Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ROD CARBON FIBER 11.0x200mm

Facility

$1,032.05

Service Code	HCPCS C1713
Hospital Charge Code	270638106
Hospital Revenue Code	278
Min. Negotiated Rate	$29.31
Max. Negotiated Rate	$516.02
Rate for Payer: Aetna Commercial	$392.18
Rate for Payer: Aetna Medicare Advantage	$309.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$263.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$263.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$206.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$263.17
Rate for Payer: Cigna Commercial	$516.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.76
Rate for Payer: Qualcare PPO/HMO/WC	$154.81
Rate for Payer: UnitedHealthcare Community & State	$32.61
Rate for Payer: Wellpoint Medicaid Managed Care	$29.31

ROD CARBON FIBER 11.0x200mm

Facility

$1,032.05

Service Code	HCPCS C1713
Hospital Charge Code	270638106
Hospital Revenue Code	278
Min. Negotiated Rate	$154.81
Max. Negotiated Rate	$249.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$206.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.76
Rate for Payer: Qualcare PPO/HMO/WC	$154.81

ROD CARBON FIBER 11.0x300mm

Facility

$1,109.30

Service Code	HCPCS C1713
Hospital Charge Code	270632993
Hospital Revenue Code	278
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$554.65
Rate for Payer: Aetna Commercial	$421.53
Rate for Payer: Aetna Medicare Advantage	$332.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$282.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$282.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$221.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$282.87
Rate for Payer: Cigna Commercial	$554.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$268.45
Rate for Payer: Qualcare PPO/HMO/WC	$166.40
Rate for Payer: UnitedHealthcare Community & State	$35.05
Rate for Payer: Wellpoint Medicaid Managed Care	$31.50

ROD CARBON FIBER 11.0x300mm

Facility

$1,109.30

Service Code	HCPCS C1713
Hospital Charge Code	270632993
Hospital Revenue Code	278
Min. Negotiated Rate	$166.40
Max. Negotiated Rate	$268.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$221.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$268.45
Rate for Payer: Qualcare PPO/HMO/WC	$166.40

ROD CARBON FIBER 11x350MM

Facility

$1,142.60

Service Code	HCPCS C1713
Hospital Charge Code	270635607
Hospital Revenue Code	278
Min. Negotiated Rate	$32.45
Max. Negotiated Rate	$571.30
Rate for Payer: Aetna Commercial	$434.19
Rate for Payer: Aetna Medicare Advantage	$342.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$291.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$291.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$291.36
Rate for Payer: Cigna Commercial	$571.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$276.51
Rate for Payer: Qualcare PPO/HMO/WC	$171.39
Rate for Payer: UnitedHealthcare Community & State	$36.11
Rate for Payer: Wellpoint Medicaid Managed Care	$32.45

ROD CARBON FIBER 11x350MM

Facility

$1,142.60

Service Code	HCPCS C1713
Hospital Charge Code	270635607
Hospital Revenue Code	278
Min. Negotiated Rate	$171.39
Max. Negotiated Rate	$276.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$276.51
Rate for Payer: Qualcare PPO/HMO/WC	$171.39

ROD CARBON FIBER 11x400MM

Facility

$1,217.45

Service Code	HCPCS C1713
Hospital Charge Code	270634841
Hospital Revenue Code	278
Min. Negotiated Rate	$34.58
Max. Negotiated Rate	$608.73
Rate for Payer: Aetna Commercial	$462.63
Rate for Payer: Aetna Medicare Advantage	$365.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$310.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$310.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$310.45
Rate for Payer: Cigna Commercial	$608.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.62
Rate for Payer: Qualcare PPO/HMO/WC	$182.62
Rate for Payer: UnitedHealthcare Community & State	$38.47
Rate for Payer: Wellpoint Medicaid Managed Care	$34.58

ROD CARBON FIBER 11x400MM

Facility

$1,217.45

Service Code	HCPCS C1713
Hospital Charge Code	270634841
Hospital Revenue Code	278
Min. Negotiated Rate	$182.62
Max. Negotiated Rate	$294.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.62
Rate for Payer: Qualcare PPO/HMO/WC	$182.62

