Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PLATE VA-LCP MEDIAL 3.5x95MM L

Facility

$6,425.85

Service Code	HCPCS C1713
Hospital Charge Code	270681459
Hospital Revenue Code	278
Min. Negotiated Rate	$963.88
Max. Negotiated Rate	$1,555.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,285.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,555.06
Rate for Payer: Qualcare PPO/HMO/WC	$963.88

PLATE VA-LCP MEDIAL 3.5x95MM L

Facility

$6,425.85

Service Code	HCPCS C1713
Hospital Charge Code	270681459
Hospital Revenue Code	278
Min. Negotiated Rate	$182.49
Max. Negotiated Rate	$3,212.93
Rate for Payer: Aetna Commercial	$2,441.82
Rate for Payer: Aetna Medicare Advantage	$1,927.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,638.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,638.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,285.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,638.59
Rate for Payer: Cigna Commercial	$3,212.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,555.06
Rate for Payer: Qualcare PPO/HMO/WC	$963.88
Rate for Payer: UnitedHealthcare Community & State	$203.06
Rate for Payer: Wellpoint Medicaid Managed Care	$182.49

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

Facility

$4,081.90

Service Code	HCPCS C1713
Hospital Charge Code	270679923
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 RAD 2.4 2COL 6H/2

Facility

$4,081.90

Service Code	HCPCS C1713
Hospital Charge Code	270679923
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 RAD CLMN 5HOLE

Facility

$2,280.40

Service Code	HCPCS C1713
Hospital Charge Code	270666941
Hospital Revenue Code	278
Min. Negotiated Rate	$342.06
Max. Negotiated Rate	$551.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$456.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$551.86
Rate for Payer: Qualcare PPO/HMO/WC	$342.06

PLATE VA-LCP RAD CLMN 5HOLE

Facility

$2,280.40

Service Code	HCPCS C1713
Hospital Charge Code	270666941
Hospital Revenue Code	278
Min. Negotiated Rate	$64.76
Max. Negotiated Rate	$1,140.20
Rate for Payer: Aetna Commercial	$866.55
Rate for Payer: Aetna Medicare Advantage	$684.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$581.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$581.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$456.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$581.50
Rate for Payer: Cigna Commercial	$1,140.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$551.86
Rate for Payer: Qualcare PPO/HMO/WC	$342.06
Rate for Payer: UnitedHealthcare Community & State	$72.06
Rate for Payer: Wellpoint Medicaid Managed Care	$64.76

PLATE VA-LCP SM BND 4H 87MM LT

Facility

$6,699.60

Service Code	HCPCS C1713
Hospital Charge Code	270676135
Hospital Revenue Code	278
Min. Negotiated Rate	$1,004.94
Max. Negotiated Rate	$1,621.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,339.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,621.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,004.94

PLATE VA-LCP SM BND 4H 87MM LT

Facility

$6,699.60

Service Code	HCPCS C1713
Hospital Charge Code	270676135
Hospital Revenue Code	278
Min. Negotiated Rate	$190.27
Max. Negotiated Rate	$3,349.80
Rate for Payer: Aetna Commercial	$2,545.85
Rate for Payer: Aetna Medicare Advantage	$2,009.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,708.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,708.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,339.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.40
Rate for Payer: Cigna Commercial	$3,349.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,621.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,004.94
Rate for Payer: UnitedHealthcare Community & State	$211.71
Rate for Payer: Wellpoint Medicaid Managed Care	$190.27

PLATE VA-LCP SM BND 6H 117MM R

Facility

$6,986.05

Service Code	HCPCS C1713
Hospital Charge Code	270679097
Hospital Revenue Code	278
Min. Negotiated Rate	$1,047.91
Max. Negotiated Rate	$1,690.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,397.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,690.62
Rate for Payer: Qualcare PPO/HMO/WC	$1,047.91

