Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PLATE VA-LCP DRSL 2.4 2H/3H+90

Facility

$2,506.00

Service Code	HCPCS C1713
Hospital Charge Code	270661606
Hospital Revenue Code	278
Min. Negotiated Rate	$375.90
Max. Negotiated Rate	$606.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$501.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$606.45
Rate for Payer: Qualcare PPO/HMO/WC	$375.90

PLATE VA-LCP DRSL 2.4 2H/4H+90

Facility

$2,598.70

Service Code	HCPCS C1713
Hospital Charge Code	270661614
Hospital Revenue Code	278
Min. Negotiated Rate	$389.81
Max. Negotiated Rate	$628.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$519.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$628.89
Rate for Payer: Qualcare PPO/HMO/WC	$389.81

PLATE VA-LCP DRSL 2.4 2H/4H+90

Facility

$2,598.70

Service Code	HCPCS C1713
Hospital Charge Code	270661614
Hospital Revenue Code	278
Min. Negotiated Rate	$73.80
Max. Negotiated Rate	$1,299.35
Rate for Payer: Aetna Commercial	$987.51
Rate for Payer: Aetna Medicare Advantage	$779.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$662.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$662.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$519.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$662.67
Rate for Payer: Cigna Commercial	$1,299.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$628.89
Rate for Payer: Qualcare PPO/HMO/WC	$389.81
Rate for Payer: UnitedHealthcare Community & State	$82.12
Rate for Payer: Wellpoint Medicaid Managed Care	$73.80

PLATE VA-LCP DRSL 2.4 2H/4H-90

Facility

$2,598.70

Service Code	HCPCS C1713
Hospital Charge Code	270661608
Hospital Revenue Code	278
Min. Negotiated Rate	$73.80
Max. Negotiated Rate	$1,299.35
Rate for Payer: Aetna Commercial	$987.51
Rate for Payer: Aetna Medicare Advantage	$779.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$662.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$662.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$519.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$662.67
Rate for Payer: Cigna Commercial	$1,299.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$628.89
Rate for Payer: Qualcare PPO/HMO/WC	$389.81
Rate for Payer: UnitedHealthcare Community & State	$82.12
Rate for Payer: Wellpoint Medicaid Managed Care	$73.80

PLATE VA-LCP DRSL 2.4 2H/4H-90

Facility

$2,598.70

Service Code	HCPCS C1713
Hospital Charge Code	270661608
Hospital Revenue Code	278
Min. Negotiated Rate	$389.81
Max. Negotiated Rate	$628.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$519.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$628.89
Rate for Payer: Qualcare PPO/HMO/WC	$389.81

PLATE VA-LCP LAT 2.7MM 3H LEFT

Facility

$3,423.70

Service Code	HCPCS C1713
Hospital Charge Code	270676461
Hospital Revenue Code	278
Min. Negotiated Rate	$97.23
Max. Negotiated Rate	$1,711.85
Rate for Payer: Aetna Commercial	$1,301.01
Rate for Payer: Aetna Medicare Advantage	$1,027.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$873.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$873.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$684.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$873.04
Rate for Payer: Cigna Commercial	$1,711.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$828.54
Rate for Payer: Qualcare PPO/HMO/WC	$513.55
Rate for Payer: UnitedHealthcare Community & State	$108.19
Rate for Payer: Wellpoint Medicaid Managed Care	$97.23

PLATE VA-LCP LAT 2.7MM 3H LEFT

Facility

$3,423.70

Service Code	HCPCS C1713
Hospital Charge Code	270676461
Hospital Revenue Code	278
Min. Negotiated Rate	$513.55
Max. Negotiated Rate	$828.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$684.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$828.54
Rate for Payer: Qualcare PPO/HMO/WC	$513.55

PLATE VA-LCP LAT 2.7MM 3H RT

Facility

$3,630.75

Service Code	HCPCS C1713
Hospital Charge Code	270669789
Hospital Revenue Code	278
Min. Negotiated Rate	$544.61
Max. Negotiated Rate	$878.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$726.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$878.64
Rate for Payer: Qualcare PPO/HMO/WC	$544.61

