid Managed Care	$171.82

PLATE 32MM 2 LEVEL ARCHON

Facility

$6,050.00

Service Code	HCPCS C1713
Hospital Charge Code	270693072
Hospital Revenue Code	278
Min. Negotiated Rate	$907.50
Max. Negotiated Rate	$1,464.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,464.10
Rate for Payer: Qualcare PPO/HMO/WC	$907.50

PLATE 32MM 3-LEVEL

Facility

$13,100.00

Service Code	HCPCS C1713
Hospital Charge Code	270688525
Hospital Revenue Code	278
Min. Negotiated Rate	$372.04
Max. Negotiated Rate	$6,550.00
Rate for Payer: Aetna Commercial	$4,978.00
Rate for Payer: Aetna Medicare Advantage	$3,930.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,340.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,340.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,620.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,340.50
Rate for Payer: Cigna Commercial	$6,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,170.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,965.00
Rate for Payer: UnitedHealthcare Community & State	$413.96
Rate for Payer: Wellpoint Medicaid Managed Care	$372.04

Know your out-of-pocket cost for care.

All Charges