PLATE VA-LCP SM BND 6H 117MM R

Facility

$6,986.05

Service Code	HCPCS C1713
Hospital Charge Code	270679097
Hospital Revenue Code	278
Min. Negotiated Rate	$198.40
Max. Negotiated Rate	$3,493.03
Rate for Payer: Aetna Commercial	$2,654.70
Rate for Payer: Aetna Medicare Advantage	$2,095.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,781.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,781.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,397.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,781.44
Rate for Payer: Cigna Commercial	$3,493.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,690.62
Rate for Payer: Qualcare PPO/HMO/WC	$1,047.91
Rate for Payer: UnitedHealthcare Community & State	$220.76
Rate for Payer: Wellpoint Medicaid Managed Care	$198.40

PLATE VA-LCP SM BND 6H 117MM R

Facility

$6,384.00

Service Code	HCPCS C1713
Hospital Charge Code	270659781
Hospital Revenue Code	278
Min. Negotiated Rate	$181.31
Max. Negotiated Rate	$3,192.00
Rate for Payer: Aetna Commercial	$2,425.92
Rate for Payer: Aetna Medicare Advantage	$1,915.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,627.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,627.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,276.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,627.92
Rate for Payer: Cigna Commercial	$3,192.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,544.93
Rate for Payer: Qualcare PPO/HMO/WC	$957.60
Rate for Payer: UnitedHealthcare Community & State	$201.73
Rate for Payer: Wellpoint Medicaid Managed Care	$181.31

PLATE VA-LCP SM BND 6H 117MM R

Facility

$6,384.00

Service Code	HCPCS C1713
Hospital Charge Code	270659781
Hospital Revenue Code	278
Min. Negotiated Rate	$957.60
Max. Negotiated Rate	$1,544.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,276.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,544.93
Rate for Payer: Qualcare PPO/HMO/WC	$957.60

PLATE VA-LCP SM BND 6H 117MM S

Facility

$6,986.05

Service Code	HCPCS C1713
Hospital Charge Code	270676516
Hospital Revenue Code	278
Min. Negotiated Rate	$198.40
Max. Negotiated Rate	$3,493.03
Rate for Payer: Aetna Commercial	$2,654.70
Rate for Payer: Aetna Medicare Advantage	$2,095.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,781.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,781.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,397.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,781.44
Rate for Payer: Cigna Commercial	$3,493.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,690.62
Rate for Payer: Qualcare PPO/HMO/WC	$1,047.91
Rate for Payer: UnitedHealthcare Community & State	$220.76
Rate for Payer: Wellpoint Medicaid Managed Care	$198.40

PLATE VA-LCP SM BND 6H 117MM S

Facility

$6,986.05

Service Code	HCPCS C1713
Hospital Charge Code	270676516
Hospital Revenue Code	278
Min. Negotiated Rate	$1,047.91
Max. Negotiated Rate	$1,690.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,397.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,690.62
Rate for Payer: Qualcare PPO/HMO/WC	$1,047.91

PLATE VA-LCP SM BND 8H 147MM

Facility

$7,918.55

Service Code	HCPCS C1713
Hospital Charge Code	270680907
Hospital Revenue Code	278
Min. Negotiated Rate	$1,187.78
Max. Negotiated Rate	$1,916.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,583.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,916.29
Rate for Payer: Qualcare PPO/HMO/WC	$1,187.78

PLATE VA-LCP SM BND 8H 147MM

Facility

$7,918.55

Service Code	HCPCS C1713
Hospital Charge Code	270680907
Hospital Revenue Code	278
Min. Negotiated Rate	$224.89
Max. Negotiated Rate	$3,959.28
Rate for Payer: Aetna Commercial	$3,009.05
Rate for Payer: Aetna Medicare Advantage	$2,375.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,019.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,019.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,583.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,019.23
Rate for Payer: Cigna Commercial	$3,959.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,916.29
Rate for Payer: Qualcare PPO/HMO/WC	$1,187.78
Rate for Payer: UnitedHealthcare Community & State	$250.23
Rate for Payer: Wellpoint Medicaid Managed Care	$224.89