PLATE VA-LCP LAT 2.7MM 3H RT

Facility

$3,630.75

Service Code	HCPCS C1713
Hospital Charge Code	270669789
Hospital Revenue Code	278
Min. Negotiated Rate	$103.11
Max. Negotiated Rate	$1,815.38
Rate for Payer: Aetna Commercial	$1,379.68
Rate for Payer: Aetna Medicare Advantage	$1,089.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$925.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$925.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$726.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$925.84
Rate for Payer: Cigna Commercial	$1,815.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$878.64
Rate for Payer: Qualcare PPO/HMO/WC	$544.61
Rate for Payer: UnitedHealthcare Community & State	$114.73
Rate for Payer: Wellpoint Medicaid Managed Care	$103.11

PLATE VA-LCP LAT 2.7MM 4H RT

Facility

$3,685.55

Service Code	HCPCS C1713
Hospital Charge Code	270676462
Hospital Revenue Code	278
Min. Negotiated Rate	$104.67
Max. Negotiated Rate	$1,842.78
Rate for Payer: Aetna Commercial	$1,400.51
Rate for Payer: Aetna Medicare Advantage	$1,105.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$939.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$939.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$737.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$939.82
Rate for Payer: Cigna Commercial	$1,842.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$891.90
Rate for Payer: Qualcare PPO/HMO/WC	$552.83
Rate for Payer: UnitedHealthcare Community & State	$116.46
Rate for Payer: Wellpoint Medicaid Managed Care	$104.67

PLATE VA-LCP LAT 2.7MM 4H RT

Facility

$3,685.55

Service Code	HCPCS C1713
Hospital Charge Code	270676462
Hospital Revenue Code	278
Min. Negotiated Rate	$552.83
Max. Negotiated Rate	$891.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$737.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$891.90
Rate for Payer: Qualcare PPO/HMO/WC	$552.83

PLATE VA-LCP LAT 2.7MM 4H RT

Facility

$3,898.80

Service Code	HCPCS C1713
Hospital Charge Code	270664889
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 LAT 2.7MM 4H RT

Facility

$3,898.80

Service Code	HCPCS C1713
Hospital Charge Code	270664889
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 LAT 2.7MM 5H RTST

Facility

$4,083.40

Service Code	HCPCS C1713
Hospital Charge Code	270664070
Hospital Revenue Code	278
Min. Negotiated Rate	$115.97
Max. Negotiated Rate	$2,041.70
Rate for Payer: Aetna Commercial	$1,551.69
Rate for Payer: Aetna Medicare Advantage	$1,225.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,041.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,041.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$816.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,041.27
Rate for Payer: Cigna Commercial	$2,041.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$988.18
Rate for Payer: Qualcare PPO/HMO/WC	$612.51
Rate for Payer: UnitedHealthcare Community & State	$129.04
Rate for Payer: Wellpoint Medicaid Managed Care	$115.97

PLATE VA-LCP LAT 2.7MM 5H RTST

Facility

$4,083.40

Service Code	HCPCS C1713
Hospital Charge Code	270664070
Hospital Revenue Code	278
Min. Negotiated Rate	$612.51
Max. Negotiated Rate	$988.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$816.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$988.18
Rate for Payer: Qualcare PPO/HMO/WC	$612.51

PLATE VA-LCP LAT 2.7MM 7H LTST

Facility

$4,341.45

Service Code	HCPCS C1713
Hospital Charge Code	270664092
Hospital Revenue Code	278
Min. Negotiated Rate	$123.30
Max. Negotiated Rate	$2,170.72
Rate for Payer: Aetna Commercial	$1,649.75
Rate for Payer: Aetna Medicare Advantage	$1,302.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,107.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,107.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$868.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,107.07
Rate for Payer: Cigna Commercial	$2,170.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.63
Rate for Payer: Qualcare PPO/HMO/WC	$651.22
Rate for Payer: UnitedHealthcare Community & State	$137.19
Rate for Payer: Wellpoint Medicaid Managed Care	$123.30

PLATE VA-LCP LAT 2.7MM 7H LTST

Facility

$4,341.45

Service Code	HCPCS C1713
Hospital Charge Code	270664092
Hospital Revenue Code	278
Min. Negotiated Rate	$651.22
Max. Negotiated Rate	$1,050.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$868.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.63
Rate for Payer: Qualcare PPO/HMO/WC	$651.22

