Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PLATE VA-LCP 2.4 2COL 7H/4H RT

Facility

$4,610.30

Service Code	HCPCS C1713
Hospital Charge Code	270664957
Hospital Revenue Code	278
Min. Negotiated Rate	$130.93
Max. Negotiated Rate	$2,305.15
Rate for Payer: Aetna Commercial	$1,751.91
Rate for Payer: Aetna Medicare Advantage	$1,383.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,175.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,175.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$922.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,175.63
Rate for Payer: Cigna Commercial	$2,305.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,115.69
Rate for Payer: Qualcare PPO/HMO/WC	$691.54
Rate for Payer: UnitedHealthcare Community & State	$145.69
Rate for Payer: Wellpoint Medicaid Managed Care	$130.93

PLATE VA-LCP 2.4 2COL 7H/4H RT

Facility

$4,610.30

Service Code	HCPCS C1713
Hospital Charge Code	270664957
Hospital Revenue Code	278
Min. Negotiated Rate	$691.54
Max. Negotiated Rate	$1,115.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$922.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,115.69
Rate for Payer: Qualcare PPO/HMO/WC	$691.54

PLATE VA-LCP 2.4 2COL 7H/5H LT

Facility

$4,567.00

Service Code	HCPCS C1713
Hospital Charge Code	270657211
Hospital Revenue Code	278
Min. Negotiated Rate	$685.05
Max. Negotiated Rate	$1,105.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$913.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,105.21
Rate for Payer: Qualcare PPO/HMO/WC	$685.05

PLATE VA-LCP 2.4 2COL 7H/5H LT

Facility

$4,567.00

Service Code	HCPCS C1713
Hospital Charge Code	270657211
Hospital Revenue Code	278
Min. Negotiated Rate	$129.70
Max. Negotiated Rate	$2,283.50
Rate for Payer: Aetna Commercial	$1,735.46
Rate for Payer: Aetna Medicare Advantage	$1,370.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,164.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,164.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$913.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,164.59
Rate for Payer: Cigna Commercial	$2,283.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,105.21
Rate for Payer: Qualcare PPO/HMO/WC	$685.05
Rate for Payer: UnitedHealthcare Community & State	$144.32
Rate for Payer: Wellpoint Medicaid Managed Care	$129.70

PLATE VA-LCP 2.4 2COL 8H/3H RT

Facility

$4,565.50

Service Code	HCPCS C1713
Hospital Charge Code	270695401
Hospital Revenue Code	278
Min. Negotiated Rate	$684.83
Max. Negotiated Rate	$1,104.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$913.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,104.85
Rate for Payer: Qualcare PPO/HMO/WC	$684.83

PLATE VA-LCP 2.4 2COL 8H/3H RT

Facility

$4,565.50

Service Code	HCPCS C1713
Hospital Charge Code	270695401
Hospital Revenue Code	278
Min. Negotiated Rate	$129.66
Max. Negotiated Rate	$2,282.75
Rate for Payer: Aetna Commercial	$1,734.89
Rate for Payer: Aetna Medicare Advantage	$1,369.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,164.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,164.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$913.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,164.20
Rate for Payer: Cigna Commercial	$2,282.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,104.85
Rate for Payer: Qualcare PPO/HMO/WC	$684.83
Rate for Payer: UnitedHealthcare Community & State	$144.27
Rate for Payer: Wellpoint Medicaid Managed Care	$129.66

PLATE VA-LCP 2.4 3H/5H +20DEG

Facility

$2,444.20

Service Code	HCPCS C1713
Hospital Charge Code	270661612
Hospital Revenue Code	278
Min. Negotiated Rate	$69.42
Max. Negotiated Rate	$1,222.10
Rate for Payer: Aetna Commercial	$928.80
Rate for Payer: Aetna Medicare Advantage	$733.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$623.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$623.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$488.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$623.27
Rate for Payer: Cigna Commercial	$1,222.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$591.50
Rate for Payer: Qualcare PPO/HMO/WC	$366.63
Rate for Payer: UnitedHealthcare Community & State	$77.24
Rate for Payer: Wellpoint Medicaid Managed Care	$69.42

