Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ROD 5.5 TI CP4 NS CRV 90MM

Facility

$1,260.00

Service Code	HCPCS C1713
Hospital Charge Code	270698927
Hospital Revenue Code	278
Min. Negotiated Rate	$35.78
Max. Negotiated Rate	$630.00
Rate for Payer: Aetna Commercial	$478.80
Rate for Payer: Aetna Medicare Advantage	$378.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$321.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$321.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$252.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$321.30
Rate for Payer: Cigna Commercial	$630.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$304.92
Rate for Payer: Qualcare PPO/HMO/WC	$189.00
Rate for Payer: UnitedHealthcare Community & State	$39.82
Rate for Payer: Wellpoint Medicaid Managed Care	$35.78

ROD 5.5 TI CP4 NS CRV 90MM

Facility

$1,260.00

Service Code	HCPCS C1713
Hospital Charge Code	270698927
Hospital Revenue Code	278
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$304.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$252.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$304.92
Rate for Payer: Qualcare PPO/HMO/WC	$189.00

ROD 5.5 X110MM

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270694078
Hospital Revenue Code	278
Min. Negotiated Rate	$78.10
Max. Negotiated Rate	$1,375.00
Rate for Payer: Aetna Commercial	$1,045.00
Rate for Payer: Aetna Medicare Advantage	$825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$701.25
Rate for Payer: Cigna Commercial	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$412.50
Rate for Payer: UnitedHealthcare Community & State	$86.90
Rate for Payer: Wellpoint Medicaid Managed Care	$78.10

ROD 5.5 X110MM

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270694078
Hospital Revenue Code	278
Min. Negotiated Rate	$412.50
Max. Negotiated Rate	$665.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$412.50

ROD 5.5x55MM CURVED

Facility

$1,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270680799
Hospital Revenue Code	278
Min. Negotiated Rate	$46.15
Max. Negotiated Rate	$812.50
Rate for Payer: Aetna Commercial	$617.50
Rate for Payer: Aetna Medicare Advantage	$487.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$414.38
Rate for Payer: Cigna Commercial	$812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.25
Rate for Payer: Qualcare PPO/HMO/WC	$243.75
Rate for Payer: UnitedHealthcare Community & State	$51.35
Rate for Payer: Wellpoint Medicaid Managed Care	$46.15

ROD 5.5x55MM CURVED

Facility

$1,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270680799
Hospital Revenue Code	278
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$393.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.25
Rate for Payer: Qualcare PPO/HMO/WC	$243.75

ROD 55x80MM LORDOSED

Facility

$1,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270680081
Hospital Revenue Code	278
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$393.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.25
Rate for Payer: Qualcare PPO/HMO/WC	$243.75

ROD 55x80MM LORDOSED

Facility

$1,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270680081
Hospital Revenue Code	278
Min. Negotiated Rate	$46.15
Max. Negotiated Rate	$812.50
Rate for Payer: Aetna Commercial	$617.50
Rate for Payer: Aetna Medicare Advantage	$487.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$414.38
Rate for Payer: Cigna Commercial	$812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.25
Rate for Payer: Qualcare PPO/HMO/WC	$243.75
Rate for Payer: UnitedHealthcare Community & State	$51.35
Rate for Payer: Wellpoint Medicaid Managed Care	$46.15

ROD 60MM

Facility

$891.20

Service Code	HCPCS C1713
Hospital Charge Code	270688861
Hospital Revenue Code	278
Min. Negotiated Rate	$133.68
Max. Negotiated Rate	$215.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$178.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.67
Rate for Payer: Qualcare PPO/HMO/WC	$133.68

ROD 60MM

Facility

$891.20

Service Code	HCPCS C1713
Hospital Charge Code	270688861
Hospital Revenue Code	278
Min. Negotiated Rate	$25.31
Max. Negotiated Rate	$445.60
Rate for Payer: Aetna Commercial	$338.66
Rate for Payer: Aetna Medicare Advantage	$267.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$178.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.26
Rate for Payer: Cigna Commercial	$445.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.67
Rate for Payer: Qualcare PPO/HMO/WC	$133.68
Rate for Payer: UnitedHealthcare Community & State	$28.16
Rate for Payer: Wellpoint Medicaid Managed Care	$25.31

ROD 60MM

Facility

$1,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270681180
Hospital Revenue Code	278
Min. Negotiated Rate	$53.25
Max. Negotiated Rate	$937.50
Rate for Payer: Aetna Commercial	$712.50
Rate for Payer: Aetna Medicare Advantage	$562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$478.12
Rate for Payer: Cigna Commercial	$937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.75
Rate for Payer: Qualcare PPO/HMO/WC	$281.25
Rate for Payer: UnitedHealthcare Community & State	$59.25
Rate for Payer: Wellpoint Medicaid Managed Care	$53.25

ROD 60MM

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270697038
Hospital Revenue Code	278
Min. Negotiated Rate	$412.50
Max. Negotiated Rate	$665.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$412.50

ROD 60MM

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270697038
Hospital Revenue Code	278
Min. Negotiated Rate	$78.10
Max. Negotiated Rate	$1,375.00
Rate for Payer: Aetna Commercial	$1,045.00
Rate for Payer: Aetna Medicare Advantage	$825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$701.25
Rate for Payer: Cigna Commercial	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$412.50
Rate for Payer: UnitedHealthcare Community & State	$86.90
Rate for Payer: Wellpoint Medicaid Managed Care	$78.10

