Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ROD CURVED NEXXT MIS 5.5X45MM

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693613
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

ROD CURVED NEXXT MIS 5.5X60MM

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693614
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

ROD CURVED NEXXT MIS 5.5X60MM

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693614
Hospital Revenue Code	278
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$665.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50
Rate for Payer: UnitedHealthcare Community & State	$55.30
Rate for Payer: Wellpoint Medicaid Managed Care	$49.70

ROD CURVED NOTCHED 50MM

Facility

$3,740.00

Service Code	HCPCS C1713
Hospital Charge Code	270674914
Hospital Revenue Code	278
Min. Negotiated Rate	$106.22
Max. Negotiated Rate	$1,870.00
Rate for Payer: Aetna Commercial	$1,421.20
Rate for Payer: Aetna Medicare Advantage	$1,122.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$953.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$953.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$748.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$953.70
Rate for Payer: Cigna Commercial	$1,870.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$905.08
Rate for Payer: Qualcare PPO/HMO/WC	$561.00
Rate for Payer: UnitedHealthcare Community & State	$118.18
Rate for Payer: Wellpoint Medicaid Managed Care	$106.22

ROD CURVED NOTCHED 50MM

Facility

$3,740.00

Service Code	HCPCS C1713
Hospital Charge Code	270674914
Hospital Revenue Code	278
Min. Negotiated Rate	$561.00
Max. Negotiated Rate	$905.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$748.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$905.08
Rate for Payer: Qualcare PPO/HMO/WC	$561.00

ROD CURVED TI50MM

Facility

$875.00

Hospital Charge Code	270703000
Hospital Revenue Code	278
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) NJ Health	$175.00
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	$211.75
Rate for Payer: Qualcare PPO/HMO/WC	$131.25
Rate for Payer: UnitedHealthcare Community & State	$27.65
Rate for Payer: Wellpoint Medicaid Managed Care	$24.85

ROD CURVED TI50MM

Facility

$875.00

Hospital Charge Code	270703000
Hospital Revenue Code	278
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$211.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.75
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

ROD CURVED TI ALLOY 5.5X40MM

Facility

$1,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270693445
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 CURVED TI ALLOY 5.5X40MM

Facility

$1,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270693445
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 CURVED TI ALLOY 5.5X45MM

Facility

$1,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270693438
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 CURVED TI ALLOY 5.5X45MM

Facility

$1,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270693438
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 EXPEDIUM 120MM

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270669374
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

ROD EXPEDIUM 120MM

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270669374
Hospital Revenue Code	278
Min. Negotiated Rate	$85.20
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$94.80
Rate for Payer: Wellpoint Medicaid Managed Care	$85.20

ROD EXPEDIUM 300MM

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270673344
Hospital Revenue Code	278
Min. Negotiated Rate	$85.20
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$94.80
Rate for Payer: Wellpoint Medicaid Managed Care	$85.20

ROD EXPEDIUM 300MM

Facility

$2,925.00

Service Code	HCPCS C1713
Hospital Charge Code	270683735
Hospital Revenue Code	278
Min. Negotiated Rate	$438.75
Max. Negotiated Rate	$707.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$585.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$707.85
Rate for Payer: Qualcare PPO/HMO/WC	$438.75

ROD EXPEDIUM 300MM

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270673344
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

ROD EXPEDIUM 300MM

Facility

$2,925.00

Service Code	HCPCS C1713
Hospital Charge Code	270683735
Hospital Revenue Code	278
Min. Negotiated Rate	$83.07
Max. Negotiated Rate	$1,462.50
Rate for Payer: Aetna Commercial	$1,111.50
Rate for Payer: Aetna Medicare Advantage	$877.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$745.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$745.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$585.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$745.88
Rate for Payer: Cigna Commercial	$1,462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$707.85
Rate for Payer: Qualcare PPO/HMO/WC	$438.75
Rate for Payer: UnitedHealthcare Community & State	$92.43
Rate for Payer: Wellpoint Medicaid Managed Care	$83.07

ROD EXTENDED TAB 30MM

Facility

$700.00

Service Code	HCPCS C1713
Hospital Charge Code	270693811
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 EXTENDED TAB 30MM

Facility

$700.00

Service Code	HCPCS C1713
Hospital Charge Code	270693811
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 EXTENDED TAB 80MM

Facility

$560.00

Service Code	HCPCS C1713
Hospital Charge Code	270694701
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 EXTENDED TAB 80MM

Facility

$560.00

Service Code	HCPCS C1713
Hospital Charge Code	270694701
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 EXTENDED TAB 85MM

Facility

$560.00

Service Code	HCPCS C1713
Hospital Charge Code	270694702
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 EXTENDED TAB 85MM

Facility

$560.00

Service Code	HCPCS C1713
Hospital Charge Code	270694702
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 EXTENSION SHUKLA 4IN DISP

Facility

$2,750.00

Hospital Charge Code	270696261
Hospital Revenue Code	272
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) PPO	$701.25
Rate for Payer: Cigna Commercial	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$715.00
Rate for Payer: Oxford Commercial	$550.00
Rate for Payer: Qualcare PPO/HMO/WC	$412.50
Rate for Payer: UnitedHealthcare Commercial	$550.00
Rate for Payer: UnitedHealthcare Community & State	$86.90
Rate for Payer: Wellpoint Medicaid Managed Care	$78.10

ROD EXTENSION SHUKLA 4IN DISP

Facility

$2,750.00

Hospital Charge Code	270696261
Hospital Revenue Code	272
Min. Negotiated Rate	$412.50
Max. Negotiated Rate	$412.50
Rate for Payer: Qualcare PPO/HMO/WC	$412.50

Know your out-of-pocket cost for care.

All Charges