Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PLATE UNIVERAL 8 HOLE

Facility

$8,085.00

Service Code	HCPCS C1713
Hospital Charge Code	270690139
Hospital Revenue Code	278
Min. Negotiated Rate	$229.61
Max. Negotiated Rate	$4,042.50
Rate for Payer: Aetna Commercial	$3,072.30
Rate for Payer: Aetna Medicare Advantage	$2,425.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,061.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,061.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,617.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,061.68
Rate for Payer: Cigna Commercial	$4,042.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,956.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,212.75
Rate for Payer: UnitedHealthcare Community & State	$255.49
Rate for Payer: Wellpoint Medicaid Managed Care	$229.61

PLATE UNIVERAL 8 HOLE

Facility

$8,085.00

Service Code	HCPCS C1713
Hospital Charge Code	270690139
Hospital Revenue Code	278
Min. Negotiated Rate	$1,212.75
Max. Negotiated Rate	$1,956.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,617.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,956.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,212.75

PLATE UNIVERSAL ANTERIOR TT

Facility

$19,055.00

Service Code	HCPCS C1713
Hospital Charge Code	270683634
Hospital Revenue Code	278
Min. Negotiated Rate	$2,858.25
Max. Negotiated Rate	$4,611.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,811.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,611.31
Rate for Payer: Qualcare PPO/HMO/WC	$2,858.25

PLATE UNIVERSAL ANTERIOR TT

Facility

$19,055.00

Service Code	HCPCS C1713
Hospital Charge Code	270683634
Hospital Revenue Code	278
Min. Negotiated Rate	$541.16
Max. Negotiated Rate	$9,527.50
Rate for Payer: Aetna Commercial	$7,240.90
Rate for Payer: Aetna Medicare Advantage	$5,716.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,859.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,859.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,811.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,859.02
Rate for Payer: Cigna Commercial	$9,527.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,611.31
Rate for Payer: Qualcare PPO/HMO/WC	$2,858.25
Rate for Payer: UnitedHealthcare Community & State	$602.14
Rate for Payer: Wellpoint Medicaid Managed Care	$541.16

PLATE VA ANTLAT DSTL TIB 10H

Facility

$9,172.15

Service Code	HCPCS C1713
Hospital Charge Code	270693046
Hospital Revenue Code	278
Min. Negotiated Rate	$260.49
Max. Negotiated Rate	$4,586.07
Rate for Payer: Aetna Commercial	$3,485.42
Rate for Payer: Aetna Medicare Advantage	$2,751.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,338.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,338.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,834.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,338.90
Rate for Payer: Cigna Commercial	$4,586.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.82
Rate for Payer: UnitedHealthcare Community & State	$289.84
Rate for Payer: Wellpoint Medicaid Managed Care	$260.49

PLATE VA ANTLAT DSTL TIB 10H

Facility

$9,172.15

Service Code	HCPCS C1713
Hospital Charge Code	270693046
Hospital Revenue Code	278
Min. Negotiated Rate	$1,375.82
Max. Negotiated Rate	$2,219.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,834.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.82

PLATE VA LCKG CALC 2.7x40MM RT

Facility

$4,842.00

Service Code	HCPCS C1713
Hospital Charge Code	270681871
Hospital Revenue Code	278
Min. Negotiated Rate	$726.30
Max. Negotiated Rate	$1,171.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$968.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,171.76
Rate for Payer: Qualcare PPO/HMO/WC	$726.30

PLATE VA LCKG CALC 2.7x40MM RT

Facility

$4,842.00

Service Code	HCPCS C1713
Hospital Charge Code	270681871
Hospital Revenue Code	278
Min. Negotiated Rate	$137.51
Max. Negotiated Rate	$2,421.00
Rate for Payer: Aetna Commercial	$1,839.96
Rate for Payer: Aetna Medicare Advantage	$1,452.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,234.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,234.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$968.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,234.71
Rate for Payer: Cigna Commercial	$2,421.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,171.76
Rate for Payer: Qualcare PPO/HMO/WC	$726.30
Rate for Payer: UnitedHealthcare Community & State	$153.01
Rate for Payer: Wellpoint Medicaid Managed Care	$137.51

