Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PLATE ANT CERVICAL 2LEVEL 24MM

Facility

$19,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270696964
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 ANT CERV SKYLINE 26 MM

Facility

$6,757.50

Service Code	HCPCS C1713
Hospital Charge Code	270691716
Hospital Revenue Code	278
Min. Negotiated Rate	$1,013.62
Max. Negotiated Rate	$1,635.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,351.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,635.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,013.62

PLATE ANT CERV SKYLINE 26 MM

Facility

$6,757.50

Service Code	HCPCS C1713
Hospital Charge Code	270691716
Hospital Revenue Code	278
Min. Negotiated Rate	$191.91
Max. Negotiated Rate	$3,378.75
Rate for Payer: Aetna Commercial	$2,567.85
Rate for Payer: Aetna Medicare Advantage	$2,027.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,723.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,723.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,351.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,723.16
Rate for Payer: Cigna Commercial	$3,378.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,635.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,013.62
Rate for Payer: UnitedHealthcare Community & State	$213.54
Rate for Payer: Wellpoint Medicaid Managed Care	$191.91

PLATE ANT CERV UNI 1LEV 20MM

Facility

$5,035.00

Service Code	HCPCS C1713
Hospital Charge Code	270689762
Hospital Revenue Code	278
Min. Negotiated Rate	$755.25
Max. Negotiated Rate	$1,218.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,007.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,218.47
Rate for Payer: Qualcare PPO/HMO/WC	$755.25

PLATE ANT CERV UNI 1LEV 20MM

Facility

$5,035.00

Service Code	HCPCS C1713
Hospital Charge Code	270689762
Hospital Revenue Code	278
Min. Negotiated Rate	$142.99
Max. Negotiated Rate	$2,517.50
Rate for Payer: Aetna Commercial	$1,913.30
Rate for Payer: Aetna Medicare Advantage	$1,510.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,283.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,283.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,007.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,283.92
Rate for Payer: Cigna Commercial	$2,517.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,218.47
Rate for Payer: Qualcare PPO/HMO/WC	$755.25
Rate for Payer: UnitedHealthcare Community & State	$159.11
Rate for Payer: Wellpoint Medicaid Managed Care	$142.99

PLATE ANTERIOR 2H 6MM

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270694365
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

PLATE ANTERIOR 2H 6MM

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270694365
Hospital Revenue Code	278
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$158.00
Rate for Payer: Wellpoint Medicaid Managed Care	$142.00

PLATE ANTERIOR LARGE

Facility

$11,020.00

Service Code	HCPCS C1713
Hospital Charge Code	270687138
Hospital Revenue Code	278
Min. Negotiated Rate	$312.97
Max. Negotiated Rate	$5,510.00
Rate for Payer: Aetna Commercial	$4,187.60
Rate for Payer: Aetna Medicare Advantage	$3,306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,810.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,810.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,810.10
Rate for Payer: Cigna Commercial	$5,510.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,666.84
Rate for Payer: Qualcare PPO/HMO/WC	$1,653.00
Rate for Payer: UnitedHealthcare Community & State	$348.23
Rate for Payer: Wellpoint Medicaid Managed Care	$312.97

PLATE ANTERIOR LARGE

Facility

$11,020.00

Service Code	HCPCS C1713
Hospital Charge Code	270687138
Hospital Revenue Code	278
Min. Negotiated Rate	$1,653.00
Max. Negotiated Rate	$2,666.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,204.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,666.84
Rate for Payer: Qualcare PPO/HMO/WC	$1,653.00

PLATE ANTERIOR RT LAT SMALL

Facility

$9,450.00

Service Code	HCPCS C1713
Hospital Charge Code	270685125
Hospital Revenue Code	278
Min. Negotiated Rate	$268.38
Max. Negotiated Rate	$4,725.00
Rate for Payer: Aetna Commercial	$3,591.00
Rate for Payer: Aetna Medicare Advantage	$2,835.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,409.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,409.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,409.75
Rate for Payer: Cigna Commercial	$4,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,286.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,417.50
Rate for Payer: UnitedHealthcare Community & State	$298.62
Rate for Payer: Wellpoint Medicaid Managed Care	$268.38

PLATE ANTERIOR RT LAT SMALL

Facility

$9,450.00

Service Code	HCPCS C1713
Hospital Charge Code	270685125
Hospital Revenue Code	278
Min. Negotiated Rate	$1,417.50
Max. Negotiated Rate	$2,286.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,890.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,286.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,417.50

PLATE ANTERIOR STR LG RT 116MM

Facility

$12,965.00

Service Code	HCPCS C1713
Hospital Charge Code	270672734
Hospital Revenue Code	278
Min. Negotiated Rate	$1,944.75
Max. Negotiated Rate	$3,137.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,593.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,137.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,944.75

