Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

LOCK SCREW 3.5 X 12MM

Facility

$522.40

Service Code	HCPCS C1713
Hospital Charge Code	270657756
Hospital Revenue Code	278
Min. Negotiated Rate	$14.84
Max. Negotiated Rate	$261.20
Rate for Payer: Aetna Commercial	$198.51
Rate for Payer: Aetna Medicare Advantage	$156.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.21
Rate for Payer: Cigna Commercial	$261.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.42
Rate for Payer: Qualcare PPO/HMO/WC	$78.36
Rate for Payer: UnitedHealthcare Community & State	$16.51
Rate for Payer: Wellpoint Medicaid Managed Care	$14.84

LOCK SCREW 3.5 X 12MM

Facility

$522.40

Service Code	HCPCS C1713
Hospital Charge Code	270657756
Hospital Revenue Code	278
Min. Negotiated Rate	$78.36
Max. Negotiated Rate	$126.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.42
Rate for Payer: Qualcare PPO/HMO/WC	$78.36

LOCK SCREW 3.5 X 14MM

Facility

$522.40

Service Code	HCPCS C1713
Hospital Charge Code	270657758
Hospital Revenue Code	278
Min. Negotiated Rate	$14.84
Max. Negotiated Rate	$261.20
Rate for Payer: Aetna Commercial	$198.51
Rate for Payer: Aetna Medicare Advantage	$156.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.21
Rate for Payer: Cigna Commercial	$261.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.42
Rate for Payer: Qualcare PPO/HMO/WC	$78.36
Rate for Payer: UnitedHealthcare Community & State	$16.51
Rate for Payer: Wellpoint Medicaid Managed Care	$14.84

LOCK SCREW 3.5 X 14MM

Facility

$522.40

Service Code	HCPCS C1713
Hospital Charge Code	270657758
Hospital Revenue Code	278
Min. Negotiated Rate	$78.36
Max. Negotiated Rate	$126.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.42
Rate for Payer: Qualcare PPO/HMO/WC	$78.36

LOCK SCREW SQUARE 2.7MM X 16MM

Facility

$522.50

Service Code	HCPCS C1713
Hospital Charge Code	270688184
Hospital Revenue Code	278
Min. Negotiated Rate	$14.84
Max. Negotiated Rate	$261.25
Rate for Payer: Aetna Commercial	$198.55
Rate for Payer: Aetna Medicare Advantage	$156.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.24
Rate for Payer: Cigna Commercial	$261.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.44
Rate for Payer: Qualcare PPO/HMO/WC	$78.38
Rate for Payer: UnitedHealthcare Community & State	$16.51
Rate for Payer: Wellpoint Medicaid Managed Care	$14.84

LOCK SCREW SQUARE 2.7MM X 16MM

Facility

$522.50

Service Code	HCPCS C1713
Hospital Charge Code	270688184
Hospital Revenue Code	278
Min. Negotiated Rate	$78.38
Max. Negotiated Rate	$126.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.44
Rate for Payer: Qualcare PPO/HMO/WC	$78.38

LOCK SCREW SQUARE 2.7MM X 18MM

Facility

$980.00

Service Code	HCPCS C1713
Hospital Charge Code	270688185
Hospital Revenue Code	278
Min. Negotiated Rate	$147.00
Max. Negotiated Rate	$237.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$196.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$237.16
Rate for Payer: Qualcare PPO/HMO/WC	$147.00

LOCK SCREW SQUARE 2.7MM X 18MM

Facility

$980.00

Service Code	HCPCS C1713
Hospital Charge Code	270688185
Hospital Revenue Code	278
Min. Negotiated Rate	$27.83
Max. Negotiated Rate	$490.00
Rate for Payer: Aetna Commercial	$372.40
Rate for Payer: Aetna Medicare Advantage	$294.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$249.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$249.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$196.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$249.90
Rate for Payer: Cigna Commercial	$490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$237.16
Rate for Payer: Qualcare PPO/HMO/WC	$147.00
Rate for Payer: UnitedHealthcare Community & State	$30.97
Rate for Payer: Wellpoint Medicaid Managed Care	$27.83