PLATE VA-LCP TMT FUSN 2.4

Facility

$3,909.00

Service Code	HCPCS C1713
Hospital Charge Code	270687830
Hospital Revenue Code	278
Min. Negotiated Rate	$111.02
Max. Negotiated Rate	$1,954.50
Rate for Payer: Aetna Commercial	$1,485.42
Rate for Payer: Aetna Medicare Advantage	$1,172.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$996.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$996.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$781.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$996.79
Rate for Payer: Cigna Commercial	$1,954.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$945.98
Rate for Payer: Qualcare PPO/HMO/WC	$586.35
Rate for Payer: UnitedHealthcare Community & State	$123.52
Rate for Payer: Wellpoint Medicaid Managed Care	$111.02

PLATE VA-LCP TMT FUSN 2.4

Facility

$3,909.00

Service Code	HCPCS C1713
Hospital Charge Code	270687830
Hospital Revenue Code	278
Min. Negotiated Rate	$586.35
Max. Negotiated Rate	$945.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$781.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$945.98
Rate for Payer: Qualcare PPO/HMO/WC	$586.35

PLATE VA-LCP VOL 2.4MM 6H/5H R

Facility

$4,567.00

Service Code	HCPCS C1713
Hospital Charge Code	270676432
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 VOL 2.4MM 6H/5H R

Facility

$5,119.40

Service Code	HCPCS C1713
Hospital Charge Code	270688223
Hospital Revenue Code	278
Min. Negotiated Rate	$767.91
Max. Negotiated Rate	$1,238.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,023.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,238.89
Rate for Payer: Qualcare PPO/HMO/WC	$767.91

PLATE VA-LCP VOL 2.4MM 6H/5H R

Facility

$5,119.40

Service Code	HCPCS C1713
Hospital Charge Code	270688223
Hospital Revenue Code	278
Min. Negotiated Rate	$145.39
Max. Negotiated Rate	$2,559.70
Rate for Payer: Aetna Commercial	$1,945.37
Rate for Payer: Aetna Medicare Advantage	$1,535.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,305.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,305.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,023.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,305.45
Rate for Payer: Cigna Commercial	$2,559.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,238.89
Rate for Payer: Qualcare PPO/HMO/WC	$767.91
Rate for Payer: UnitedHealthcare Community & State	$161.77
Rate for Payer: Wellpoint Medicaid Managed Care	$145.39

PLATE VA-LCP VOL 2.4MM 6H/5H R

Facility

$4,567.00

Service Code	HCPCS C1713
Hospital Charge Code	270676432
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 VOLR 2.4 6H/5H LT

Facility

$4,408.05

Service Code	HCPCS C1713
Hospital Charge Code	270675139
Hospital Revenue Code	278
Min. Negotiated Rate	$125.19
Max. Negotiated Rate	$2,204.03
Rate for Payer: Aetna Commercial	$1,675.06
Rate for Payer: Aetna Medicare Advantage	$1,322.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,124.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,124.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$881.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,124.05
Rate for Payer: Cigna Commercial	$2,204.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,066.75
Rate for Payer: Qualcare PPO/HMO/WC	$661.21
Rate for Payer: UnitedHealthcare Community & State	$139.29
Rate for Payer: Wellpoint Medicaid Managed Care	$125.19

PLATE VA-LCP VOLR 2.4 6H/5H LT

Facility

$4,408.05

Service Code	HCPCS C1713
Hospital Charge Code	270675139
Hospital Revenue Code	278
Min. Negotiated Rate	$661.21
Max. Negotiated Rate	$1,066.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$881.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,066.75
Rate for Payer: Qualcare PPO/HMO/WC	$661.21

PLATE VA LKG CLC 2.7x70MM LTST

Facility

$4,712.25

Hospital Charge Code	270678308
Hospital Revenue Code	278
Min. Negotiated Rate	$133.83
Max. Negotiated Rate	$2,356.12
Rate for Payer: Aetna Commercial	$1,790.65
Rate for Payer: Aetna Medicare Advantage	$1,413.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,201.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,201.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$942.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,201.62
Rate for Payer: Cigna Commercial	$2,356.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,140.36
Rate for Payer: Qualcare PPO/HMO/WC	$706.84
Rate for Payer: UnitedHealthcare Community & State	$148.91
Rate for Payer: Wellpoint Medicaid Managed Care	$133.83

Know your out-of-pocket cost for care.

All Charges