PLATE ANTERIOR STR LG RT 116MM

Facility

$12,965.00

Service Code	HCPCS C1713
Hospital Charge Code	270672734
Hospital Revenue Code	278
Min. Negotiated Rate	$368.21
Max. Negotiated Rate	$6,482.50
Rate for Payer: Aetna Commercial	$4,926.70
Rate for Payer: Aetna Medicare Advantage	$3,889.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,306.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,306.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,593.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,306.07
Rate for Payer: Cigna Commercial	$6,482.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,137.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,944.75
Rate for Payer: UnitedHealthcare Community & State	$409.69
Rate for Payer: Wellpoint Medicaid Managed Care	$368.21

PLATE ARCHON 36MM 2LEVEL

Facility

$6,050.00

Service Code	HCPCS C1713
Hospital Charge Code	270693540
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 ARCHON 36MM 2LEVEL

Facility

$6,050.00

Service Code	HCPCS C1713
Hospital Charge Code	270693540
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 ARCHON 38MM 2-LEVEL

Facility

$6,050.00

Service Code	HCPCS C1889
Hospital Charge Code	270693343
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 ARCHON 38MM 2-LEVEL

Facility

$6,050.00

Service Code	HCPCS C1889
Hospital Charge Code	270693343
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 ARCHON 40MM 2 LEVEL

Facility

$6,050.00

Service Code	HCPCS C1713
Hospital Charge Code	270694489
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 ARCHON 40MM 2 LEVEL

Facility

$6,050.00

Service Code	HCPCS C1713
Hospital Charge Code	270694489
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 BEND 4 H 87 MM RIGHT LCP

Facility

$7,162.60

Service Code	HCPCS C1713
Hospital Charge Code	270686078
Hospital Revenue Code	278
Min. Negotiated Rate	$1,074.39
Max. Negotiated Rate	$1,733.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,432.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,733.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,074.39

PLATE BEND 4 H 87 MM RIGHT LCP

Facility

$7,162.60

Service Code	HCPCS C1713
Hospital Charge Code	270686078
Hospital Revenue Code	278
Min. Negotiated Rate	$203.42
Max. Negotiated Rate	$3,581.30
Rate for Payer: Aetna Commercial	$2,721.79
Rate for Payer: Aetna Medicare Advantage	$2,148.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,826.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,826.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,432.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,826.46
Rate for Payer: Cigna Commercial	$3,581.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,733.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,074.39
Rate for Payer: UnitedHealthcare Community & State	$226.34
Rate for Payer: Wellpoint Medicaid Managed Care	$203.42

PLATE BROAD 14H 4.5x260MM

Facility

$3,279.00

Hospital Charge Code	270675501
Hospital Revenue Code	278
Min. Negotiated Rate	$93.12
Max. Negotiated Rate	$1,639.50
Rate for Payer: Aetna Commercial	$1,246.02
Rate for Payer: Aetna Medicare Advantage	$983.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$836.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$836.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$655.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$836.14
Rate for Payer: Cigna Commercial	$1,639.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.52
Rate for Payer: Qualcare PPO/HMO/WC	$491.85
Rate for Payer: UnitedHealthcare Community & State	$103.62
Rate for Payer: Wellpoint Medicaid Managed Care	$93.12

PLATE BROAD 14H 4.5x260MM

Facility

$3,279.00

Hospital Charge Code	270675501
Hospital Revenue Code	278
Min. Negotiated Rate	$491.85
Max. Negotiated Rate	$793.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$655.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.52
Rate for Payer: Qualcare PPO/HMO/WC	$491.85

PLATE BROAD 4 HOLE ALTA

Facility

$610.00

Hospital Charge Code	270335169
Hospital Revenue Code	278
Min. Negotiated Rate	$91.50
Max. Negotiated Rate	$147.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$122.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.62
Rate for Payer: Qualcare PPO/HMO/WC	$91.50

PLATE BROAD 4 HOLE ALTA

Facility

$610.00

Hospital Charge Code	270335169
Hospital Revenue Code	278
Min. Negotiated Rate	$17.32
Max. Negotiated Rate	$305.00
Rate for Payer: Aetna Commercial	$231.80
Rate for Payer: Aetna Medicare Advantage	$183.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$122.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.55
Rate for Payer: Cigna Commercial	$305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.62
Rate for Payer: Qualcare PPO/HMO/WC	$91.50
Rate for Payer: UnitedHealthcare Community & State	$19.28
Rate for Payer: Wellpoint Medicaid Managed Care	$17.32

Know your out-of-pocket cost for care.

All Charges