Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

22X11 BIFURCATED GRAFT

Facility

$4,565.00

Service Code	HCPCS C1768
Hospital Charge Code	270683831
Hospital Revenue Code	278
Min. Negotiated Rate	$129.65
Max. Negotiated Rate	$2,282.50
Rate for Payer: Aetna Commercial	$1,734.70
Rate for Payer: Aetna Medicare Advantage	$1,369.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,164.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,164.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$913.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,164.08
Rate for Payer: Cigna Commercial	$2,282.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,104.73
Rate for Payer: Qualcare PPO/HMO/WC	$684.75
Rate for Payer: UnitedHealthcare Community & State	$144.25
Rate for Payer: Wellpoint Medicaid Managed Care	$129.65

22 X 30CM STRAIGHT GRAFT

Facility

$3,015.00

Service Code	HCPCS C1768
Hospital Charge Code	270683834
Hospital Revenue Code	278
Min. Negotiated Rate	$452.25
Max. Negotiated Rate	$729.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$603.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$729.63
Rate for Payer: Qualcare PPO/HMO/WC	$452.25

22 X 30CM STRAIGHT GRAFT

Facility

$3,015.00

Service Code	HCPCS C1768
Hospital Charge Code	270683834
Hospital Revenue Code	278
Min. Negotiated Rate	$85.63
Max. Negotiated Rate	$1,507.50
Rate for Payer: Aetna Commercial	$1,145.70
Rate for Payer: Aetna Medicare Advantage	$904.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$768.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$768.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$603.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$768.83
Rate for Payer: Cigna Commercial	$1,507.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$729.63
Rate for Payer: Qualcare PPO/HMO/WC	$452.25
Rate for Payer: UnitedHealthcare Community & State	$95.27
Rate for Payer: Wellpoint Medicaid Managed Care	$85.63

2-2 X 4 RECTANGLE ELECTRODES

Facility

$18.49

Hospital Charge Code	270660516
Hospital Revenue Code	270
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$9.24
Rate for Payer: Aetna Commercial	$7.03
Rate for Payer: Aetna Medicare Advantage	$5.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.71
Rate for Payer: Cigna Commercial	$9.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.81
Rate for Payer: Oxford Commercial	$3.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.77
Rate for Payer: UnitedHealthcare Commercial	$3.70
Rate for Payer: UnitedHealthcare Community & State	$0.58
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

2-2 X 4 RECTANGLE ELECTRODES

Facility

$18.49

Hospital Charge Code	270660516
Hospital Revenue Code	270
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$2.77
Rate for Payer: Qualcare PPO/HMO/WC	$2.77

2301 AXONICS REMOTE CONTROL

Facility

$4,400.00

Hospital Charge Code	270702023
Hospital Revenue Code	278
Min. Negotiated Rate	$124.96
Max. Negotiated Rate	$2,200.00
Rate for Payer: Aetna Commercial	$1,672.00
Rate for Payer: Aetna Medicare Advantage	$1,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,122.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,122.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$880.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,122.00
Rate for Payer: Cigna Commercial	$2,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,064.80
Rate for Payer: Qualcare PPO/HMO/WC	$660.00
Rate for Payer: UnitedHealthcare Community & State	$139.04
Rate for Payer: Wellpoint Medicaid Managed Care	$124.96

2301 AXONICS REMOTE CONTROL

Facility

$4,400.00

Hospital Charge Code	270702023
Hospital Revenue Code	278
Min. Negotiated Rate	$660.00
Max. Negotiated Rate	$1,064.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$880.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,064.80
Rate for Payer: Qualcare PPO/HMO/WC	$660.00

2.3MM SHORT BEVEL 35 DEG ICW

Facility

$2,455.00

Hospital Charge Code	270678531
Hospital Revenue Code	272
Min. Negotiated Rate	$368.25
Max. Negotiated Rate	$368.25
Rate for Payer: Qualcare PPO/HMO/WC	$368.25

2.3MM SHORT BEVEL 35 DEG ICW

Facility

$2,455.00

Hospital Charge Code	270678531
Hospital Revenue Code	272
Min. Negotiated Rate	$69.72
Max. Negotiated Rate	$1,227.50
Rate for Payer: Aetna Commercial	$932.90
Rate for Payer: Aetna Medicare Advantage	$736.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$626.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$626.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$626.02
Rate for Payer: Cigna Commercial	$1,227.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$638.30
Rate for Payer: Oxford Commercial	$491.00
Rate for Payer: Qualcare PPO/HMO/WC	$368.25
Rate for Payer: UnitedHealthcare Commercial	$491.00
Rate for Payer: UnitedHealthcare Community & State	$77.58
Rate for Payer: Wellpoint Medicaid Managed Care	$69.72

2.3 X 12 BONE SCREW

Facility

$750.00

Hospital Charge Code	270657993
Hospital Revenue Code	278
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$23.70
Rate for Payer: Wellpoint Medicaid Managed Care	$21.30

2.3 X 12 BONE SCREW

Facility

$750.00

Hospital Charge Code	270657993
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

2.3X13MM BONE SCREWS,CROSS PIN

Facility

$683.70

Service Code	HCPCS C1713
Hospital Charge Code	270687944
Hospital Revenue Code	278
Min. Negotiated Rate	$102.56
Max. Negotiated Rate	$165.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.46
Rate for Payer: Qualcare PPO/HMO/WC	$102.56

