Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ROD BULLET LORDO MERC 5.5X50MM

Facility

$700.00

Service Code	HCPCS C1713
Hospital Charge Code	270693127
Hospital Revenue Code	278
Min. Negotiated Rate	$19.88
Max. Negotiated Rate	$350.00
Rate for Payer: Aetna Commercial	$266.00
Rate for Payer: Aetna Medicare Advantage	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.50
Rate for Payer: Cigna Commercial	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: Qualcare PPO/HMO/WC	$105.00
Rate for Payer: UnitedHealthcare Community & State	$22.12
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

ROD BULLET LORDO MERC 5.5X50MM

Facility

$700.00

Service Code	HCPCS C1713
Hospital Charge Code	270693127
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$169.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: Qualcare PPO/HMO/WC	$105.00

ROD BULLET LORDOS MIS 5.5X60MM

Facility

$560.00

Service Code	HCPCS C1713
Hospital Charge Code	270697717
Hospital Revenue Code	278
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$135.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$112.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.52
Rate for Payer: Qualcare PPO/HMO/WC	$84.00

ROD BULLET LORDOS MIS 5.5X60MM

Facility

$560.00

Service Code	HCPCS C1713
Hospital Charge Code	270697717
Hospital Revenue Code	278
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$280.00
Rate for Payer: Aetna Commercial	$212.80
Rate for Payer: Aetna Medicare Advantage	$168.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$142.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$142.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$112.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$142.80
Rate for Payer: Cigna Commercial	$280.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.52
Rate for Payer: Qualcare PPO/HMO/WC	$84.00
Rate for Payer: UnitedHealthcare Community & State	$17.70
Rate for Payer: Wellpoint Medicaid Managed Care	$15.90

ROD BULLET NOSE CURV 5.5X55MM

Facility

$1,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270693336
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 BULLET NOSE CURV 5.5X55MM

Facility

$1,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270693336
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 BULLET NOSE CURV 5.5X65MM

Facility

$1,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270694868
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 BULLET NOSE CURV 5.5X65MM

Facility

$1,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270694868
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 CAP SPINE SOLERA 4.75X35MM

Facility

$6,850.00

Service Code	HCPCS C1713
Hospital Charge Code	270696282
Hospital Revenue Code	278
Min. Negotiated Rate	$1,027.50
Max. Negotiated Rate	$1,657.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,370.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,657.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,027.50

ROD CAP SPINE SOLERA 4.75X35MM

Facility

$6,850.00

Service Code	HCPCS C1713
Hospital Charge Code	270696282
Hospital Revenue Code	278
Min. Negotiated Rate	$194.54
Max. Negotiated Rate	$3,425.00
Rate for Payer: Aetna Commercial	$2,603.00
Rate for Payer: Aetna Medicare Advantage	$2,055.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,746.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,746.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,746.75
Rate for Payer: Cigna Commercial	$3,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,657.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,027.50
Rate for Payer: UnitedHealthcare Community & State	$216.46
Rate for Payer: Wellpoint Medicaid Managed Care	$194.54

ROD CARBON 100MM

Facility

$845.00

Service Code	HCPCS C1713
Hospital Charge Code	270699325
Hospital Revenue Code	278
Min. Negotiated Rate	$126.75
Max. Negotiated Rate	$204.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.49
Rate for Payer: Qualcare PPO/HMO/WC	$126.75

ROD CARBON 100MM

Facility

$845.00

Service Code	HCPCS C1713
Hospital Charge Code	270699325
Hospital Revenue Code	278
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$422.50
Rate for Payer: Aetna Commercial	$321.10
Rate for Payer: Aetna Medicare Advantage	$253.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.47
Rate for Payer: Cigna Commercial	$422.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.49
Rate for Payer: Qualcare PPO/HMO/WC	$126.75
Rate for Payer: UnitedHealthcare Community & State	$26.70
Rate for Payer: Wellpoint Medicaid Managed Care	$24.00

ROD CARBON 11X250MM

Facility

$2,435.00

Service Code	HCPCS C1713
Hospital Charge Code	270669003
Hospital Revenue Code	278
Min. Negotiated Rate	$69.15
Max. Negotiated Rate	$1,217.50
Rate for Payer: Aetna Commercial	$925.30
Rate for Payer: Aetna Medicare Advantage	$730.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$620.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$620.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$487.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$620.92
Rate for Payer: Cigna Commercial	$1,217.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$589.27
Rate for Payer: Qualcare PPO/HMO/WC	$365.25
Rate for Payer: UnitedHealthcare Community & State	$76.95
Rate for Payer: Wellpoint Medicaid Managed Care	$69.15

ROD CARBON 11X250MM

Facility

$2,435.00

Service Code	HCPCS C1713
Hospital Charge Code	270669003
Hospital Revenue Code	278
Min. Negotiated Rate	$365.25
Max. Negotiated Rate	$589.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$487.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$589.27
Rate for Payer: Qualcare PPO/HMO/WC	$365.25

ROD CARBON 11x400

Facility

$3,063.25

Hospital Charge Code	270650715
Hospital Revenue Code	279
Min. Negotiated Rate	$459.49
Max. Negotiated Rate	$459.49
Rate for Payer: Qualcare PPO/HMO/WC	$459.49