ROD CARBON FIBER 11x450MM

Facility

$1,253.95

Service Code	HCPCS C1713
Hospital Charge Code	270639006
Hospital Revenue Code	278
Min. Negotiated Rate	$35.61
Max. Negotiated Rate	$626.98
Rate for Payer: Aetna Commercial	$476.50
Rate for Payer: Aetna Medicare Advantage	$376.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$319.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$319.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$319.76
Rate for Payer: Cigna Commercial	$626.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$303.46
Rate for Payer: Qualcare PPO/HMO/WC	$188.09
Rate for Payer: UnitedHealthcare Community & State	$39.62
Rate for Payer: Wellpoint Medicaid Managed Care	$35.61

ROD CARBON FIBER 11x450MM

Facility

$1,253.95

Service Code	HCPCS C1713
Hospital Charge Code	270639006
Hospital Revenue Code	278
Min. Negotiated Rate	$188.09
Max. Negotiated Rate	$303.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$303.46
Rate for Payer: Qualcare PPO/HMO/WC	$188.09

ROD CARBON FIBER 8.0mm X 160mm

Facility

$704.50

Service Code	HCPCS C1713
Hospital Charge Code	270644917
Hospital Revenue Code	278
Min. Negotiated Rate	$20.01
Max. Negotiated Rate	$352.25
Rate for Payer: Aetna Commercial	$267.71
Rate for Payer: Aetna Medicare Advantage	$211.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$179.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$179.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$179.65
Rate for Payer: Cigna Commercial	$352.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.49
Rate for Payer: Qualcare PPO/HMO/WC	$105.67
Rate for Payer: UnitedHealthcare Community & State	$22.26
Rate for Payer: Wellpoint Medicaid Managed Care	$20.01

ROD CARBON FIBER 8.0mm X 160mm

Facility

$704.50

Service Code	HCPCS C1713
Hospital Charge Code	270644917
Hospital Revenue Code	278
Min. Negotiated Rate	$105.67
Max. Negotiated Rate	$170.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.49
Rate for Payer: Qualcare PPO/HMO/WC	$105.67

ROD CARBON FIBER 8.0mm X 220mm

Facility

$698.35

Service Code	HCPCS C1713
Hospital Charge Code	270619758
Hospital Revenue Code	278
Min. Negotiated Rate	$19.83
Max. Negotiated Rate	$349.18
Rate for Payer: Aetna Commercial	$265.37
Rate for Payer: Aetna Medicare Advantage	$209.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$139.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.08
Rate for Payer: Cigna Commercial	$349.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.00
Rate for Payer: Qualcare PPO/HMO/WC	$104.75
Rate for Payer: UnitedHealthcare Community & State	$22.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.83

ROD CARBON FIBER 8.0mm X 220mm

Facility

$698.35

Service Code	HCPCS C1713
Hospital Charge Code	270619758
Hospital Revenue Code	278
Min. Negotiated Rate	$104.75
Max. Negotiated Rate	$169.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$139.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.00
Rate for Payer: Qualcare PPO/HMO/WC	$104.75

ROD CARBON FIBER 8.0mm X 280mm

Facility

$704.50

Service Code	HCPCS C1713
Hospital Charge Code	270644918
Hospital Revenue Code	278
Min. Negotiated Rate	$105.67
Max. Negotiated Rate	$170.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.49
Rate for Payer: Qualcare PPO/HMO/WC	$105.67

ROD CARBON FIBER 8.0mm X 280mm

Facility

$704.50

Service Code	HCPCS C1713
Hospital Charge Code	270644918
Hospital Revenue Code	278
Min. Negotiated Rate	$20.01
Max. Negotiated Rate	$352.25
Rate for Payer: Aetna Commercial	$267.71
Rate for Payer: Aetna Medicare Advantage	$211.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$179.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$179.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$179.65
Rate for Payer: Cigna Commercial	$352.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.49
Rate for Payer: Qualcare PPO/HMO/WC	$105.67
Rate for Payer: UnitedHealthcare Community & State	$22.26
Rate for Payer: Wellpoint Medicaid Managed Care	$20.01

