Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

KIT SCREW LOCKING CAP 4.5X22MM

Facility

$601.60

Service Code	HCPCS C1713
Hospital Charge Code	270668812
Hospital Revenue Code	278
Min. Negotiated Rate	$17.09
Max. Negotiated Rate	$300.80
Rate for Payer: Aetna Commercial	$228.61
Rate for Payer: Aetna Medicare Advantage	$180.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$120.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.41
Rate for Payer: Cigna Commercial	$300.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.59
Rate for Payer: Qualcare PPO/HMO/WC	$90.24
Rate for Payer: UnitedHealthcare Community & State	$19.01
Rate for Payer: Wellpoint Medicaid Managed Care	$17.09

KIT SCREW LOCKING CAP 4.5X22MM

Facility

$601.60

Service Code	HCPCS C1713
Hospital Charge Code	270668812
Hospital Revenue Code	278
Min. Negotiated Rate	$90.24
Max. Negotiated Rate	$145.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$120.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.59
Rate for Payer: Qualcare PPO/HMO/WC	$90.24

KIT SDK BONE GRAFT 7510200

Facility

$17,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270629242
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$4,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

KIT SDK BONE GRAFT 7510200

Facility

$17,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270629242
Hospital Revenue Code	278
Min. Negotiated Rate	$497.00
Max. Negotiated Rate	$8,750.00
Rate for Payer: Aetna Commercial	$6,650.00
Rate for Payer: Aetna Medicare Advantage	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,462.50
Rate for Payer: Cigna Commercial	$8,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00
Rate for Payer: UnitedHealthcare Community & State	$553.00
Rate for Payer: Wellpoint Medicaid Managed Care	$497.00

KIT SEPARATION PLATE 8001001A

Facility

$2,505.00

Hospital Charge Code	270633430
Hospital Revenue Code	272
Min. Negotiated Rate	$375.75
Max. Negotiated Rate	$375.75
Rate for Payer: Qualcare PPO/HMO/WC	$375.75

KIT SEPARATION PLATE 8001001A

Facility

$2,505.00

Hospital Charge Code	270633430
Hospital Revenue Code	272
Min. Negotiated Rate	$71.14
Max. Negotiated Rate	$1,252.50
Rate for Payer: Aetna Commercial	$951.90
Rate for Payer: Aetna Medicare Advantage	$751.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$638.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$638.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$638.77
Rate for Payer: Cigna Commercial	$1,252.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$651.30
Rate for Payer: Oxford Commercial	$501.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.75
Rate for Payer: UnitedHealthcare Commercial	$501.00
Rate for Payer: UnitedHealthcare Community & State	$79.16
Rate for Payer: Wellpoint Medicaid Managed Care	$71.14

KIT SHOULDER STABILIZATION

Facility

$333.38

Hospital Charge Code	270652581
Hospital Revenue Code	270
Min. Negotiated Rate	$9.47
Max. Negotiated Rate	$166.69
Rate for Payer: Aetna Commercial	$126.68
Rate for Payer: Aetna Medicare Advantage	$100.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.01
Rate for Payer: Cigna Commercial	$166.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.68
Rate for Payer: Oxford Commercial	$66.68
Rate for Payer: Qualcare PPO/HMO/WC	$50.01
Rate for Payer: UnitedHealthcare Commercial	$66.68
Rate for Payer: UnitedHealthcare Community & State	$10.53
Rate for Payer: Wellpoint Medicaid Managed Care	$9.47

KIT SHOULDER STABILIZATION

Facility

$333.38

Hospital Charge Code	270652581
Hospital Revenue Code	270
Min. Negotiated Rate	$50.01
Max. Negotiated Rate	$50.01
Rate for Payer: Qualcare PPO/HMO/WC	$50.01

KIT SHOULDER SUSPENSION 3583

Facility

$415.63

Hospital Charge Code	270605461
Hospital Revenue Code	272
Min. Negotiated Rate	$62.34
Max. Negotiated Rate	$62.34
Rate for Payer: Qualcare PPO/HMO/WC	$62.34

KIT SHOULDER SUSPENSION 3583

Facility

$415.63

Hospital Charge Code	270605461
Hospital Revenue Code	272
Min. Negotiated Rate	$11.80
Max. Negotiated Rate	$207.81
Rate for Payer: Aetna Commercial	$157.94
Rate for Payer: Aetna Medicare Advantage	$124.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.99
Rate for Payer: Cigna Commercial	$207.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.06
Rate for Payer: Oxford Commercial	$83.13
Rate for Payer: Qualcare PPO/HMO/WC	$62.34
Rate for Payer: UnitedHealthcare Commercial	$83.13
Rate for Payer: UnitedHealthcare Community & State	$13.13
Rate for Payer: Wellpoint Medicaid Managed Care	$11.80

KIT SKINTE REGENERATE HARVEST

Facility

$28,625.00

Hospital Charge Code	270690741
Hospital Revenue Code	272
Min. Negotiated Rate	$812.95
Max. Negotiated Rate	$14,312.50
Rate for Payer: Aetna Commercial	$10,877.50
Rate for Payer: Aetna Medicare Advantage	$8,587.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,299.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,299.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,299.38
Rate for Payer: Cigna Commercial	$14,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,442.50
Rate for Payer: Oxford Commercial	$5,725.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,293.75
Rate for Payer: UnitedHealthcare Commercial	$5,725.00
Rate for Payer: UnitedHealthcare Community & State	$904.55
Rate for Payer: Wellpoint Medicaid Managed Care	$812.95

