Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PLATE VA-LCP 2.7/3.5MM 12H LT

Facility

$7,752.80

Service Code	HCPCS C1713
Hospital Charge Code	270676154
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.92
Max. Negotiated Rate	$1,876.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,876.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.92

PLATEVA-LCP2.7/3.5MM142MM6HLT

Facility

$6,182.15

Service Code	HCPCS C1713
Hospital Charge Code	270695501
Hospital Revenue Code	278
Min. Negotiated Rate	$175.57
Max. Negotiated Rate	$3,091.07
Rate for Payer: Aetna Commercial	$2,349.22
Rate for Payer: Aetna Medicare Advantage	$1,854.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,576.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,576.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,236.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,576.45
Rate for Payer: Cigna Commercial	$3,091.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,496.08
Rate for Payer: Qualcare PPO/HMO/WC	$927.32
Rate for Payer: UnitedHealthcare Community & State	$195.36
Rate for Payer: Wellpoint Medicaid Managed Care	$175.57

PLATEVA-LCP2.7/3.5MM142MM6HLT

Facility

$6,182.15

Service Code	HCPCS C1713
Hospital Charge Code	270695501
Hospital Revenue Code	278
Min. Negotiated Rate	$927.32
Max. Negotiated Rate	$1,496.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,236.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,496.08
Rate for Payer: Qualcare PPO/HMO/WC	$927.32

PLATE VA-LCP 2.7/3.5MM 14H RT

Facility

$10,200.50

Service Code	HCPCS C1713
Hospital Charge Code	270693277
Hospital Revenue Code	278
Min. Negotiated Rate	$1,530.08
Max. Negotiated Rate	$2,468.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,040.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,468.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,530.08

PLATE VA-LCP 2.7/3.5MM 14H RT

Facility

$10,200.50

Service Code	HCPCS C1713
Hospital Charge Code	270693277
Hospital Revenue Code	278
Min. Negotiated Rate	$289.69
Max. Negotiated Rate	$5,100.25
Rate for Payer: Aetna Commercial	$3,876.19
Rate for Payer: Aetna Medicare Advantage	$3,060.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,601.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,601.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,040.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,601.13
Rate for Payer: Cigna Commercial	$5,100.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,468.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,530.08
Rate for Payer: UnitedHealthcare Community & State	$322.34
Rate for Payer: Wellpoint Medicaid Managed Care	$289.69

PLATE VA-LCP 2.7/3.5MM 4H

Facility

$7,233.70

Service Code	HCPCS C1713
Hospital Charge Code	270679060
Hospital Revenue Code	278
Min. Negotiated Rate	$1,085.06
Max. Negotiated Rate	$1,750.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,446.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,750.56
Rate for Payer: Qualcare PPO/HMO/WC	$1,085.06

PLATE VA-LCP 2.7/3.5MM 4H

Facility

$7,233.70

Service Code	HCPCS C1713
Hospital Charge Code	270679060
Hospital Revenue Code	278
Min. Negotiated Rate	$205.44
Max. Negotiated Rate	$3,616.85
Rate for Payer: Aetna Commercial	$2,748.81
Rate for Payer: Aetna Medicare Advantage	$2,170.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,844.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,844.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,446.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,844.59
Rate for Payer: Cigna Commercial	$3,616.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,750.56
Rate for Payer: Qualcare PPO/HMO/WC	$1,085.06
Rate for Payer: UnitedHealthcare Community & State	$228.58
Rate for Payer: Wellpoint Medicaid Managed Care	$205.44

PLATE VA-LCP 2.7/3.5MM 4H 6T

Facility

$6,665.15

Service Code	HCPCS C1713
Hospital Charge Code	270677596
Hospital Revenue Code	278
Min. Negotiated Rate	$999.77
Max. Negotiated Rate	$1,612.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,333.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,612.97
Rate for Payer: Qualcare PPO/HMO/WC	$999.77

PLATE VA-LCP 2.7/3.5MM 4H 6T

Facility

$6,665.15

Service Code	HCPCS C1713
Hospital Charge Code	270677596
Hospital Revenue Code	278
Min. Negotiated Rate	$189.29
Max. Negotiated Rate	$3,332.57
Rate for Payer: Aetna Commercial	$2,532.76
Rate for Payer: Aetna Medicare Advantage	$1,999.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,699.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,699.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,333.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,699.61
Rate for Payer: Cigna Commercial	$3,332.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,612.97
Rate for Payer: Qualcare PPO/HMO/WC	$999.77
Rate for Payer: UnitedHealthcare Community & State	$210.62
Rate for Payer: Wellpoint Medicaid Managed Care	$189.29

