Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PLATE SKY 3 LEVEL TI 51MM

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270666240
Hospital Revenue Code	278
Min. Negotiated Rate	$205.90
Max. Negotiated Rate	$3,625.00
Rate for Payer: Aetna Commercial	$2,755.00
Rate for Payer: Aetna Medicare Advantage	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,848.75
Rate for Payer: Cigna Commercial	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50
Rate for Payer: UnitedHealthcare Community & State	$229.10
Rate for Payer: Wellpoint Medicaid Managed Care	$205.90

PLATE SKY 3 LEVEL TI 54MM

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270673370
Hospital Revenue Code	278
Min. Negotiated Rate	$205.90
Max. Negotiated Rate	$3,625.00
Rate for Payer: Aetna Commercial	$2,755.00
Rate for Payer: Aetna Medicare Advantage	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,848.75
Rate for Payer: Cigna Commercial	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50
Rate for Payer: UnitedHealthcare Community & State	$229.10
Rate for Payer: Wellpoint Medicaid Managed Care	$205.90

PLATE SKY 3 LEVEL TI 54MM

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270673370
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$1,754.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

PLATE SKY 3 LEVEL TI 57MM

Facility

$7,250.00

Hospital Charge Code	270668466
Hospital Revenue Code	278
Min. Negotiated Rate	$205.90
Max. Negotiated Rate	$3,625.00
Rate for Payer: Aetna Commercial	$2,755.00
Rate for Payer: Aetna Medicare Advantage	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,848.75
Rate for Payer: Cigna Commercial	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50
Rate for Payer: UnitedHealthcare Community & State	$229.10
Rate for Payer: Wellpoint Medicaid Managed Care	$205.90

PLATE SKY 3 LEVEL TI 57MM

Facility

$7,250.00

Hospital Charge Code	270668466
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$1,754.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

PLATE SKYKINE 32MM

Facility

$6,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270686918
Hospital Revenue Code	278
Min. Negotiated Rate	$191.70
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,565.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Community & State	$213.30
Rate for Payer: Wellpoint Medicaid Managed Care	$191.70

PLATE SKYKINE 32MM

Facility

$6,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270686918
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

PLATE SKYL ANT CERV 16X54MM 3L

Facility

$8,265.00

Service Code	HCPCS C1713
Hospital Charge Code	270694859
Hospital Revenue Code	278
Min. Negotiated Rate	$1,239.75
Max. Negotiated Rate	$2,000.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,653.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,000.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,239.75

PLATE SKYL ANT CERV 16X54MM 3L

Facility

$8,265.00

Service Code	HCPCS C1713
Hospital Charge Code	270694859
Hospital Revenue Code	278
Min. Negotiated Rate	$234.73
Max. Negotiated Rate	$4,132.50
Rate for Payer: Aetna Commercial	$3,140.70
Rate for Payer: Aetna Medicare Advantage	$2,479.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,107.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,107.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,653.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,107.57
Rate for Payer: Cigna Commercial	$4,132.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,000.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,239.75
Rate for Payer: UnitedHealthcare Community & State	$261.17
Rate for Payer: Wellpoint Medicaid Managed Care	$234.73

PLATE SKYLINE 32MM

Facility

$6,042.00

Service Code	HCPCS C1713
Hospital Charge Code	270686937
Hospital Revenue Code	278
Min. Negotiated Rate	$906.30
Max. Negotiated Rate	$1,462.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,208.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,462.16
Rate for Payer: Qualcare PPO/HMO/WC	$906.30

PLATE SKYLINE 32MM

Facility

$6,042.00

Service Code	HCPCS C1713
Hospital Charge Code	270686937
Hospital Revenue Code	278
Min. Negotiated Rate	$171.59
Max. Negotiated Rate	$3,021.00
Rate for Payer: Aetna Commercial	$2,295.96
Rate for Payer: Aetna Medicare Advantage	$1,812.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,540.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,540.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,208.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,540.71
Rate for Payer: Cigna Commercial	$3,021.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,462.16
Rate for Payer: Qualcare PPO/HMO/WC	$906.30
Rate for Payer: UnitedHealthcare Community & State	$190.93
Rate for Payer: Wellpoint Medicaid Managed Care	$171.59

PLATE SKYLINE 34MM

Facility

$6,042.00

Service Code	HCPCS C1713
Hospital Charge Code	270689203
Hospital Revenue Code	278
Min. Negotiated Rate	$906.30
Max. Negotiated Rate	$1,462.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,208.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,462.16
Rate for Payer: Qualcare PPO/HMO/WC	$906.30