PLATE VA-LCP 2.4 3H/5H +20DEG

Facility

$2,444.20

Service Code	HCPCS C1713
Hospital Charge Code	270661612
Hospital Revenue Code	278
Min. Negotiated Rate	$366.63
Max. Negotiated Rate	$591.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$488.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$591.50
Rate for Payer: Qualcare PPO/HMO/WC	$366.63

PLATE VA-LCP 2.4 3H/5H +90DEG

Facility

$2,444.20

Service Code	HCPCS C1713
Hospital Charge Code	270661610
Hospital Revenue Code	278
Min. Negotiated Rate	$69.42
Max. Negotiated Rate	$1,222.10
Rate for Payer: Aetna Commercial	$928.80
Rate for Payer: Aetna Medicare Advantage	$733.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$623.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$623.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$488.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$623.27
Rate for Payer: Cigna Commercial	$1,222.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$591.50
Rate for Payer: Qualcare PPO/HMO/WC	$366.63
Rate for Payer: UnitedHealthcare Community & State	$77.24
Rate for Payer: Wellpoint Medicaid Managed Care	$69.42

PLATE VA-LCP 2.4 3H/5H +90DEG

Facility

$2,444.20

Service Code	HCPCS C1713
Hospital Charge Code	270661610
Hospital Revenue Code	278
Min. Negotiated Rate	$366.63
Max. Negotiated Rate	$591.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$488.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$591.50
Rate for Payer: Qualcare PPO/HMO/WC	$366.63

PLATE VA-LCP 2.4 3H/5H -90DEG

Facility

$2,444.20

Service Code	HCPCS C1713
Hospital Charge Code	270661611
Hospital Revenue Code	278
Min. Negotiated Rate	$69.42
Max. Negotiated Rate	$1,222.10
Rate for Payer: Aetna Commercial	$928.80
Rate for Payer: Aetna Medicare Advantage	$733.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$623.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$623.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$488.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$623.27
Rate for Payer: Cigna Commercial	$1,222.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$591.50
Rate for Payer: Qualcare PPO/HMO/WC	$366.63
Rate for Payer: UnitedHealthcare Community & State	$77.24
Rate for Payer: Wellpoint Medicaid Managed Care	$69.42

PLATE VA-LCP 2.4 3H/5H -90DEG

Facility

$2,444.20

Service Code	HCPCS C1713
Hospital Charge Code	270661611
Hospital Revenue Code	278
Min. Negotiated Rate	$366.63
Max. Negotiated Rate	$591.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$488.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$591.50
Rate for Payer: Qualcare PPO/HMO/WC	$366.63

PLATE VA-LCP 2.4MM 6H/2H LEFT

Facility

$4,081.90

Service Code	HCPCS C1713
Hospital Charge Code	270676423
Hospital Revenue Code	278
Min. Negotiated Rate	$115.93
Max. Negotiated Rate	$2,040.95
Rate for Payer: Aetna Commercial	$1,551.12
Rate for Payer: Aetna Medicare Advantage	$1,224.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,040.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,040.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$816.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,040.88
Rate for Payer: Cigna Commercial	$2,040.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$987.82
Rate for Payer: Qualcare PPO/HMO/WC	$612.28
Rate for Payer: UnitedHealthcare Community & State	$128.99
Rate for Payer: Wellpoint Medicaid Managed Care	$115.93

PLATE VA-LCP 2.4MM 6H/2H LEFT

Facility

$4,081.90

Service Code	HCPCS C1713
Hospital Charge Code	270676423
Hospital Revenue Code	278
Min. Negotiated Rate	$612.28
Max. Negotiated Rate	$987.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$816.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$987.82
Rate for Payer: Qualcare PPO/HMO/WC	$612.28