LOCK SCREW SQUARE 2.7MM X 24MM

Facility

$650.00

Service Code	HCPCS C1776
Hospital Charge Code	270663849
Hospital Revenue Code	278
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$157.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.30
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

LOCK SCREW SQUARE 2.7MM X 24MM

Facility

$650.00

Service Code	HCPCS C1776
Hospital Charge Code	270663849
Hospital Revenue Code	278
Min. Negotiated Rate	$18.46
Max. Negotiated Rate	$325.00
Rate for Payer: Aetna Commercial	$247.00
Rate for Payer: Aetna Medicare Advantage	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.75
Rate for Payer: Cigna Commercial	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.30
Rate for Payer: Qualcare PPO/HMO/WC	$97.50
Rate for Payer: UnitedHealthcare Community & State	$20.54
Rate for Payer: Wellpoint Medicaid Managed Care	$18.46

LOCM,150-199 MG/ML

Facility

$1,638.00

Hospital Charge Code	2008175
Hospital Revenue Code	255
Min. Negotiated Rate	$245.70
Max. Negotiated Rate	$245.70
Rate for Payer: Qualcare PPO/HMO/WC	$245.70

LOCM,150-199 MG/ML

Facility

$1,638.00

Hospital Charge Code	2008175
Hospital Revenue Code	255
Min. Negotiated Rate	$46.52
Max. Negotiated Rate	$819.00
Rate for Payer: Aetna Commercial	$622.44
Rate for Payer: Aetna Medicare Advantage	$491.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$417.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$417.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$417.69
Rate for Payer: Cigna Commercial	$819.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$425.88
Rate for Payer: Oxford Commercial	$327.60
Rate for Payer: Qualcare PPO/HMO/WC	$245.70
Rate for Payer: UnitedHealthcare Commercial	$327.60
Rate for Payer: UnitedHealthcare Community & State	$51.76
Rate for Payer: Wellpoint Medicaid Managed Care	$46.52

LOCOSAMIDE UNIT 50MG/5ML

Facility

$291.12

Service Code	NDC 904746466
Hospital Charge Code	606390602
Hospital Revenue Code	250
Min. Negotiated Rate	$8.27
Max. Negotiated Rate	$145.56
Rate for Payer: Aetna Commercial	$110.63
Rate for Payer: Aetna Medicare Advantage	$87.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.24
Rate for Payer: Cigna Commercial	$145.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.69
Rate for Payer: Oxford Commercial	$58.22
Rate for Payer: Qualcare PPO/HMO/WC	$43.67
Rate for Payer: UnitedHealthcare Commercial	$58.22
Rate for Payer: UnitedHealthcare Community & State	$9.20
Rate for Payer: Wellpoint Medicaid Managed Care	$8.27

LOCOSAMIDE UNIT 50MG/5ML

Facility

$291.12

Service Code	NDC 904746466
Hospital Charge Code	606390602
Hospital Revenue Code	250
Min. Negotiated Rate	$43.67
Max. Negotiated Rate	$43.67
Rate for Payer: Qualcare PPO/HMO/WC	$43.67

LO IMPLANT, 8x10x25MM

Facility

$29,335.00

Hospital Charge Code	270665931
Hospital Revenue Code	270
Min. Negotiated Rate	$4,400.25
Max. Negotiated Rate	$4,400.25
Rate for Payer: Qualcare PPO/HMO/WC	$4,400.25

LO IMPLANT, 8x10x25MM

Facility

$29,335.00

Hospital Charge Code	270665931
Hospital Revenue Code	270
Min. Negotiated Rate	$833.11
Max. Negotiated Rate	$14,667.50
Rate for Payer: Aetna Commercial	$11,147.30
Rate for Payer: Aetna Medicare Advantage	$8,800.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,480.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,480.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,480.43
Rate for Payer: Cigna Commercial	$14,667.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,627.10
Rate for Payer: Oxford Commercial	$5,867.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,400.25
Rate for Payer: UnitedHealthcare Commercial	$5,867.00
Rate for Payer: UnitedHealthcare Community & State	$926.99
Rate for Payer: Wellpoint Medicaid Managed Care	$833.11

