Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

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	$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/4H LEFT

Facility

$4,403.25

Service Code	HCPCS C1713
Hospital Charge Code	270676426
Hospital Revenue Code	278
Min. Negotiated Rate	$125.05
Max. Negotiated Rate	$2,201.62
Rate for Payer: Aetna Commercial	$1,673.23
Rate for Payer: Aetna Medicare Advantage	$1,320.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,122.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,122.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$880.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,122.83
Rate for Payer: Cigna Commercial	$2,201.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,065.59
Rate for Payer: Qualcare PPO/HMO/WC	$660.49
Rate for Payer: UnitedHealthcare Community & State	$139.14
Rate for Payer: Wellpoint Medicaid Managed Care	$125.05

PLATE VA-LCP 2.4MM 6H/4H LEFT

Facility

$4,403.25

Service Code	HCPCS C1713
Hospital Charge Code	270676426
Hospital Revenue Code	278
Min. Negotiated Rate	$660.49
Max. Negotiated Rate	$1,065.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$880.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,065.59
Rate for Payer: Qualcare PPO/HMO/WC	$660.49

PLATE VA-LCP 2.4MM 6H/4H RIGHT

Facility

$4,403.25

Service Code	HCPCS C1713
Hospital Charge Code	270676427
Hospital Revenue Code	278
Min. Negotiated Rate	$125.05
Max. Negotiated Rate	$2,201.62
Rate for Payer: Aetna Commercial	$1,673.23
Rate for Payer: Aetna Medicare Advantage	$1,320.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,122.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,122.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$880.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,122.83
Rate for Payer: Cigna Commercial	$2,201.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,065.59
Rate for Payer: Qualcare PPO/HMO/WC	$660.49
Rate for Payer: UnitedHealthcare Community & State	$139.14
Rate for Payer: Wellpoint Medicaid Managed Care	$125.05

PLATE VA-LCP 2.4MM 6H/4H RIGHT

Facility

$4,403.25

Service Code	HCPCS C1713
Hospital Charge Code	270676427
Hospital Revenue Code	278
Min. Negotiated Rate	$660.49
Max. Negotiated Rate	$1,065.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$880.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,065.59
Rate for Payer: Qualcare PPO/HMO/WC	$660.49

PLATE VA-LCP 2.4MM 6H/4H RT ST

Facility

$4,610.30

Service Code	HCPCS C1713
Hospital Charge Code	270670539
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 2.4MM 6H/4H RT ST

Facility

$4,610.30

Service Code	HCPCS C1713
Hospital Charge Code	270670539
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 2.4MM 6H/5H LEFT

Facility

$4,567.00

Service Code	HCPCS C1713
Hospital Charge Code	270676429
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 2.4MM 6H/5H LEFT

Facility

$4,567.00

Service Code	HCPCS C1713
Hospital Charge Code	270676429
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 2.4MM 6H/5H RIGHT

Facility

$4,567.00

Service Code	HCPCS C1713
Hospital Charge Code	270676428
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 2.4MM 6H/5H RIGHT

Facility

$4,567.00

Service Code	HCPCS C1713
Hospital Charge Code	270676428
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 2.7/3.5 2H/L/73MM

Facility

$3,918.10

Hospital Charge Code	270677622
Hospital Revenue Code	278
Min. Negotiated Rate	$587.72
Max. Negotiated Rate	$948.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$783.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$948.18
Rate for Payer: Qualcare PPO/HMO/WC	$587.72

PLATE VA-LCP 2.7/3.5 2H/L/73MM

Facility

$3,918.10

Hospital Charge Code	270677622
Hospital Revenue Code	278
Min. Negotiated Rate	$111.27
Max. Negotiated Rate	$1,959.05
Rate for Payer: Aetna Commercial	$1,488.88
Rate for Payer: Aetna Medicare Advantage	$1,175.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$999.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$999.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$783.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$999.12
Rate for Payer: Cigna Commercial	$1,959.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$948.18
Rate for Payer: Qualcare PPO/HMO/WC	$587.72
Rate for Payer: UnitedHealthcare Community & State	$123.81
Rate for Payer: Wellpoint Medicaid Managed Care	$111.27

PLATE VA-LCP 2.7/3.5 2H L 90MM

Facility

$4,613.35

Service Code	HCPCS C1713
Hospital Charge Code	270670537
Hospital Revenue Code	278
Min. Negotiated Rate	$131.02
Max. Negotiated Rate	$2,306.68
Rate for Payer: Aetna Commercial	$1,753.07
Rate for Payer: Aetna Medicare Advantage	$1,384.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,176.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,176.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$922.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,176.40
Rate for Payer: Cigna Commercial	$2,306.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,116.43
Rate for Payer: Qualcare PPO/HMO/WC	$692.00
Rate for Payer: UnitedHealthcare Community & State	$145.78
Rate for Payer: Wellpoint Medicaid Managed Care	$131.02

PLATE VA-LCP 2.7/3.5 2H L 90MM

Facility

$4,613.35

Service Code	HCPCS C1713
Hospital Charge Code	270670537
Hospital Revenue Code	278
Min. Negotiated Rate	$692.00
Max. Negotiated Rate	$1,116.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$922.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,116.43
Rate for Payer: Qualcare PPO/HMO/WC	$692.00

