Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PLT SPINAL LAT 18X12X55MM 10D

Facility

$29,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270693154
Hospital Revenue Code	278
Min. Negotiated Rate	$830.70
Max. Negotiated Rate	$14,625.00
Rate for Payer: Aetna Commercial	$11,115.00
Rate for Payer: Aetna Medicare Advantage	$8,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,458.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,458.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,458.75
Rate for Payer: Cigna Commercial	$14,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,078.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,387.50
Rate for Payer: UnitedHealthcare Community & State	$924.30
Rate for Payer: Wellpoint Medicaid Managed Care	$830.70

PLT SPINAL LAT 18X12X55MM 10D

Facility

$29,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270693154
Hospital Revenue Code	278
Min. Negotiated Rate	$4,387.50
Max. Negotiated Rate	$7,078.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,078.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,387.50

PLT VA-LCP AC 2.7X3.5MM 9H89MM

Facility

$5,051.60

Service Code	HCPCS C1713
Hospital Charge Code	270693550
Hospital Revenue Code	278
Min. Negotiated Rate	$143.47
Max. Negotiated Rate	$2,525.80
Rate for Payer: Aetna Commercial	$1,919.61
Rate for Payer: Aetna Medicare Advantage	$1,515.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,288.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,288.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,010.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,288.16
Rate for Payer: Cigna Commercial	$2,525.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,222.49
Rate for Payer: Qualcare PPO/HMO/WC	$757.74
Rate for Payer: UnitedHealthcare Community & State	$159.63
Rate for Payer: Wellpoint Medicaid Managed Care	$143.47

PLT VA-LCP AC 2.7X3.5MM 9H89MM

Facility

$5,051.60

Service Code	HCPCS C1713
Hospital Charge Code	270693550
Hospital Revenue Code	278
Min. Negotiated Rate	$757.74
Max. Negotiated Rate	$1,222.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,010.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,222.49
Rate for Payer: Qualcare PPO/HMO/WC	$757.74

PLUG 10MM FRES H

Facility

$12,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270685328
Hospital Revenue Code	278
Min. Negotiated Rate	$1,875.00
Max. Negotiated Rate	$3,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.00

PLUG 10MM FRES H

Facility

$12,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270685328
Hospital Revenue Code	278
Min. Negotiated Rate	$355.00
Max. Negotiated Rate	$6,250.00
Rate for Payer: Aetna Commercial	$4,750.00
Rate for Payer: Aetna Medicare Advantage	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,187.50
Rate for Payer: Cigna Commercial	$6,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.00
Rate for Payer: UnitedHealthcare Community & State	$395.00
Rate for Payer: Wellpoint Medicaid Managed Care	$355.00

PLUG ACETABULAR DOME HOLE

Facility

$336.00

Hospital Charge Code	270676580
Hospital Revenue Code	278
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$81.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$67.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.31
Rate for Payer: Qualcare PPO/HMO/WC	$50.40

PLUG ACETABULAR DOME HOLE

Facility

$336.00

Hospital Charge Code	270676580
Hospital Revenue Code	278
Min. Negotiated Rate	$9.54
Max. Negotiated Rate	$168.00
Rate for Payer: Aetna Commercial	$127.68
Rate for Payer: Aetna Medicare Advantage	$100.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$67.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.68
Rate for Payer: Cigna Commercial	$168.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.31
Rate for Payer: Qualcare PPO/HMO/WC	$50.40
Rate for Payer: UnitedHealthcare Community & State	$10.62
Rate for Payer: Wellpoint Medicaid Managed Care	$9.54

PLUG CANN D=8 L=16MM

Facility

$2,409.75

Service Code	HCPCS C1889
Hospital Charge Code	270704122
Hospital Revenue Code	278
Min. Negotiated Rate	$68.44
Max. Negotiated Rate	$1,204.88
Rate for Payer: Aetna Commercial	$915.71
Rate for Payer: Aetna Medicare Advantage	$722.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$614.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$614.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$481.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$614.49
Rate for Payer: Cigna Commercial	$1,204.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$583.16
Rate for Payer: Qualcare PPO/HMO/WC	$361.46
Rate for Payer: UnitedHealthcare Community & State	$76.15
Rate for Payer: Wellpoint Medicaid Managed Care	$68.44