LO IMPLANT 8X10X30MM

Facility

$29,335.00

Hospital Charge Code	270657291
Hospital Revenue Code	278
Min. Negotiated Rate	$4,400.25
Max. Negotiated Rate	$7,099.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,867.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,099.07
Rate for Payer: Qualcare PPO/HMO/WC	$4,400.25

LO IMPLANT 8X10X30MM

Facility

$29,335.00

Hospital Charge Code	270657291
Hospital Revenue Code	278
Min. Negotiated Rate	$833.11
Max. Negotiated Rate	$14,667.50
Rate for Payer: Aetna Commercial	$11,147.30
Rate for Payer: Aetna Medicare Advantage	$8,800.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,480.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,480.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,867.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,480.43
Rate for Payer: Cigna Commercial	$14,667.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,099.07
Rate for Payer: Qualcare PPO/HMO/WC	$4,400.25
Rate for Payer: UnitedHealthcare Community & State	$926.99
Rate for Payer: Wellpoint Medicaid Managed Care	$833.11

LOKELMA 10 GM

Facility

$174.20

Service Code	NDC 310111039
Hospital Charge Code	606390285
Hospital Revenue Code	250
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$87.10
Rate for Payer: Aetna Commercial	$66.20
Rate for Payer: Aetna Medicare Advantage	$52.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.42
Rate for Payer: Cigna Commercial	$87.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.29
Rate for Payer: Oxford Commercial	$34.84
Rate for Payer: Qualcare PPO/HMO/WC	$26.13
Rate for Payer: UnitedHealthcare Commercial	$34.84
Rate for Payer: UnitedHealthcare Community & State	$5.50
Rate for Payer: Wellpoint Medicaid Managed Care	$4.95

LOKELMA 10 GM

Facility

$174.20

Service Code	NDC 310111039
Hospital Charge Code	606390285
Hospital Revenue Code	250
Min. Negotiated Rate	$26.13
Max. Negotiated Rate	$26.13
Rate for Payer: Qualcare PPO/HMO/WC	$26.13

LOKELMA 5 GM

Facility

$174.20

Service Code	NDC 310110539
Hospital Charge Code	606390284
Hospital Revenue Code	250
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$87.10
Rate for Payer: Aetna Commercial	$66.20
Rate for Payer: Aetna Medicare Advantage	$52.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.42
Rate for Payer: Cigna Commercial	$87.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.29
Rate for Payer: Oxford Commercial	$34.84
Rate for Payer: Qualcare PPO/HMO/WC	$26.13
Rate for Payer: UnitedHealthcare Commercial	$34.84
Rate for Payer: UnitedHealthcare Community & State	$5.50
Rate for Payer: Wellpoint Medicaid Managed Care	$4.95

LOKELMA 5 GM

Facility

$174.20

Service Code	NDC 310110539
Hospital Charge Code	606390284
Hospital Revenue Code	250
Min. Negotiated Rate	$26.13
Max. Negotiated Rate	$26.13
Rate for Payer: Qualcare PPO/HMO/WC	$26.13

LONG BLADE EXTENDER

Facility

$875.00

Hospital Charge Code	270694230
Hospital Revenue Code	272
Min. Negotiated Rate	$24.85
Max. Negotiated Rate	$437.50
Rate for Payer: Aetna Commercial	$332.50
Rate for Payer: Aetna Medicare Advantage	$262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.12
Rate for Payer: Cigna Commercial	$437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$227.50
Rate for Payer: Oxford Commercial	$175.00
Rate for Payer: Qualcare PPO/HMO/WC	$131.25
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$27.65
Rate for Payer: Wellpoint Medicaid Managed Care	$24.85

LONG BLADE EXTENDER

Facility

$875.00

Hospital Charge Code	270694230
Hospital Revenue Code	272
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$131.25
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

longevity dm bearing 28 x 40mm

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270690807
Hospital Revenue Code	278
Min. Negotiated Rate	$106.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$118.50
Rate for Payer: Wellpoint Medicaid Managed Care	$106.50

Know your out-of-pocket cost for care.

All Charges