PLATE VA-LCP 2.7/3.5 2H LT

Facility

$4,406.35

Service Code	HCPCS C1713
Hospital Charge Code	270674356
Hospital Revenue Code	278
Min. Negotiated Rate	$660.95
Max. Negotiated Rate	$1,066.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$881.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,066.34
Rate for Payer: Qualcare PPO/HMO/WC	$660.95

PLATE VA-LCP 2.7/3.5 2H LT

Facility

$4,406.35

Service Code	HCPCS C1713
Hospital Charge Code	270674356
Hospital Revenue Code	278
Min. Negotiated Rate	$125.14
Max. Negotiated Rate	$2,203.18
Rate for Payer: Aetna Commercial	$1,674.41
Rate for Payer: Aetna Medicare Advantage	$1,321.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,123.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,123.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$881.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,123.62
Rate for Payer: Cigna Commercial	$2,203.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,066.34
Rate for Payer: Qualcare PPO/HMO/WC	$660.95
Rate for Payer: UnitedHealthcare Community & State	$139.24
Rate for Payer: Wellpoint Medicaid Managed Care	$125.14

PLATE VA-LCP 2.7/3.5 2H LT ST

Facility

$4,613.35

Service Code	HCPCS C1713
Hospital Charge Code	270649738
Hospital Revenue Code	278
Min. Negotiated Rate	$692.00
Max. Negotiated Rate	$1,116.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$922.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,116.43
Rate for Payer: Qualcare PPO/HMO/WC	$692.00

PLATE VA-LCP 2.7/3.5 2H LT ST

Facility

$4,125.15

Service Code	HCPCS C1713
Hospital Charge Code	270673548
Hospital Revenue Code	278
Min. Negotiated Rate	$117.15
Max. Negotiated Rate	$2,062.57
Rate for Payer: Aetna Commercial	$1,567.56
Rate for Payer: Aetna Medicare Advantage	$1,237.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,051.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,051.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,051.91
Rate for Payer: Cigna Commercial	$2,062.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$998.29
Rate for Payer: Qualcare PPO/HMO/WC	$618.77
Rate for Payer: UnitedHealthcare Community & State	$130.35
Rate for Payer: Wellpoint Medicaid Managed Care	$117.15

PLATE VA-LCP 2.7/3.5 2H LT ST

Facility

$4,613.35

Service Code	HCPCS C1713
Hospital Charge Code	270649738
Hospital Revenue Code	278
Min. Negotiated Rate	$131.02
Max. Negotiated Rate	$2,306.68
Rate for Payer: Aetna Commercial	$1,753.07
Rate for Payer: Aetna Medicare Advantage	$1,384.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,176.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,176.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$922.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,176.40
Rate for Payer: Cigna Commercial	$2,306.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,116.43
Rate for Payer: Qualcare PPO/HMO/WC	$692.00
Rate for Payer: UnitedHealthcare Community & State	$145.78
Rate for Payer: Wellpoint Medicaid Managed Care	$131.02

PLATE VA-LCP 2.7/3.5 2H LT ST

Facility

$4,125.15

Service Code	HCPCS C1713
Hospital Charge Code	270673548
Hospital Revenue Code	278
Min. Negotiated Rate	$618.77
Max. Negotiated Rate	$998.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$998.29
Rate for Payer: Qualcare PPO/HMO/WC	$618.77

PLATE VA-LCP 2.7/3.5 2H/R/73MM

Facility

$3,918.10

Hospital Charge Code	270677621
Hospital Revenue Code	278
Min. Negotiated Rate	$587.72
Max. Negotiated Rate	$948.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$783.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$948.18
Rate for Payer: Qualcare PPO/HMO/WC	$587.72

PLATE VA-LCP 2.7/3.5 2H/R/73MM

Facility

$3,918.10

Hospital Charge Code	270677621
Hospital Revenue Code	278
Min. Negotiated Rate	$111.27
Max. Negotiated Rate	$1,959.05
Rate for Payer: Aetna Commercial	$1,488.88
Rate for Payer: Aetna Medicare Advantage	$1,175.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$999.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$999.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$783.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$999.12
Rate for Payer: Cigna Commercial	$1,959.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$948.18
Rate for Payer: Qualcare PPO/HMO/WC	$587.72
Rate for Payer: UnitedHealthcare Community & State	$123.81
Rate for Payer: Wellpoint Medicaid Managed Care	$111.27

PLATE VA-LCP 2.7/3.5 2H/R/90MM

Facility

$4,406.35

Hospital Charge Code	270677623
Hospital Revenue Code	278
Min. Negotiated Rate	$660.95
Max. Negotiated Rate	$1,066.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$881.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,066.34
Rate for Payer: Qualcare PPO/HMO/WC	$660.95

PLATE VA-LCP 2.7/3.5 2H/R/90MM

Facility

$4,406.35

Hospital Charge Code	270677623
Hospital Revenue Code	278
Min. Negotiated Rate	$125.14
Max. Negotiated Rate	$2,203.18
Rate for Payer: Aetna Commercial	$1,674.41
Rate for Payer: Aetna Medicare Advantage	$1,321.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,123.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,123.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$881.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,123.62
Rate for Payer: Cigna Commercial	$2,203.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,066.34
Rate for Payer: Qualcare PPO/HMO/WC	$660.95
Rate for Payer: UnitedHealthcare Community & State	$139.24
Rate for Payer: Wellpoint Medicaid Managed Care	$125.14

Know your out-of-pocket cost for care.

All Charges