PLUG CANN D=8 L=16MM

Facility

$2,409.75

Service Code	HCPCS C1889
Hospital Charge Code	270704122
Hospital Revenue Code	278
Min. Negotiated Rate	$361.46
Max. Negotiated Rate	$583.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$481.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$583.16
Rate for Payer: Qualcare PPO/HMO/WC	$361.46

PLUG DOWEL CANCELLOUS 10X 16MM

Facility

$2,295.00

Service Code	HCPCS C1713
Hospital Charge Code	270684095
Hospital Revenue Code	278
Min. Negotiated Rate	$65.18
Max. Negotiated Rate	$1,147.50
Rate for Payer: Aetna Commercial	$872.10
Rate for Payer: Aetna Medicare Advantage	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$585.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$585.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$585.23
Rate for Payer: Cigna Commercial	$1,147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$555.39
Rate for Payer: Qualcare PPO/HMO/WC	$344.25
Rate for Payer: UnitedHealthcare Community & State	$72.52
Rate for Payer: Wellpoint Medicaid Managed Care	$65.18

PLUG DOWEL CANCELLOUS 10X 16MM

Facility

$2,295.00

Service Code	HCPCS C1713
Hospital Charge Code	270684095
Hospital Revenue Code	278
Min. Negotiated Rate	$344.25
Max. Negotiated Rate	$555.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$459.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$555.39
Rate for Payer: Qualcare PPO/HMO/WC	$344.25

PLUG DOWEL CANCELLOUS 11X 16MM

Facility

$2,295.00

Service Code	HCPCS C1713
Hospital Charge Code	270684096
Hospital Revenue Code	278
Min. Negotiated Rate	$344.25
Max. Negotiated Rate	$555.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$459.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$555.39
Rate for Payer: Qualcare PPO/HMO/WC	$344.25

PLUG DOWEL CANCELLOUS 11X 16MM

Facility

$2,295.00

Service Code	HCPCS C1713
Hospital Charge Code	270684096
Hospital Revenue Code	278
Min. Negotiated Rate	$65.18
Max. Negotiated Rate	$1,147.50
Rate for Payer: Aetna Commercial	$872.10
Rate for Payer: Aetna Medicare Advantage	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$585.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$585.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$585.23
Rate for Payer: Cigna Commercial	$1,147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$555.39
Rate for Payer: Qualcare PPO/HMO/WC	$344.25
Rate for Payer: UnitedHealthcare Community & State	$72.52
Rate for Payer: Wellpoint Medicaid Managed Care	$65.18

PLUG DOWEL CANCELLOUS 7MM

Facility

$2,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270689469
Hospital Revenue Code	278
Min. Negotiated Rate	$371.25
Max. Negotiated Rate	$598.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.95
Rate for Payer: Qualcare PPO/HMO/WC	$371.25

PLUG DOWEL CANCELLOUS 7MM

Facility

$2,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270689469
Hospital Revenue Code	278
Min. Negotiated Rate	$70.29
Max. Negotiated Rate	$1,237.50
Rate for Payer: Aetna Commercial	$940.50
Rate for Payer: Aetna Medicare Advantage	$742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$631.12
Rate for Payer: Cigna Commercial	$1,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.95
Rate for Payer: Qualcare PPO/HMO/WC	$371.25
Rate for Payer: UnitedHealthcare Community & State	$78.21
Rate for Payer: Wellpoint Medicaid Managed Care	$70.29

PLUG DOWEL CANCELLOUS 8MM

Facility

$2,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270689470
Hospital Revenue Code	278
Min. Negotiated Rate	$371.25
Max. Negotiated Rate	$598.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.95
Rate for Payer: Qualcare PPO/HMO/WC	$371.25