2.3X13MM BONE SCREWS,CROSS PIN

Facility

$683.70

Service Code	HCPCS C1713
Hospital Charge Code	270687944
Hospital Revenue Code	278
Min. Negotiated Rate	$19.42
Max. Negotiated Rate	$341.85
Rate for Payer: Aetna Commercial	$259.81
Rate for Payer: Aetna Medicare Advantage	$205.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$174.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$174.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$174.34
Rate for Payer: Cigna Commercial	$341.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.46
Rate for Payer: Qualcare PPO/HMO/WC	$102.56
Rate for Payer: UnitedHealthcare Community & State	$21.60
Rate for Payer: Wellpoint Medicaid Managed Care	$19.42

23 X 16 CORTICAL SCREW

Facility

$475.00

Service Code	HCPCS C1713
Hospital Charge Code	270656435
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

23 X 16 CORTICAL SCREW

Facility

$475.00

Service Code	HCPCS C1713
Hospital Charge Code	270656435
Hospital Revenue Code	278
Min. Negotiated Rate	$13.49
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Community & State	$15.01
Rate for Payer: Wellpoint Medicaid Managed Care	$13.49

2.3 X 16MM LOCK SCREW

Facility

$540.00

Service Code	HCPCS C1713
Hospital Charge Code	270656005
Hospital Revenue Code	278
Min. Negotiated Rate	$15.34
Max. Negotiated Rate	$270.00
Rate for Payer: Aetna Commercial	$205.20
Rate for Payer: Aetna Medicare Advantage	$162.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$137.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$137.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$137.70
Rate for Payer: Cigna Commercial	$270.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.68
Rate for Payer: Qualcare PPO/HMO/WC	$81.00
Rate for Payer: UnitedHealthcare Community & State	$17.06
Rate for Payer: Wellpoint Medicaid Managed Care	$15.34

2.3 X 16MM LOCK SCREW

Facility

$540.00

Service Code	HCPCS C1713
Hospital Charge Code	270656005
Hospital Revenue Code	278
Min. Negotiated Rate	$81.00
Max. Negotiated Rate	$130.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.68
Rate for Payer: Qualcare PPO/HMO/WC	$81.00

2.3 X 16 SOLID SCREW

Facility

$465.00

Hospital Charge Code	270662539
Hospital Revenue Code	278
Min. Negotiated Rate	$69.75
Max. Negotiated Rate	$112.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.53
Rate for Payer: Qualcare PPO/HMO/WC	$69.75

2.3 X 16 SOLID SCREW

Facility

$240.00

Hospital Charge Code	270662472
Hospital Revenue Code	278
Min. Negotiated Rate	$6.82
Max. Negotiated Rate	$120.00
Rate for Payer: Aetna Commercial	$91.20
Rate for Payer: Aetna Medicare Advantage	$72.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.20
Rate for Payer: Cigna Commercial	$120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.08
Rate for Payer: Qualcare PPO/HMO/WC	$36.00
Rate for Payer: UnitedHealthcare Community & State	$7.58
Rate for Payer: Wellpoint Medicaid Managed Care	$6.82

2.3 X 16 SOLID SCREW

Facility

$465.00

Hospital Charge Code	270662539
Hospital Revenue Code	278
Min. Negotiated Rate	$13.21
Max. Negotiated Rate	$232.50
Rate for Payer: Aetna Commercial	$176.70
Rate for Payer: Aetna Medicare Advantage	$139.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$118.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$118.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$118.58
Rate for Payer: Cigna Commercial	$232.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.53
Rate for Payer: Qualcare PPO/HMO/WC	$69.75
Rate for Payer: UnitedHealthcare Community & State	$14.69
Rate for Payer: Wellpoint Medicaid Managed Care	$13.21

2.3 X 16 SOLID SCREW

Facility

$240.00

Hospital Charge Code	270662472
Hospital Revenue Code	278
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$58.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.08
Rate for Payer: Qualcare PPO/HMO/WC	$36.00

2.3 X 18 CORTICAL SCREW

Facility

$465.00

Service Code	HCPCS C1713
Hospital Charge Code	270656436
Hospital Revenue Code	278
Min. Negotiated Rate	$69.75
Max. Negotiated Rate	$112.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.53
Rate for Payer: Qualcare PPO/HMO/WC	$69.75

2.3 X 18 CORTICAL SCREW

Facility

$465.00

Service Code	HCPCS C1713
Hospital Charge Code	270656436
Hospital Revenue Code	278
Min. Negotiated Rate	$13.21
Max. Negotiated Rate	$232.50
Rate for Payer: Aetna Commercial	$176.70
Rate for Payer: Aetna Medicare Advantage	$139.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$118.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$118.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$118.58
Rate for Payer: Cigna Commercial	$232.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.53
Rate for Payer: Qualcare PPO/HMO/WC	$69.75
Rate for Payer: UnitedHealthcare Community & State	$14.69
Rate for Payer: Wellpoint Medicaid Managed Care	$13.21

2.3 X 20 CANNULATED SCREW

Facility

$680.00

Service Code	HCPCS C1713
Hospital Charge Code	270656425
Hospital Revenue Code	278
Min. Negotiated Rate	$19.31
Max. Negotiated Rate	$340.00
Rate for Payer: Aetna Commercial	$258.40
Rate for Payer: Aetna Medicare Advantage	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.40
Rate for Payer: Cigna Commercial	$340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.56
Rate for Payer: Qualcare PPO/HMO/WC	$102.00
Rate for Payer: UnitedHealthcare Community & State	$21.49
Rate for Payer: Wellpoint Medicaid Managed Care	$19.31

2.3 X 20 CANNULATED SCREW

Facility

$680.00

Service Code	HCPCS C1713
Hospital Charge Code	270656425
Hospital Revenue Code	278
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$164.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.56
Rate for Payer: Qualcare PPO/HMO/WC	$102.00

Know your out-of-pocket cost for care.

All Charges