PLATE VA-LCP 2.7/3.5MM 4H 6T S

Facility

$6,872.15

Service Code	HCPCS C1713
Hospital Charge Code	270678670
Hospital Revenue Code	278
Min. Negotiated Rate	$1,030.82
Max. Negotiated Rate	$1,663.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,374.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,663.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,030.82

PLATE VA-LCP 2.7/3.5MM 4H 6T S

Facility

$6,872.15

Service Code	HCPCS C1713
Hospital Charge Code	270678670
Hospital Revenue Code	278
Min. Negotiated Rate	$195.17
Max. Negotiated Rate	$3,436.07
Rate for Payer: Aetna Commercial	$2,611.42
Rate for Payer: Aetna Medicare Advantage	$2,061.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,752.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,752.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,374.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,752.40
Rate for Payer: Cigna Commercial	$3,436.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,663.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,030.82
Rate for Payer: UnitedHealthcare Community & State	$217.16
Rate for Payer: Wellpoint Medicaid Managed Care	$195.17

PLATE VA-LCP 2.7/3.5MM 6H LT

Facility

$6,541.55

Service Code	HCPCS C1713
Hospital Charge Code	270678038
Hospital Revenue Code	278
Min. Negotiated Rate	$981.23
Max. Negotiated Rate	$1,583.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,308.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,583.06
Rate for Payer: Qualcare PPO/HMO/WC	$981.23

PLATE VA-LCP 2.7/3.5MM 6H LT

Facility

$6,541.55

Service Code	HCPCS C1713
Hospital Charge Code	270678038
Hospital Revenue Code	278
Min. Negotiated Rate	$185.78
Max. Negotiated Rate	$3,270.78
Rate for Payer: Aetna Commercial	$2,485.79
Rate for Payer: Aetna Medicare Advantage	$1,962.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,668.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,668.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,308.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,668.10
Rate for Payer: Cigna Commercial	$3,270.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,583.06
Rate for Payer: Qualcare PPO/HMO/WC	$981.23
Rate for Payer: UnitedHealthcare Community & State	$206.71
Rate for Payer: Wellpoint Medicaid Managed Care	$185.78

PLATE VA-LCP 2.7/3.5MM 6H RT

Facility

$6,742.40

Service Code	HCPCS C1713
Hospital Charge Code	270660907
Hospital Revenue Code	278
Min. Negotiated Rate	$191.48
Max. Negotiated Rate	$3,371.20
Rate for Payer: Aetna Commercial	$2,562.11
Rate for Payer: Aetna Medicare Advantage	$2,022.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,719.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,719.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,348.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,719.31
Rate for Payer: Cigna Commercial	$3,371.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,631.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,011.36
Rate for Payer: UnitedHealthcare Community & State	$213.06
Rate for Payer: Wellpoint Medicaid Managed Care	$191.48

PLATE VA-LCP 2.7/3.5MM 6H RT

Facility

$6,742.40

Service Code	HCPCS C1713
Hospital Charge Code	270660907
Hospital Revenue Code	278
Min. Negotiated Rate	$1,011.36
Max. Negotiated Rate	$1,631.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,348.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,631.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,011.36

PLATE VA-LCP2.7/3.5MM TIB 6HRT

Facility

$9,204.65

Service Code	HCPCS C1713
Hospital Charge Code	270696119
Hospital Revenue Code	278
Min. Negotiated Rate	$1,380.70
Max. Negotiated Rate	$2,227.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,840.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,227.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,380.70

PLATE VA-LCP2.7/3.5MM TIB 6HRT

Facility

$9,204.65

Service Code	HCPCS C1713
Hospital Charge Code	270696119
Hospital Revenue Code	278
Min. Negotiated Rate	$261.41
Max. Negotiated Rate	$4,602.32
Rate for Payer: Aetna Commercial	$3,497.77
Rate for Payer: Aetna Medicare Advantage	$2,761.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,347.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,347.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,840.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,347.19
Rate for Payer: Cigna Commercial	$4,602.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,227.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,380.70
Rate for Payer: UnitedHealthcare Community & State	$290.87
Rate for Payer: Wellpoint Medicaid Managed Care	$261.41