ROD CARBON 11x400

Facility

$3,063.25

Hospital Charge Code	270650715
Hospital Revenue Code	279
Min. Negotiated Rate	$87.00
Max. Negotiated Rate	$1,531.62
Rate for Payer: Aetna Commercial	$1,164.04
Rate for Payer: Aetna Medicare Advantage	$918.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$781.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$781.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$781.13
Rate for Payer: Cigna Commercial	$1,531.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$796.45
Rate for Payer: Oxford Commercial	$612.65
Rate for Payer: Qualcare PPO/HMO/WC	$459.49
Rate for Payer: UnitedHealthcare Commercial	$612.65
Rate for Payer: UnitedHealthcare Community & State	$96.80
Rate for Payer: Wellpoint Medicaid Managed Care	$87.00

ROD CARBON 11x450

Facility

$2,154.25

Service Code	HCPCS C1713
Hospital Charge Code	270648626
Hospital Revenue Code	278
Min. Negotiated Rate	$323.14
Max. Negotiated Rate	$521.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$430.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$521.33
Rate for Payer: Qualcare PPO/HMO/WC	$323.14

ROD CARBON 11x450

Facility

$2,154.25

Service Code	HCPCS C1713
Hospital Charge Code	270648626
Hospital Revenue Code	278
Min. Negotiated Rate	$61.18
Max. Negotiated Rate	$1,077.12
Rate for Payer: Aetna Commercial	$818.62
Rate for Payer: Aetna Medicare Advantage	$646.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$549.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$549.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$430.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$549.33
Rate for Payer: Cigna Commercial	$1,077.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$521.33
Rate for Payer: Qualcare PPO/HMO/WC	$323.14
Rate for Payer: UnitedHealthcare Community & State	$68.07
Rate for Payer: Wellpoint Medicaid Managed Care	$61.18

ROD CARBON 150MM

Facility

$845.00

Service Code	HCPCS C1713
Hospital Charge Code	270699326
Hospital Revenue Code	278
Min. Negotiated Rate	$126.75
Max. Negotiated Rate	$204.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.49
Rate for Payer: Qualcare PPO/HMO/WC	$126.75

ROD CARBON 150MM

Facility

$845.00

Service Code	HCPCS C1713
Hospital Charge Code	270699326
Hospital Revenue Code	278
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$422.50
Rate for Payer: Aetna Commercial	$321.10
Rate for Payer: Aetna Medicare Advantage	$253.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.47
Rate for Payer: Cigna Commercial	$422.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.49
Rate for Payer: Qualcare PPO/HMO/WC	$126.75
Rate for Payer: UnitedHealthcare Community & State	$26.70
Rate for Payer: Wellpoint Medicaid Managed Care	$24.00

ROD CARBON 150mm 14160

Facility

$880.00

Service Code	HCPCS C1713
Hospital Charge Code	270639791
Hospital Revenue Code	278
Min. Negotiated Rate	$132.00
Max. Negotiated Rate	$212.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$176.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.96
Rate for Payer: Qualcare PPO/HMO/WC	$132.00

ROD CARBON 150mm 14160

Facility

$880.00

Service Code	HCPCS C1713
Hospital Charge Code	270639791
Hospital Revenue Code	278
Min. Negotiated Rate	$24.99
Max. Negotiated Rate	$440.00
Rate for Payer: Aetna Commercial	$334.40
Rate for Payer: Aetna Medicare Advantage	$264.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$224.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$224.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$176.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$224.40
Rate for Payer: Cigna Commercial	$440.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.96
Rate for Payer: Qualcare PPO/HMO/WC	$132.00
Rate for Payer: UnitedHealthcare Community & State	$27.81
Rate for Payer: Wellpoint Medicaid Managed Care	$24.99

ROD CARBON 200MM

Facility

$845.00

Service Code	HCPCS C1713
Hospital Charge Code	270699327
Hospital Revenue Code	278
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$422.50
Rate for Payer: Aetna Commercial	$321.10
Rate for Payer: Aetna Medicare Advantage	$253.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.47
Rate for Payer: Cigna Commercial	$422.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.49
Rate for Payer: Qualcare PPO/HMO/WC	$126.75
Rate for Payer: UnitedHealthcare Community & State	$26.70
Rate for Payer: Wellpoint Medicaid Managed Care	$24.00

ROD CARBON 200MM

Facility

$845.00

Service Code	HCPCS C1713
Hospital Charge Code	270699327
Hospital Revenue Code	278
Min. Negotiated Rate	$126.75
Max. Negotiated Rate	$204.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.49
Rate for Payer: Qualcare PPO/HMO/WC	$126.75

ROD CARBON 300MM

Facility

$845.00

Service Code	HCPCS C1713
Hospital Charge Code	270699328
Hospital Revenue Code	278
Min. Negotiated Rate	$126.75
Max. Negotiated Rate	$204.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.49
Rate for Payer: Qualcare PPO/HMO/WC	$126.75

Know your out-of-pocket cost for care.

All Charges