PLATE VA-LCP LAT 2.7MM 7H R

Facility

$4,134.40

Service Code	HCPCS C1713
Hospital Charge Code	270676465
Hospital Revenue Code	278
Min. Negotiated Rate	$620.16
Max. Negotiated Rate	$1,000.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$826.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,000.52
Rate for Payer: Qualcare PPO/HMO/WC	$620.16

PLATE VA-LCP LAT 2.7MM 7H R

Facility

$4,134.40

Service Code	HCPCS C1713
Hospital Charge Code	270676465
Hospital Revenue Code	278
Min. Negotiated Rate	$117.42
Max. Negotiated Rate	$2,067.20
Rate for Payer: Aetna Commercial	$1,571.07
Rate for Payer: Aetna Medicare Advantage	$1,240.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,054.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,054.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$826.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,054.27
Rate for Payer: Cigna Commercial	$2,067.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,000.52
Rate for Payer: Qualcare PPO/HMO/WC	$620.16
Rate for Payer: UnitedHealthcare Community & State	$130.65
Rate for Payer: Wellpoint Medicaid Managed Care	$117.42

PLATE VA LCP LAT 2.7MM 7H RT S

Facility

$4,471.70

Service Code	HCPCS C1713
Hospital Charge Code	270680328
Hospital Revenue Code	278
Min. Negotiated Rate	$670.75
Max. Negotiated Rate	$1,082.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$894.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.15
Rate for Payer: Qualcare PPO/HMO/WC	$670.75

PLATE VA LCP LAT 2.7MM 7H RT S

Facility

$4,471.70

Service Code	HCPCS C1713
Hospital Charge Code	270680328
Hospital Revenue Code	278
Min. Negotiated Rate	$127.00
Max. Negotiated Rate	$2,235.85
Rate for Payer: Aetna Commercial	$1,699.25
Rate for Payer: Aetna Medicare Advantage	$1,341.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,140.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,140.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$894.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,140.28
Rate for Payer: Cigna Commercial	$2,235.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.15
Rate for Payer: Qualcare PPO/HMO/WC	$670.75
Rate for Payer: UnitedHealthcare Community & State	$141.31
Rate for Payer: Wellpoint Medicaid Managed Care	$127.00

PLATE VA-LCP LG BND 4H 87MM RT

Facility

$6,516.00

Service Code	HCPCS C1713
Hospital Charge Code	270675180
Hospital Revenue Code	278
Min. Negotiated Rate	$185.05
Max. Negotiated Rate	$3,258.00
Rate for Payer: Aetna Commercial	$2,476.08
Rate for Payer: Aetna Medicare Advantage	$1,954.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,661.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,661.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,303.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,661.58
Rate for Payer: Cigna Commercial	$3,258.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,576.87
Rate for Payer: Qualcare PPO/HMO/WC	$977.40
Rate for Payer: UnitedHealthcare Community & State	$205.91
Rate for Payer: Wellpoint Medicaid Managed Care	$185.05

PLATE VA-LCP LG BND 4H 87MM RT

Facility

$6,516.00

Service Code	HCPCS C1713
Hospital Charge Code	270675180
Hospital Revenue Code	278
Min. Negotiated Rate	$977.40
Max. Negotiated Rate	$1,576.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,303.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,576.87
Rate for Payer: Qualcare PPO/HMO/WC	$977.40

PLATE VA-LCP LG BND 6H 117MM L

Facility

$6,585.00

Service Code	HCPCS C1713
Hospital Charge Code	270676493
Hospital Revenue Code	278
Min. Negotiated Rate	$987.75
Max. Negotiated Rate	$1,593.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,317.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,593.57
Rate for Payer: Qualcare PPO/HMO/WC	$987.75

PLATE VA-LCP LG BND 6H 117MM L

Facility

$6,585.00

Service Code	HCPCS C1713
Hospital Charge Code	270676493
Hospital Revenue Code	278
Min. Negotiated Rate	$187.01
Max. Negotiated Rate	$3,292.50
Rate for Payer: Aetna Commercial	$2,502.30
Rate for Payer: Aetna Medicare Advantage	$1,975.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,679.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,679.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,317.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,679.17
Rate for Payer: Cigna Commercial	$3,292.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,593.57
Rate for Payer: Qualcare PPO/HMO/WC	$987.75
Rate for Payer: UnitedHealthcare Community & State	$208.09
Rate for Payer: Wellpoint Medicaid Managed Care	$187.01

Know your out-of-pocket cost for care.

All Charges