PLATE VA-LCP 2.7/3.5x101MM 10H

Facility

$4,251.85

Service Code	HCPCS C1713
Hospital Charge Code	270675007
Hospital Revenue Code	278
Min. Negotiated Rate	$120.75
Max. Negotiated Rate	$2,125.93
Rate for Payer: Aetna Commercial	$1,615.70
Rate for Payer: Aetna Medicare Advantage	$1,275.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,084.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,084.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,084.22
Rate for Payer: Cigna Commercial	$2,125.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.95
Rate for Payer: Qualcare PPO/HMO/WC	$637.78
Rate for Payer: UnitedHealthcare Community & State	$134.36
Rate for Payer: Wellpoint Medicaid Managed Care	$120.75

PLATE VA-LCP 2.7/3.5x101MM 10H

Facility

$4,251.85

Service Code	HCPCS C1713
Hospital Charge Code	270675007
Hospital Revenue Code	278
Min. Negotiated Rate	$637.78
Max. Negotiated Rate	$1,028.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.95
Rate for Payer: Qualcare PPO/HMO/WC	$637.78

PLATE VA-LCP 2.7MM 3HOLE RIGHT

Facility

$3,324.00

Hospital Charge Code	270676460
Hospital Revenue Code	278
Min. Negotiated Rate	$94.40
Max. Negotiated Rate	$1,662.00
Rate for Payer: Aetna Commercial	$1,263.12
Rate for Payer: Aetna Medicare Advantage	$997.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$847.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$847.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$664.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$847.62
Rate for Payer: Cigna Commercial	$1,662.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$804.41
Rate for Payer: Qualcare PPO/HMO/WC	$498.60
Rate for Payer: UnitedHealthcare Community & State	$105.04
Rate for Payer: Wellpoint Medicaid Managed Care	$94.40

PLATE VA-LCP 2.7MM 3HOLE RIGHT

Facility

$3,324.00

Hospital Charge Code	270676460
Hospital Revenue Code	278
Min. Negotiated Rate	$498.60
Max. Negotiated Rate	$804.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$664.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$804.41
Rate for Payer: Qualcare PPO/HMO/WC	$498.60

PLATE VA-LCP 2.7MM 4HL LT STER

Facility

$3,898.80

Service Code	HCPCS C1713
Hospital Charge Code	270663830
Hospital Revenue Code	278
Min. Negotiated Rate	$110.73
Max. Negotiated Rate	$1,949.40
Rate for Payer: Aetna Commercial	$1,481.54
Rate for Payer: Aetna Medicare Advantage	$1,169.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$994.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$994.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$779.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$994.19
Rate for Payer: Cigna Commercial	$1,949.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$943.51
Rate for Payer: Qualcare PPO/HMO/WC	$584.82
Rate for Payer: UnitedHealthcare Community & State	$123.20
Rate for Payer: Wellpoint Medicaid Managed Care	$110.73

PLATE VA-LCP 2.7MM 4HL LT STER

Facility

$3,898.80

Service Code	HCPCS C1713
Hospital Charge Code	270663830
Hospital Revenue Code	278
Min. Negotiated Rate	$584.82
Max. Negotiated Rate	$943.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$779.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$943.51
Rate for Payer: Qualcare PPO/HMO/WC	$584.82

PLATE VA-LCP 2.7MM 4HOLE LEFT

Facility

$3,474.00

Service Code	HCPCS C1713
Hospital Charge Code	270676228
Hospital Revenue Code	278
Min. Negotiated Rate	$521.10
Max. Negotiated Rate	$840.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$694.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.71
Rate for Payer: Qualcare PPO/HMO/WC	$521.10

PLATE VA-LCP 2.7MM 4HOLE LEFT

Facility

$3,474.00

Service Code	HCPCS C1713
Hospital Charge Code	270676228
Hospital Revenue Code	278
Min. Negotiated Rate	$98.66
Max. Negotiated Rate	$1,737.00
Rate for Payer: Aetna Commercial	$1,320.12
Rate for Payer: Aetna Medicare Advantage	$1,042.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$885.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$885.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$694.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$885.87
Rate for Payer: Cigna Commercial	$1,737.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.71
Rate for Payer: Qualcare PPO/HMO/WC	$521.10
Rate for Payer: UnitedHealthcare Community & State	$109.78
Rate for Payer: Wellpoint Medicaid Managed Care	$98.66

Know your out-of-pocket cost for care.

All Charges