ROD 60MM

Facility

$1,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270681180
Hospital Revenue Code	278
Min. Negotiated Rate	$281.25
Max. Negotiated Rate	$453.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.75
Rate for Payer: Qualcare PPO/HMO/WC	$281.25

ROD 60MM BENT

Facility

$175.00

Service Code	HCPCS C1713
Hospital Charge Code	270702663
Hospital Revenue Code	278
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$42.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.35
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

ROD 60MM BENT

Facility

$175.00

Service Code	HCPCS C1713
Hospital Charge Code	270702663
Hospital Revenue Code	278
Min. Negotiated Rate	$4.97
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$66.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.35
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Community & State	$5.53
Rate for Payer: Wellpoint Medicaid Managed Care	$4.97

ROD 65MM

Facility

$525.00

Service Code	HCPCS C1716
Hospital Charge Code	270701774
Hospital Revenue Code	278
Min. Negotiated Rate	$14.91
Max. Negotiated Rate	$2,166.34
Rate for Payer: Aetna Commercial	$1,624.38
Rate for Payer: Aetna Medicare Advantage	$1,934.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,166.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,166.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$597.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,166.34
Rate for Payer: Cigna Commercial	$1,197.08
Rate for Payer: Cigna Medicare Advantage	$597.20
Rate for Payer: Clover Medicare Advantage	$567.34
Rate for Payer: EmblemHealth Commercial	$1,791.60
Rate for Payer: Humana Medicare Advantage	$615.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$597.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: Qualcare PPO/HMO/WC	$78.75
Rate for Payer: UnitedHealthcare Community & State	$16.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$597.20
Rate for Payer: Wellcare Medicare Advantage	$597.20
Rate for Payer: Wellpoint Medicaid Managed Care	$14.91

ROD 65MM

Facility

$3,280.00

Hospital Charge Code	270667338
Hospital Revenue Code	278
Min. Negotiated Rate	$492.00
Max. Negotiated Rate	$793.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$656.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.76
Rate for Payer: Qualcare PPO/HMO/WC	$492.00

ROD 65MM

Facility

$3,280.00

Hospital Charge Code	270667338
Hospital Revenue Code	278
Min. Negotiated Rate	$93.15
Max. Negotiated Rate	$1,640.00
Rate for Payer: Aetna Commercial	$1,246.40
Rate for Payer: Aetna Medicare Advantage	$984.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$836.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$836.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$656.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$836.40
Rate for Payer: Cigna Commercial	$1,640.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.76
Rate for Payer: Qualcare PPO/HMO/WC	$492.00
Rate for Payer: UnitedHealthcare Community & State	$103.65
Rate for Payer: Wellpoint Medicaid Managed Care	$93.15

ROD 65MM

Facility

$525.00

Service Code	HCPCS C1716
Hospital Charge Code	270701774
Hospital Revenue Code	278
Min. Negotiated Rate	$78.75
Max. Negotiated Rate	$127.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: Qualcare PPO/HMO/WC	$78.75

ROD 70MM

Facility

$1,375.00

Hospital Charge Code	270703138
Hospital Revenue Code	278
Min. Negotiated Rate	$39.05
Max. Negotiated Rate	$687.50
Rate for Payer: Aetna Commercial	$522.50
Rate for Payer: Aetna Medicare Advantage	$412.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$350.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$350.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$350.62
Rate for Payer: Cigna Commercial	$687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$332.75
Rate for Payer: Qualcare PPO/HMO/WC	$206.25
Rate for Payer: UnitedHealthcare Community & State	$43.45
Rate for Payer: Wellpoint Medicaid Managed Care	$39.05

ROD 70MM

Facility

$1,375.00

Hospital Charge Code	270703138
Hospital Revenue Code	278
Min. Negotiated Rate	$206.25
Max. Negotiated Rate	$332.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$332.75
Rate for Payer: Qualcare PPO/HMO/WC	$206.25

ROD 70MM

Facility

$2,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270701775
Hospital Revenue Code	278
Min. Negotiated Rate	$74.55
Max. Negotiated Rate	$1,312.50
Rate for Payer: Aetna Commercial	$997.50
Rate for Payer: Aetna Medicare Advantage	$787.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$669.38
Rate for Payer: Cigna Commercial	$1,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$635.25
Rate for Payer: Qualcare PPO/HMO/WC	$393.75
Rate for Payer: UnitedHealthcare Community & State	$82.95
Rate for Payer: Wellpoint Medicaid Managed Care	$74.55

ROD 70MM

Facility

$2,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270701775
Hospital Revenue Code	278
Min. Negotiated Rate	$393.75
Max. Negotiated Rate	$635.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$635.25
Rate for Payer: Qualcare PPO/HMO/WC	$393.75

ROD 80 MM

Facility

$2,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270693061
Hospital Revenue Code	278
Min. Negotiated Rate	$446.25
Max. Negotiated Rate	$719.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$719.95
Rate for Payer: Qualcare PPO/HMO/WC	$446.25

Know your out-of-pocket cost for care.

All Charges