PLATE SKYLINE 34MM

Facility

$6,042.00

Service Code	HCPCS C1713
Hospital Charge Code	270689203
Hospital Revenue Code	278
Min. Negotiated Rate	$171.59
Max. Negotiated Rate	$3,021.00
Rate for Payer: Aetna Commercial	$2,295.96
Rate for Payer: Aetna Medicare Advantage	$1,812.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,540.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,540.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,208.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,540.71
Rate for Payer: Cigna Commercial	$3,021.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,462.16
Rate for Payer: Qualcare PPO/HMO/WC	$906.30
Rate for Payer: UnitedHealthcare Community & State	$190.93
Rate for Payer: Wellpoint Medicaid Managed Care	$171.59

PLATE SKYLINE 34 MM LEVEL 2

Facility

$6,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270681013
Hospital Revenue Code	278
Min. Negotiated Rate	$191.70
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,565.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Community & State	$213.30
Rate for Payer: Wellpoint Medicaid Managed Care	$191.70

PLATE SKYLINE 34 MM LEVEL 2

Facility

$6,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270681013
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

PLATE SKYLINE 42 MM

Facility

$7,290.00

Service Code	HCPCS C1713
Hospital Charge Code	270686283
Hospital Revenue Code	278
Min. Negotiated Rate	$1,093.50
Max. Negotiated Rate	$1,764.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,458.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,764.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,093.50

PLATE SKYLINE 42 MM

Facility

$7,290.00

Service Code	HCPCS C1713
Hospital Charge Code	270686283
Hospital Revenue Code	278
Min. Negotiated Rate	$207.04
Max. Negotiated Rate	$3,645.00
Rate for Payer: Aetna Commercial	$2,770.20
Rate for Payer: Aetna Medicare Advantage	$2,187.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,858.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,858.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,458.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,858.95
Rate for Payer: Cigna Commercial	$3,645.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,764.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,093.50
Rate for Payer: UnitedHealthcare Community & State	$230.36
Rate for Payer: Wellpoint Medicaid Managed Care	$207.04

PLATE SKYLINE 48 MM

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270681583
Hospital Revenue Code	278
Min. Negotiated Rate	$205.90
Max. Negotiated Rate	$3,625.00
Rate for Payer: Aetna Commercial	$2,755.00
Rate for Payer: Aetna Medicare Advantage	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,848.75
Rate for Payer: Cigna Commercial	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50
Rate for Payer: UnitedHealthcare Community & State	$229.10
Rate for Payer: Wellpoint Medicaid Managed Care	$205.90

PLATE SKYLINE 48 MM

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270681583
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$1,754.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

PLATE SKYLINE 54MM

Facility

$11,075.00

Hospital Charge Code	270665835
Hospital Revenue Code	278
Min. Negotiated Rate	$314.53
Max. Negotiated Rate	$5,537.50
Rate for Payer: Aetna Commercial	$4,208.50
Rate for Payer: Aetna Medicare Advantage	$3,322.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,824.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,824.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,824.12
Rate for Payer: Cigna Commercial	$5,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,680.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,661.25
Rate for Payer: UnitedHealthcare Community & State	$349.97
Rate for Payer: Wellpoint Medicaid Managed Care	$314.53

PLATE SKYLINE 54MM

Facility

$11,075.00

Hospital Charge Code	270665835
Hospital Revenue Code	278
Min. Negotiated Rate	$1,661.25
Max. Negotiated Rate	$2,680.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,680.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,661.25

PLATE SLIM 34MM HP 34 MM

Facility

$15,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270694191
Hospital Revenue Code	278
Min. Negotiated Rate	$441.62
Max. Negotiated Rate	$7,775.00
Rate for Payer: Aetna Commercial	$5,909.00
Rate for Payer: Aetna Medicare Advantage	$4,665.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,965.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,965.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,965.25
Rate for Payer: Cigna Commercial	$7,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,763.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,332.50
Rate for Payer: UnitedHealthcare Community & State	$491.38
Rate for Payer: Wellpoint Medicaid Managed Care	$441.62

PLATE SLIM 34MM HP 34 MM

Facility

$15,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270694191
Hospital Revenue Code	278
Min. Negotiated Rate	$2,332.50
Max. Negotiated Rate	$3,763.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,763.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,332.50

PLATE SLIM 3 LEVEL 49MM

Facility

$19,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270695651
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 SLIM 3 LEVEL 49MM

Facility

$19,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270695651
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

Know your out-of-pocket cost for care.

All Charges