PLATE VA LCKG CALC 2.7x56MM RT

Facility

$4,492.00

Service Code	HCPCS C1713
Hospital Charge Code	270680136
Hospital Revenue Code	278
Min. Negotiated Rate	$127.57
Max. Negotiated Rate	$2,246.00
Rate for Payer: Aetna Commercial	$1,706.96
Rate for Payer: Aetna Medicare Advantage	$1,347.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,145.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,145.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$898.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,145.46
Rate for Payer: Cigna Commercial	$2,246.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,087.06
Rate for Payer: Qualcare PPO/HMO/WC	$673.80
Rate for Payer: UnitedHealthcare Community & State	$141.95
Rate for Payer: Wellpoint Medicaid Managed Care	$127.57

PLATE VA LCKG CALC 2.7x56MM RT

Facility

$4,492.00

Service Code	HCPCS C1713
Hospital Charge Code	270680136
Hospital Revenue Code	278
Min. Negotiated Rate	$673.80
Max. Negotiated Rate	$1,087.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$898.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,087.06
Rate for Payer: Qualcare PPO/HMO/WC	$673.80

PLATE VA LCKG CALC 2.7x70MM RT

Facility

$4,520.65

Hospital Charge Code	270677508
Hospital Revenue Code	278
Min. Negotiated Rate	$128.39
Max. Negotiated Rate	$2,260.32
Rate for Payer: Aetna Commercial	$1,717.85
Rate for Payer: Aetna Medicare Advantage	$1,356.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,152.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,152.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$904.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,152.77
Rate for Payer: Cigna Commercial	$2,260.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,094.00
Rate for Payer: Qualcare PPO/HMO/WC	$678.10
Rate for Payer: UnitedHealthcare Community & State	$142.85
Rate for Payer: Wellpoint Medicaid Managed Care	$128.39

PLATE VA LCKG CALC 2.7x70MM RT

Facility

$4,520.65

Hospital Charge Code	270677508
Hospital Revenue Code	278
Min. Negotiated Rate	$678.10
Max. Negotiated Rate	$1,094.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$904.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,094.00
Rate for Payer: Qualcare PPO/HMO/WC	$678.10

PLATE-VA LCKGMESH 2.4/2.7mm 12

Facility

$7,145.15

Service Code	HCPCS C1713
Hospital Charge Code	270683898
Hospital Revenue Code	278
Min. Negotiated Rate	$202.92
Max. Negotiated Rate	$3,572.57
Rate for Payer: Aetna Commercial	$2,715.16
Rate for Payer: Aetna Medicare Advantage	$2,143.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,822.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,822.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,429.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,822.01
Rate for Payer: Cigna Commercial	$3,572.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,729.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,071.77
Rate for Payer: UnitedHealthcare Community & State	$225.79
Rate for Payer: Wellpoint Medicaid Managed Care	$202.92

PLATE-VA LCKGMESH 2.4/2.7mm 12

Facility

$7,145.15

Service Code	HCPCS C1713
Hospital Charge Code	270683898
Hospital Revenue Code	278
Min. Negotiated Rate	$1,071.77
Max. Negotiated Rate	$1,729.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,429.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,729.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,071.77

PLATE VA LCP 2.3 3.5MM 8H RT

Facility

$6,813.45

Service Code	HCPCS C1713
Hospital Charge Code	270660906
Hospital Revenue Code	278
Min. Negotiated Rate	$1,022.02
Max. Negotiated Rate	$1,648.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,362.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,648.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,022.02

PLATE VA LCP 2.3 3.5MM 8H RT

Facility

$6,813.45

Service Code	HCPCS C1713
Hospital Charge Code	270660906
Hospital Revenue Code	278
Min. Negotiated Rate	$193.50
Max. Negotiated Rate	$3,406.72
Rate for Payer: Aetna Commercial	$2,589.11
Rate for Payer: Aetna Medicare Advantage	$2,044.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,737.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,737.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,362.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,737.43
Rate for Payer: Cigna Commercial	$3,406.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,648.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,022.02
Rate for Payer: UnitedHealthcare Community & State	$215.31
Rate for Payer: Wellpoint Medicaid Managed Care	$193.50

PLATE VA-LCP 2.4/2.7MM 2 HOLE

Facility

$4,822.60

Service Code	HCPCS C1713
Hospital Charge Code	270695925
Hospital Revenue Code	278
Min. Negotiated Rate	$723.39
Max. Negotiated Rate	$1,167.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$964.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,167.07
Rate for Payer: Qualcare PPO/HMO/WC	$723.39