PLUG DOWEL CANCELLOUS 8MM

Facility

$2,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270689470
Hospital Revenue Code	278
Min. Negotiated Rate	$70.29
Max. Negotiated Rate	$1,237.50
Rate for Payer: Aetna Commercial	$940.50
Rate for Payer: Aetna Medicare Advantage	$742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$631.12
Rate for Payer: Cigna Commercial	$1,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.95
Rate for Payer: Qualcare PPO/HMO/WC	$371.25
Rate for Payer: UnitedHealthcare Community & State	$78.21
Rate for Payer: Wellpoint Medicaid Managed Care	$70.29

PLUG DOWEL CANCELLOUS 9MM

Facility

$2,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270689471
Hospital Revenue Code	278
Min. Negotiated Rate	$371.25
Max. Negotiated Rate	$598.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.95
Rate for Payer: Qualcare PPO/HMO/WC	$371.25

PLUG DOWEL CANCELLOUS 9MM

Facility

$2,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270689471
Hospital Revenue Code	278
Min. Negotiated Rate	$70.29
Max. Negotiated Rate	$1,237.50
Rate for Payer: Aetna Commercial	$940.50
Rate for Payer: Aetna Medicare Advantage	$742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$631.12
Rate for Payer: Cigna Commercial	$1,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.95
Rate for Payer: Qualcare PPO/HMO/WC	$371.25
Rate for Payer: UnitedHealthcare Community & State	$78.21
Rate for Payer: Wellpoint Medicaid Managed Care	$70.29

PLUG INTRAMEDULLARY LG

Facility

$895.00

Service Code	HCPCS C1713
Hospital Charge Code	270605341
Hospital Revenue Code	278
Min. Negotiated Rate	$134.25
Max. Negotiated Rate	$216.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$179.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.59
Rate for Payer: Qualcare PPO/HMO/WC	$134.25

PLUG INTRAMEDULLARY LG

Facility

$895.00

Service Code	HCPCS C1713
Hospital Charge Code	270605341
Hospital Revenue Code	278
Min. Negotiated Rate	$25.42
Max. Negotiated Rate	$447.50
Rate for Payer: Aetna Commercial	$340.10
Rate for Payer: Aetna Medicare Advantage	$268.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$228.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$228.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$179.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$228.22
Rate for Payer: Cigna Commercial	$447.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.59
Rate for Payer: Qualcare PPO/HMO/WC	$134.25
Rate for Payer: UnitedHealthcare Community & State	$28.28
Rate for Payer: Wellpoint Medicaid Managed Care	$25.42

PLUG MESH PROLOOP MED

Facility

$673.75

Service Code	HCPCS C1781
Hospital Charge Code	270653937
Hospital Revenue Code	278
Min. Negotiated Rate	$19.13
Max. Negotiated Rate	$336.88
Rate for Payer: Aetna Commercial	$256.02
Rate for Payer: Aetna Medicare Advantage	$202.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$171.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$171.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$171.81
Rate for Payer: Cigna Commercial	$336.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.05
Rate for Payer: Qualcare PPO/HMO/WC	$101.06
Rate for Payer: UnitedHealthcare Community & State	$21.29
Rate for Payer: Wellpoint Medicaid Managed Care	$19.13

PLUG MESH PROLOOP MED

Facility

$673.75

Service Code	HCPCS C1781
Hospital Charge Code	270653937
Hospital Revenue Code	278
Min. Negotiated Rate	$101.06
Max. Negotiated Rate	$163.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.05
Rate for Payer: Qualcare PPO/HMO/WC	$101.06

PLUG MESH PROLOOP MEDIUM 13704

Facility

$622.30

Service Code	HCPCS C1781
Hospital Charge Code	270651873
Hospital Revenue Code	278
Min. Negotiated Rate	$93.34
Max. Negotiated Rate	$150.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.60
Rate for Payer: Qualcare PPO/HMO/WC	$93.34

Know your out-of-pocket cost for care.

All Charges