KIT SKINTE REGENERATE HARVEST

Facility

$300.00

Service Code	HCPCS Q4200
Hospital Charge Code	270685478
Hospital Revenue Code	636
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$72.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

KIT SKINTE REGENERATE HARVEST

Facility

$28,625.00

Hospital Charge Code	270690741
Hospital Revenue Code	272
Min. Negotiated Rate	$4,293.75
Max. Negotiated Rate	$4,293.75
Rate for Payer: Qualcare PPO/HMO/WC	$4,293.75

KIT SKINTE REGENERATE HARVEST

Facility

$300.00

Service Code	HCPCS Q4200
Hospital Charge Code	270685478
Hospital Revenue Code	636
Min. Negotiated Rate	$8.52
Max. Negotiated Rate	$536.29
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$536.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$536.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$536.29
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$45.00
Rate for Payer: UnitedHealthcare Community & State	$9.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$8.52

KIT SMOKE EVACUATION PENCIL

Facility

$139.30

Hospital Charge Code	270677420
Hospital Revenue Code	272
Min. Negotiated Rate	$20.89
Max. Negotiated Rate	$20.89
Rate for Payer: Qualcare PPO/HMO/WC	$20.89

KIT SMOKE EVACUATION PENCIL

Facility

$139.30

Hospital Charge Code	270677420
Hospital Revenue Code	272
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$69.65
Rate for Payer: Aetna Commercial	$52.93
Rate for Payer: Aetna Medicare Advantage	$41.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.52
Rate for Payer: Cigna Commercial	$69.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.22
Rate for Payer: Oxford Commercial	$27.86
Rate for Payer: Qualcare PPO/HMO/WC	$20.89
Rate for Payer: UnitedHealthcare Commercial	$27.86
Rate for Payer: UnitedHealthcare Community & State	$4.40
Rate for Payer: Wellpoint Medicaid Managed Care	$3.96

KIT SONIC ANCHOR 2.5x10mm

Facility

$2,544.00

Service Code	HCPCS C1713
Hospital Charge Code	270680908
Hospital Revenue Code	278
Min. Negotiated Rate	$72.25
Max. Negotiated Rate	$1,272.00
Rate for Payer: Aetna Commercial	$966.72
Rate for Payer: Aetna Medicare Advantage	$763.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$648.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$648.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$508.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$648.72
Rate for Payer: Cigna Commercial	$1,272.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$615.65
Rate for Payer: Qualcare PPO/HMO/WC	$381.60
Rate for Payer: UnitedHealthcare Community & State	$80.39
Rate for Payer: Wellpoint Medicaid Managed Care	$72.25

KIT SONIC ANCHOR 2.5x10mm

Facility

$2,544.00

Service Code	HCPCS C1713
Hospital Charge Code	270680908
Hospital Revenue Code	278
Min. Negotiated Rate	$381.60
Max. Negotiated Rate	$615.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$508.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$615.65
Rate for Payer: Qualcare PPO/HMO/WC	$381.60

KIT SPEED ARC IMPLANT 9BRIDGE

Facility

$7,000.00

Hospital Charge Code	270672146
Hospital Revenue Code	278
Min. Negotiated Rate	$198.80
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,660.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00
Rate for Payer: UnitedHealthcare Community & State	$221.20
Rate for Payer: Wellpoint Medicaid Managed Care	$198.80

KIT SPEED ARC IMPLANT 9BRIDGE

Facility

$7,000.00

Hospital Charge Code	270672146
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

KIT SPINE MAZOR X DISP

Facility

$7,500.00

Hospital Charge Code	270698617
Hospital Revenue Code	272
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

KIT SPINE MAZOR X DISP

Facility

$7,500.00

Hospital Charge Code	270698617
Hospital Revenue Code	272
Min. Negotiated Rate	$213.00
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,950.00
Rate for Payer: Oxford Commercial	$1,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00
Rate for Payer: UnitedHealthcare Commercial	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$237.00
Rate for Payer: Wellpoint Medicaid Managed Care	$213.00

KIT SPRAY ACCESSORY 934500

Facility

$208.00

Hospital Charge Code	270635992
Hospital Revenue Code	272
Min. Negotiated Rate	$5.91
Max. Negotiated Rate	$104.00
Rate for Payer: Aetna Commercial	$79.04
Rate for Payer: Aetna Medicare Advantage	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.04
Rate for Payer: Cigna Commercial	$104.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.08
Rate for Payer: Oxford Commercial	$41.60
Rate for Payer: Qualcare PPO/HMO/WC	$31.20
Rate for Payer: UnitedHealthcare Commercial	$41.60
Rate for Payer: UnitedHealthcare Community & State	$6.57
Rate for Payer: Wellpoint Medicaid Managed Care	$5.91

KIT SPRAY ACCESSORY 934500

Facility

$208.00

Hospital Charge Code	270635992
Hospital Revenue Code	272
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$31.20
Rate for Payer: Qualcare PPO/HMO/WC	$31.20

KIT STAPLE FUSEFORSE 15X15MM

Facility

$6,425.00

Hospital Charge Code	270678362
Hospital Revenue Code	272
Min. Negotiated Rate	$963.75
Max. Negotiated Rate	$963.75
Rate for Payer: Qualcare PPO/HMO/WC	$963.75

Know your out-of-pocket cost for care.

All Charges