PLATE VA-LCP 2.4/2.7MM 2 HOLE

Facility

$4,822.60

Service Code	HCPCS C1713
Hospital Charge Code	270695925
Hospital Revenue Code	278
Min. Negotiated Rate	$136.96
Max. Negotiated Rate	$2,411.30
Rate for Payer: Aetna Commercial	$1,832.59
Rate for Payer: Aetna Medicare Advantage	$1,446.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,229.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,229.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$964.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,229.76
Rate for Payer: Cigna Commercial	$2,411.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,167.07
Rate for Payer: Qualcare PPO/HMO/WC	$723.39
Rate for Payer: UnitedHealthcare Community & State	$152.39
Rate for Payer: Wellpoint Medicaid Managed Care	$136.96

PLATE VALCP 2.4 2CL HD 7H/3H R

Facility

$4,242.55

Service Code	HCPCS C1713
Hospital Charge Code	270679374
Hospital Revenue Code	278
Min. Negotiated Rate	$636.38
Max. Negotiated Rate	$1,026.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$848.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,026.70
Rate for Payer: Qualcare PPO/HMO/WC	$636.38

PLATE VALCP 2.4 2CL HD 7H/3H R

Facility

$4,242.55

Service Code	HCPCS C1713
Hospital Charge Code	270679374
Hospital Revenue Code	278
Min. Negotiated Rate	$120.49
Max. Negotiated Rate	$2,121.28
Rate for Payer: Aetna Commercial	$1,612.17
Rate for Payer: Aetna Medicare Advantage	$1,272.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,081.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,081.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$848.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,081.85
Rate for Payer: Cigna Commercial	$2,121.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,026.70
Rate for Payer: Qualcare PPO/HMO/WC	$636.38
Rate for Payer: UnitedHealthcare Community & State	$134.06
Rate for Payer: Wellpoint Medicaid Managed Care	$120.49

PLATE VA-LCP 2.4 2 CLM 6H/3H R

Facility

$4,242.55

Service Code	HCPCS C1713
Hospital Charge Code	270661960
Hospital Revenue Code	278
Min. Negotiated Rate	$120.49
Max. Negotiated Rate	$2,121.28
Rate for Payer: Aetna Commercial	$1,612.17
Rate for Payer: Aetna Medicare Advantage	$1,272.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,081.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,081.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$848.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,081.85
Rate for Payer: Cigna Commercial	$2,121.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,026.70
Rate for Payer: Qualcare PPO/HMO/WC	$636.38
Rate for Payer: UnitedHealthcare Community & State	$134.06
Rate for Payer: Wellpoint Medicaid Managed Care	$120.49

PLATE VA-LCP 2.4 2 CLM 6H/3H R

Facility

$4,242.55

Service Code	HCPCS C1713
Hospital Charge Code	270661960
Hospital Revenue Code	278
Min. Negotiated Rate	$636.38
Max. Negotiated Rate	$1,026.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$848.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,026.70
Rate for Payer: Qualcare PPO/HMO/WC	$636.38

PLATE VA-LCP 2.4 2COL 6H/2H LT

Facility

$4,288.90

Hospital Charge Code	270677782
Hospital Revenue Code	278
Min. Negotiated Rate	$643.34
Max. Negotiated Rate	$1,037.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$857.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,037.91
Rate for Payer: Qualcare PPO/HMO/WC	$643.34

PLATE VA-LCP 2.4 2COL 6H/2H LT

Facility

$4,288.90

Hospital Charge Code	270677782
Hospital Revenue Code	278
Min. Negotiated Rate	$121.80
Max. Negotiated Rate	$2,144.45
Rate for Payer: Aetna Commercial	$1,629.78
Rate for Payer: Aetna Medicare Advantage	$1,286.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,093.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,093.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$857.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,093.67
Rate for Payer: Cigna Commercial	$2,144.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,037.91
Rate for Payer: Qualcare PPO/HMO/WC	$643.34
Rate for Payer: UnitedHealthcare Community & State	$135.53
Rate for Payer: Wellpoint Medicaid Managed Care	$121.80

PLATE VA-LCP 2.4 2COL 6H/2H RT

Facility

$4,417.55

Service Code	HCPCS C1713
Hospital Charge Code	270661259
Hospital Revenue Code	278
Min. Negotiated Rate	$662.63
Max. Negotiated Rate	$1,069.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$883.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,069.05
Rate for Payer: Qualcare PPO/HMO/WC	$662.63

Know your out-of-pocket cost for care.

All Charges