Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PLATE CERVICAL LEVEL 2 38MM

Facility

$9,900.00

Service Code	HCPCS C1713
Hospital Charge Code	270677097
Hospital Revenue Code	278
Min. Negotiated Rate	$281.16
Max. Negotiated Rate	$4,950.00
Rate for Payer: Aetna Commercial	$3,762.00
Rate for Payer: Aetna Medicare Advantage	$2,970.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,524.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,524.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,524.50
Rate for Payer: Cigna Commercial	$4,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,395.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,485.00
Rate for Payer: UnitedHealthcare Community & State	$312.84
Rate for Payer: Wellpoint Medicaid Managed Care	$281.16

PLATE CERVICAL LEVEL 2 38MM

Facility

$9,900.00

Service Code	HCPCS C1713
Hospital Charge Code	270677097
Hospital Revenue Code	278
Min. Negotiated Rate	$1,485.00
Max. Negotiated Rate	$2,395.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,980.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,395.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,485.00

PLATE CERVICAL LEVEL 2 41MM

Facility

$9,900.00

Hospital Charge Code	270678249
Hospital Revenue Code	278
Min. Negotiated Rate	$1,485.00
Max. Negotiated Rate	$2,395.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,980.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,395.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,485.00

PLATE CERVICAL LEVEL 2 41MM

Facility

$9,900.00

Hospital Charge Code	270678249
Hospital Revenue Code	278
Min. Negotiated Rate	$281.16
Max. Negotiated Rate	$4,950.00
Rate for Payer: Aetna Commercial	$3,762.00
Rate for Payer: Aetna Medicare Advantage	$2,970.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,524.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,524.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,524.50
Rate for Payer: Cigna Commercial	$4,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,395.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,485.00
Rate for Payer: UnitedHealthcare Community & State	$312.84
Rate for Payer: Wellpoint Medicaid Managed Care	$281.16

PLATE CERVICAL LEVEL 3 52MM

Facility

$11,000.00

Hospital Charge Code	270677463
Hospital Revenue Code	278
Min. Negotiated Rate	$1,650.00
Max. Negotiated Rate	$2,662.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,662.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,650.00

PLATE CERVICAL LEVEL 3 52MM

Facility

$11,000.00

Hospital Charge Code	270677463
Hospital Revenue Code	278
Min. Negotiated Rate	$312.40
Max. Negotiated Rate	$5,500.00
Rate for Payer: Aetna Commercial	$4,180.00
Rate for Payer: Aetna Medicare Advantage	$3,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,805.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,805.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,805.00
Rate for Payer: Cigna Commercial	$5,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,662.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,650.00
Rate for Payer: UnitedHealthcare Community & State	$347.60
Rate for Payer: Wellpoint Medicaid Managed Care	$312.40

PLATE CERVICAL TI 28MM 2LEV

Facility

$17,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270697149
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$4,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

PLATE CERVICAL TI 28MM 2LEV

Facility

$17,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270697149
Hospital Revenue Code	278
Min. Negotiated Rate	$497.00
Max. Negotiated Rate	$8,750.00
Rate for Payer: Aetna Commercial	$6,650.00
Rate for Payer: Aetna Medicare Advantage	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,462.50
Rate for Payer: Cigna Commercial	$8,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00
Rate for Payer: UnitedHealthcare Community & State	$553.00
Rate for Payer: Wellpoint Medicaid Managed Care	$497.00

PLATE CERVICAL TI 2 LEVEL 30MM

Facility

$17,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270697545
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$4,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

PLATE CERVICAL TI 2 LEVEL 30MM

Facility

$17,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270697545
Hospital Revenue Code	278
Min. Negotiated Rate	$497.00
Max. Negotiated Rate	$8,750.00
Rate for Payer: Aetna Commercial	$6,650.00
Rate for Payer: Aetna Medicare Advantage	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,462.50
Rate for Payer: Cigna Commercial	$8,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00
Rate for Payer: UnitedHealthcare Community & State	$553.00
Rate for Payer: Wellpoint Medicaid Managed Care	$497.00

PLATE CERV SAPPH ONELEVEL 8MM

Facility

$8,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270692989
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

PLATE CERV SAPPH ONELEVEL 8MM

Facility

$8,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270692989
Hospital Revenue Code	278
Min. Negotiated Rate	$234.30
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Community & State	$260.70
Rate for Payer: Wellpoint Medicaid Managed Care	$234.30

PLATE CERV SKYLINE 1 LEV 14MM

Facility

$7,685.00

Service Code	HCPCS C1713
Hospital Charge Code	270698990
Hospital Revenue Code	278
Min. Negotiated Rate	$1,152.75
Max. Negotiated Rate	$1,859.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,537.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,859.77
Rate for Payer: Qualcare PPO/HMO/WC	$1,152.75