ROD CARBON FIBER 9.5x350mm

Facility

$990.00

Hospital Charge Code	270672337
Hospital Revenue Code	278
Min. Negotiated Rate	$148.50
Max. Negotiated Rate	$239.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$198.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$239.58
Rate for Payer: Qualcare PPO/HMO/WC	$148.50

ROD CARBON FIBER 9.5x350mm

Facility

$990.00

Hospital Charge Code	270672337
Hospital Revenue Code	278
Min. Negotiated Rate	$28.12
Max. Negotiated Rate	$495.00
Rate for Payer: Aetna Commercial	$376.20
Rate for Payer: Aetna Medicare Advantage	$297.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$252.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$252.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$198.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$252.45
Rate for Payer: Cigna Commercial	$495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$239.58
Rate for Payer: Qualcare PPO/HMO/WC	$148.50
Rate for Payer: UnitedHealthcare Community & State	$31.28
Rate for Payer: Wellpoint Medicaid Managed Care	$28.12

ROD CD SOLERA TI PERC 5.5X90MM

Facility

$3,205.00

Service Code	HCPCS C1713
Hospital Charge Code	270699431
Hospital Revenue Code	278
Min. Negotiated Rate	$480.75
Max. Negotiated Rate	$775.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$641.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$775.61
Rate for Payer: Qualcare PPO/HMO/WC	$480.75

ROD CD SOLERA TI PERC 5.5X90MM

Facility

$3,205.00

Service Code	HCPCS C1713
Hospital Charge Code	270699431
Hospital Revenue Code	278
Min. Negotiated Rate	$91.02
Max. Negotiated Rate	$1,602.50
Rate for Payer: Aetna Commercial	$1,217.90
Rate for Payer: Aetna Medicare Advantage	$961.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$817.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$817.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$641.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$817.27
Rate for Payer: Cigna Commercial	$1,602.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$775.61
Rate for Payer: Qualcare PPO/HMO/WC	$480.75
Rate for Payer: UnitedHealthcare Community & State	$101.28
Rate for Payer: Wellpoint Medicaid Managed Care	$91.02

ROD CLAMP RING 393436

Facility

$4,128.25

Service Code	HCPCS C1713
Hospital Charge Code	270632994
Hospital Revenue Code	278
Min. Negotiated Rate	$619.24
Max. Negotiated Rate	$999.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$999.04
Rate for Payer: Qualcare PPO/HMO/WC	$619.24

ROD CLAMP RING 393436

Facility

$4,128.25

Service Code	HCPCS C1713
Hospital Charge Code	270632994
Hospital Revenue Code	278
Min. Negotiated Rate	$117.24
Max. Negotiated Rate	$2,064.12
Rate for Payer: Aetna Commercial	$1,568.73
Rate for Payer: Aetna Medicare Advantage	$1,238.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,052.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,052.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,052.70
Rate for Payer: Cigna Commercial	$2,064.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$999.04
Rate for Payer: Qualcare PPO/HMO/WC	$619.24
Rate for Payer: UnitedHealthcare Community & State	$130.45
Rate for Payer: Wellpoint Medicaid Managed Care	$117.24

ROD CL PERC TI 5.5X45MMROD CL

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695964
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 CL PERC TI 5.5X45MMROD CL

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695964
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 CONNECTING 11X200MM

Facility

$2,530.00

Service Code	HCPCS C1713
Hospital Charge Code	270669477
Hospital Revenue Code	278
Min. Negotiated Rate	$379.50
Max. Negotiated Rate	$612.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$506.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$612.26
Rate for Payer: Qualcare PPO/HMO/WC	$379.50

Know your out-of-pocket cost for care.

All Charges