Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PLATE ACP 14MM 1LEVEL

Facility

$19,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270695532
Hospital Revenue Code	278
Min. Negotiated Rate	$546.70
Max. Negotiated Rate	$9,625.00
Rate for Payer: Aetna Commercial	$7,315.00
Rate for Payer: Aetna Medicare Advantage	$5,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,908.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,908.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,908.75
Rate for Payer: Cigna Commercial	$9,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,658.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,887.50
Rate for Payer: UnitedHealthcare Community & State	$608.30
Rate for Payer: Wellpoint Medicaid Managed Care	$546.70

PLATE ACP 14MM 1LEVEL

Facility

$19,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270695532
Hospital Revenue Code	278
Min. Negotiated Rate	$2,887.50
Max. Negotiated Rate	$4,658.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,658.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,887.50

PLATE ACP 1.6V 18MM 1LEVEL

Facility

$11,203.50

Service Code	HCPCS C1713
Hospital Charge Code	270694182
Hospital Revenue Code	278
Min. Negotiated Rate	$318.18
Max. Negotiated Rate	$5,601.75
Rate for Payer: Aetna Commercial	$4,257.33
Rate for Payer: Aetna Medicare Advantage	$3,361.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,856.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,856.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,240.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,856.89
Rate for Payer: Cigna Commercial	$5,601.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,711.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,680.53
Rate for Payer: UnitedHealthcare Community & State	$354.03
Rate for Payer: Wellpoint Medicaid Managed Care	$318.18

PLATE ACP 1.6V 18MM 1LEVEL

Facility

$11,203.50

Service Code	HCPCS C1713
Hospital Charge Code	270694182
Hospital Revenue Code	278
Min. Negotiated Rate	$1,680.53
Max. Negotiated Rate	$2,711.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,240.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,711.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,680.53

PLATE ACP 1.6V 1LEV 20MM

Facility

$11,203.50

Service Code	HCPCS C1713
Hospital Charge Code	270696632
Hospital Revenue Code	278
Min. Negotiated Rate	$318.18
Max. Negotiated Rate	$5,601.75
Rate for Payer: Aetna Commercial	$4,257.33
Rate for Payer: Aetna Medicare Advantage	$3,361.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,856.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,856.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,240.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,856.89
Rate for Payer: Cigna Commercial	$5,601.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,711.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,680.53
Rate for Payer: UnitedHealthcare Community & State	$354.03
Rate for Payer: Wellpoint Medicaid Managed Care	$318.18

PLATE ACP 1.6V 1LEV 20MM

Facility

$11,203.50

Service Code	HCPCS C1713
Hospital Charge Code	270696632
Hospital Revenue Code	278
Min. Negotiated Rate	$1,680.53
Max. Negotiated Rate	$2,711.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,240.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,711.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,680.53

PLATE ACP 1.6V 22MM 1LEVEL

Facility

$11,203.50

Service Code	HCPCS C1713
Hospital Charge Code	270695533
Hospital Revenue Code	278
Min. Negotiated Rate	$1,680.53
Max. Negotiated Rate	$2,711.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,240.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,711.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,680.53

PLATE ACP 1.6V 22MM 1LEVEL

Facility

$11,203.50

Service Code	HCPCS C1713
Hospital Charge Code	270695533
Hospital Revenue Code	278
Min. Negotiated Rate	$318.18
Max. Negotiated Rate	$5,601.75
Rate for Payer: Aetna Commercial	$4,257.33
Rate for Payer: Aetna Medicare Advantage	$3,361.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,856.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,856.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,240.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,856.89
Rate for Payer: Cigna Commercial	$5,601.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,711.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,680.53
Rate for Payer: UnitedHealthcare Community & State	$354.03
Rate for Payer: Wellpoint Medicaid Managed Care	$318.18

PLATE ACP 1.6V 24MM 1LEV

Facility

$11,203.50

Service Code	HCPCS C1713
Hospital Charge Code	270694491
Hospital Revenue Code	278
Min. Negotiated Rate	$318.18
Max. Negotiated Rate	$5,601.75
Rate for Payer: Aetna Commercial	$4,257.33
Rate for Payer: Aetna Medicare Advantage	$3,361.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,856.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,856.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,240.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,856.89
Rate for Payer: Cigna Commercial	$5,601.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,711.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,680.53
Rate for Payer: UnitedHealthcare Community & State	$354.03
Rate for Payer: Wellpoint Medicaid Managed Care	$318.18

PLATE ACP 1.6V 24MM 1LEV

Facility

$11,203.50

Service Code	HCPCS C1713
Hospital Charge Code	270694491
Hospital Revenue Code	278
Min. Negotiated Rate	$1,680.53
Max. Negotiated Rate	$2,711.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,240.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,711.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,680.53

PLATE ACP 1.6V 2LEVEL 34MM

Facility

$12,144.00

Service Code	HCPCS C1713
Hospital Charge Code	270694722
Hospital Revenue Code	278
Min. Negotiated Rate	$344.89
Max. Negotiated Rate	$6,072.00
Rate for Payer: Aetna Commercial	$4,614.72
Rate for Payer: Aetna Medicare Advantage	$3,643.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,096.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,096.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,428.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,096.72
Rate for Payer: Cigna Commercial	$6,072.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,938.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,821.60
Rate for Payer: UnitedHealthcare Community & State	$383.75
Rate for Payer: Wellpoint Medicaid Managed Care	$344.89