PLATE VA-LCP 2.4MM 6H/2H RIGHT

Facility

$4,081.90

Service Code	HCPCS C1713
Hospital Charge Code	270676424
Hospital Revenue Code	278
Min. Negotiated Rate	$612.28
Max. Negotiated Rate	$987.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$816.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$987.82
Rate for Payer: Qualcare PPO/HMO/WC	$612.28

PLATE VA-LCP 2.4MM 6H/2H RIGHT

Facility

$4,081.90

Service Code	HCPCS C1713
Hospital Charge Code	270676424
Hospital Revenue Code	278
Min. Negotiated Rate	$115.93
Max. Negotiated Rate	$2,040.95
Rate for Payer: Aetna Commercial	$1,551.12
Rate for Payer: Aetna Medicare Advantage	$1,224.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,040.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,040.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$816.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,040.88
Rate for Payer: Cigna Commercial	$2,040.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$987.82
Rate for Payer: Qualcare PPO/HMO/WC	$612.28
Rate for Payer: UnitedHealthcare Community & State	$128.99
Rate for Payer: Wellpoint Medicaid Managed Care	$115.93

PLATE VA-LCP 2.4MM 6H/2H RT ST

Facility

$4,288.90

Service Code	HCPCS C1713
Hospital Charge Code	270677144
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 2.4MM 6H/2H RT ST

Facility

$4,288.90

Service Code	HCPCS C1713
Hospital Charge Code	270677144
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 2.4MM 6H/3H LEFT

Facility

$4,242.55

Service Code	HCPCS C1713
Hospital Charge Code	270661958
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 2.4MM 6H/3H LEFT

Facility

$4,242.55

Service Code	HCPCS C1713
Hospital Charge Code	270661958
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 2.4MM 6H/3H LT ST

Facility

$4,449.60

Service Code	HCPCS C1713
Hospital Charge Code	270663936
Hospital Revenue Code	278
Min. Negotiated Rate	$126.37
Max. Negotiated Rate	$2,224.80
Rate for Payer: Aetna Commercial	$1,690.85
Rate for Payer: Aetna Medicare Advantage	$1,334.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,134.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,134.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$889.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,134.65
Rate for Payer: Cigna Commercial	$2,224.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,076.80
Rate for Payer: Qualcare PPO/HMO/WC	$667.44
Rate for Payer: UnitedHealthcare Community & State	$140.61
Rate for Payer: Wellpoint Medicaid Managed Care	$126.37

PLATE VA-LCP 2.4MM 6H/3H LT ST

Facility

$4,449.60

Service Code	HCPCS C1713
Hospital Charge Code	270663936
Hospital Revenue Code	278
Min. Negotiated Rate	$667.44
Max. Negotiated Rate	$1,076.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$889.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,076.80
Rate for Payer: Qualcare PPO/HMO/WC	$667.44

PLATE VA-LCP 2.4MM 6H/3H RIGHT

Facility

$4,242.55

Service Code	HCPCS C1713
Hospital Charge Code	270676425
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 2.4MM 6H/3H RIGHT

Facility

$4,583.10

Service Code	HCPCS C1713
Hospital Charge Code	270680600
Hospital Revenue Code	278
Min. Negotiated Rate	$130.16
Max. Negotiated Rate	$2,291.55
Rate for Payer: Aetna Commercial	$1,741.58
Rate for Payer: Aetna Medicare Advantage	$1,374.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,168.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,168.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$916.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,168.69
Rate for Payer: Cigna Commercial	$2,291.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,109.11
Rate for Payer: Qualcare PPO/HMO/WC	$687.47
Rate for Payer: UnitedHealthcare Community & State	$144.83
Rate for Payer: Wellpoint Medicaid Managed Care	$130.16

PLATE VA-LCP 2.4MM 6H/3H RIGHT

Facility

$4,583.10

Service Code	HCPCS C1713
Hospital Charge Code	270680600
Hospital Revenue Code	278
Min. Negotiated Rate	$687.47
Max. Negotiated Rate	$1,109.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$916.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,109.11
Rate for Payer: Qualcare PPO/HMO/WC	$687.47

Know your out-of-pocket cost for care.

All Charges