PLATE CERV SKYLINE 1 LEV 14MM

Facility

$7,685.00

Service Code	HCPCS C1713
Hospital Charge Code	270698990
Hospital Revenue Code	278
Min. Negotiated Rate	$218.25
Max. Negotiated Rate	$3,842.50
Rate for Payer: Aetna Commercial	$2,920.30
Rate for Payer: Aetna Medicare Advantage	$2,305.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,959.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,959.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,537.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,959.67
Rate for Payer: Cigna Commercial	$3,842.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,859.77
Rate for Payer: Qualcare PPO/HMO/WC	$1,152.75
Rate for Payer: UnitedHealthcare Community & State	$242.85
Rate for Payer: Wellpoint Medicaid Managed Care	$218.25

PLATE CERV TERRACE 2LEVEL 40MM

Facility

$19,990.00

Service Code	HCPCS C1713
Hospital Charge Code	270696967
Hospital Revenue Code	278
Min. Negotiated Rate	$2,998.50
Max. Negotiated Rate	$4,837.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,998.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,837.58
Rate for Payer: Qualcare PPO/HMO/WC	$2,998.50

PLATE CERV TERRACE 2LEVEL 40MM

Facility

$19,990.00

Service Code	HCPCS C1713
Hospital Charge Code	270696967
Hospital Revenue Code	278
Min. Negotiated Rate	$567.72
Max. Negotiated Rate	$9,995.00
Rate for Payer: Aetna Commercial	$7,596.20
Rate for Payer: Aetna Medicare Advantage	$5,997.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,097.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,097.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,998.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,097.45
Rate for Payer: Cigna Commercial	$9,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,837.58
Rate for Payer: Qualcare PPO/HMO/WC	$2,998.50
Rate for Payer: UnitedHealthcare Community & State	$631.68
Rate for Payer: Wellpoint Medicaid Managed Care	$567.72

PLATE CERV ZEVO TI 2L 1.9X37MM

Facility

$11,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270697848
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 CERV ZEVO TI 2L 1.9X37MM

Facility

$11,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270697848
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 CLAVICAL

Facility

$4,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270687718
Hospital Revenue Code	278
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$1,028.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: Qualcare PPO/HMO/WC	$637.50

PLATE CLAVICAL

Facility

$4,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270687718
Hospital Revenue Code	278
Min. Negotiated Rate	$120.70
Max. Negotiated Rate	$2,125.00
Rate for Payer: Aetna Commercial	$1,615.00
Rate for Payer: Aetna Medicare Advantage	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,083.75
Rate for Payer: Cigna Commercial	$2,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: Qualcare PPO/HMO/WC	$637.50
Rate for Payer: UnitedHealthcare Community & State	$134.30
Rate for Payer: Wellpoint Medicaid Managed Care	$120.70

PLATE CLAVICAL 3.5MM 8 HOLE

Facility

$4,379.40

Service Code	HCPCS C1713
Hospital Charge Code	270685590
Hospital Revenue Code	278
Min. Negotiated Rate	$656.91
Max. Negotiated Rate	$1,059.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,059.81
Rate for Payer: Qualcare PPO/HMO/WC	$656.91

PLATE CLAVICAL 3.5MM 8 HOLE

Facility

$4,379.40

Service Code	HCPCS C1713
Hospital Charge Code	270685590
Hospital Revenue Code	278
Min. Negotiated Rate	$124.37
Max. Negotiated Rate	$2,189.70
Rate for Payer: Aetna Commercial	$1,664.17
Rate for Payer: Aetna Medicare Advantage	$1,313.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,116.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,116.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,116.75
Rate for Payer: Cigna Commercial	$2,189.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,059.81
Rate for Payer: Qualcare PPO/HMO/WC	$656.91
Rate for Payer: UnitedHealthcare Community & State	$138.39
Rate for Payer: Wellpoint Medicaid Managed Care	$124.37

PLATE CLAVICAL ANTERIOR 10 HO

Facility

$5,830.00

Hospital Charge Code	270669425
Hospital Revenue Code	278
Min. Negotiated Rate	$165.57
Max. Negotiated Rate	$2,915.00
Rate for Payer: Aetna Commercial	$2,215.40
Rate for Payer: Aetna Medicare Advantage	$1,749.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,486.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,486.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,166.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,486.65
Rate for Payer: Cigna Commercial	$2,915.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,410.86
Rate for Payer: Qualcare PPO/HMO/WC	$874.50
Rate for Payer: UnitedHealthcare Community & State	$184.23
Rate for Payer: Wellpoint Medicaid Managed Care	$165.57

PLATE CLAVICAL ANTERIOR 10 HO

Facility

$5,830.00

Hospital Charge Code	270669425
Hospital Revenue Code	278
Min. Negotiated Rate	$874.50
Max. Negotiated Rate	$1,410.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,166.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,410.86
Rate for Payer: Qualcare PPO/HMO/WC	$874.50

PLATE CLAVICAL SYSTEM

Facility

$11,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270687868
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

Know your out-of-pocket cost for care.

All Charges