PLATE ACP 1.6V 2LEVEL 34MM

Facility

$12,144.00

Service Code	HCPCS C1713
Hospital Charge Code	270694722
Hospital Revenue Code	278
Min. Negotiated Rate	$1,821.60
Max. Negotiated Rate	$2,938.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,428.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,938.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,821.60

PLATE ACP 1.6V 36MM 2-LEVEL

Facility

$850.00

Service Code	HCPCS C1713
Hospital Charge Code	270695254
Hospital Revenue Code	278
Min. Negotiated Rate	$24.14
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Community & State	$26.86
Rate for Payer: Wellpoint Medicaid Managed Care	$24.14

PLATE ACP 1.6V 36MM 2-LEVEL

Facility

$850.00

Service Code	HCPCS C1713
Hospital Charge Code	270695254
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

PLATE ACP 1.6V 38MM 2 LEVEL

Facility

$12,140.00

Service Code	HCPCS C1713
Hospital Charge Code	270693080
Hospital Revenue Code	278
Min. Negotiated Rate	$344.78
Max. Negotiated Rate	$6,070.00
Rate for Payer: Aetna Commercial	$4,613.20
Rate for Payer: Aetna Medicare Advantage	$3,642.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,095.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,095.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,428.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,095.70
Rate for Payer: Cigna Commercial	$6,070.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,937.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,821.00
Rate for Payer: UnitedHealthcare Community & State	$383.62
Rate for Payer: Wellpoint Medicaid Managed Care	$344.78

PLATE ACP 1.6V 38MM 2 LEVEL

Facility

$12,140.00

Service Code	HCPCS C1713
Hospital Charge Code	270693080
Hospital Revenue Code	278
Min. Negotiated Rate	$1,821.00
Max. Negotiated Rate	$2,937.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,428.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,937.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,821.00

PLATE ACP 1.6V 40MM 2LEVEL

Facility

$12,144.00

Service Code	HCPCS C1713
Hospital Charge Code	270694179
Hospital Revenue Code	278
Min. Negotiated Rate	$344.89
Max. Negotiated Rate	$6,072.00
Rate for Payer: Aetna Commercial	$4,614.72
Rate for Payer: Aetna Medicare Advantage	$3,643.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,096.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,096.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,428.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,096.72
Rate for Payer: Cigna Commercial	$6,072.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,938.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,821.60
Rate for Payer: UnitedHealthcare Community & State	$383.75
Rate for Payer: Wellpoint Medicaid Managed Care	$344.89

PLATE ACP 1.6V 40MM 2LEVEL

Facility

$12,144.00

Service Code	HCPCS C1713
Hospital Charge Code	270694179
Hospital Revenue Code	278
Min. Negotiated Rate	$1,821.60
Max. Negotiated Rate	$2,938.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,428.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,938.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,821.60

PLATE ACP 1.6V 42MM 2LEVEL

Facility

$6,050.00

Service Code	HCPCS C1713
Hospital Charge Code	270695490
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 ACP 1.6V 42MM 2LEVEL

Facility

$6,050.00

Service Code	HCPCS C1713
Hospital Charge Code	270695490
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 ACP 1.9 1 LEVEL

Facility

$11,200.00

Service Code	HCPCS C1713
Hospital Charge Code	270694206
Hospital Revenue Code	278
Min. Negotiated Rate	$318.08
Max. Negotiated Rate	$5,600.00
Rate for Payer: Aetna Commercial	$4,256.00
Rate for Payer: Aetna Medicare Advantage	$3,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,856.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,856.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,856.00
Rate for Payer: Cigna Commercial	$5,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,710.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,680.00
Rate for Payer: UnitedHealthcare Community & State	$353.92
Rate for Payer: Wellpoint Medicaid Managed Care	$318.08

PLATE ACP 1.9 1 LEVEL

Facility

$11,200.00

Service Code	HCPCS C1713
Hospital Charge Code	270694206
Hospital Revenue Code	278
Min. Negotiated Rate	$1,680.00
Max. Negotiated Rate	$2,710.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,710.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,680.00

PLATE ACP 1.9 1 LEVEL 16MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270698447
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 ACP 1.9 1 LEVEL 16MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270698447
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 ACP 1.9H 3LEVEL 52MM

Facility

$13,068.00

Service Code	HCPCS C1713
Hospital Charge Code	270694727
Hospital Revenue Code	278
Min. Negotiated Rate	$371.13
Max. Negotiated Rate	$6,534.00
Rate for Payer: Aetna Commercial	$4,965.84
Rate for Payer: Aetna Medicare Advantage	$3,920.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,332.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,332.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,613.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,332.34
Rate for Payer: Cigna Commercial	$6,534.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,162.46
Rate for Payer: Qualcare PPO/HMO/WC	$1,960.20
Rate for Payer: UnitedHealthcare Community & State	$412.95
Rate for Payer: Wellpoint Medicaid Managed Care	$371.13

Know your out-of-pocket cost for care.

All Charges