Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ROD NOTCHED STRAIGHT 100MM

Facility

$4,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270656113
Hospital Revenue Code	278
Min. Negotiated Rate	$120.70
Max. Negotiated Rate	$2,125.00
Rate for Payer: Aetna Commercial	$1,615.00
Rate for Payer: Aetna Medicare Advantage	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,083.75
Rate for Payer: Cigna Commercial	$2,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: Qualcare PPO/HMO/WC	$637.50
Rate for Payer: UnitedHealthcare Community & State	$134.30
Rate for Payer: Wellpoint Medicaid Managed Care	$120.70

ROD NOTCHED STRAIGHT 120MM

Facility

$3,505.00

Hospital Charge Code	270656114
Hospital Revenue Code	278
Min. Negotiated Rate	$525.75
Max. Negotiated Rate	$848.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$701.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$848.21
Rate for Payer: Qualcare PPO/HMO/WC	$525.75

ROD NOTCHED STRAIGHT 120MM

Facility

$3,505.00

Hospital Charge Code	270656114
Hospital Revenue Code	278
Min. Negotiated Rate	$99.54
Max. Negotiated Rate	$1,752.50
Rate for Payer: Aetna Commercial	$1,331.90
Rate for Payer: Aetna Medicare Advantage	$1,051.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$893.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$893.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$701.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$893.77
Rate for Payer: Cigna Commercial	$1,752.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$848.21
Rate for Payer: Qualcare PPO/HMO/WC	$525.75
Rate for Payer: UnitedHealthcare Community & State	$110.76
Rate for Payer: Wellpoint Medicaid Managed Care	$99.54

ROD OVERWATCH EXTENDED 90MM

Facility

$700.00

Service Code	HCPCS C1713
Hospital Charge Code	270694126
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 OVERWATCH EXTENDED 90MM

Facility

$700.00

Service Code	HCPCS C1713
Hospital Charge Code	270694126
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 OVERWATCH MIS 130MM

Facility

$700.00

Service Code	HCPCS C1713
Hospital Charge Code	270694721
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 OVERWATCH MIS 130MM

Facility

$700.00

Service Code	HCPCS C1713
Hospital Charge Code	270694721
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 PALISADE FIXED 30MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270692239
Hospital Revenue Code	278
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

ROD PALISADE FIXED 30MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270692239
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

ROD PANTA2 COMPRESSION 5MM

Facility

$10,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270699964
Hospital Revenue Code	278
Min. Negotiated Rate	$287.55
Max. Negotiated Rate	$5,062.50
Rate for Payer: Aetna Commercial	$3,847.50
Rate for Payer: Aetna Medicare Advantage	$3,037.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,581.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,581.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,581.88
Rate for Payer: Cigna Commercial	$5,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,450.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,518.75
Rate for Payer: UnitedHealthcare Community & State	$319.95
Rate for Payer: Wellpoint Medicaid Managed Care	$287.55

ROD PANTA2 COMPRESSION 5MM

Facility

$10,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270699964
Hospital Revenue Code	278
Min. Negotiated Rate	$1,518.75
Max. Negotiated Rate	$2,450.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,450.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,518.75

ROD PERC CCM 4.75X65MM

Facility

$3,205.00

Service Code	HCPCS C1713
Hospital Charge Code	270699279
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 PERC CCM 4.75X65MM

Facility

$3,205.00

Service Code	HCPCS C1713
Hospital Charge Code	270699279
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 PERC TI 5.5X100MM

Facility

$3,205.00

Service Code	HCPCS C1713
Hospital Charge Code	270699076
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 PERC TI 5.5X100MM

Facility

$3,205.00

Service Code	HCPCS C1713
Hospital Charge Code	270699076
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 POCT STRAIGHT TI 3.5X350MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270695760
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

ROD POCT STRAIGHT TI 3.5X350MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270695760
Hospital Revenue Code	278
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

ROD PRE-BENT 3.5MM 80-215 COCR

Facility

$2,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270697897
Hospital Revenue Code	278
Min. Negotiated Rate	$371.25
Max. Negotiated Rate	$598.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.95
Rate for Payer: Qualcare PPO/HMO/WC	$371.25

ROD PRE-BENT 3.5MM 80-215 COCR

Facility

$2,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270697897
Hospital Revenue Code	278
Min. Negotiated Rate	$70.29
Max. Negotiated Rate	$1,237.50
Rate for Payer: Aetna Commercial	$940.50
Rate for Payer: Aetna Medicare Advantage	$742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$631.12
Rate for Payer: Cigna Commercial	$1,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.95
Rate for Payer: Qualcare PPO/HMO/WC	$371.25
Rate for Payer: UnitedHealthcare Community & State	$78.21
Rate for Payer: Wellpoint Medicaid Managed Care	$70.29

ROD PREBENT TBOLT TI 5.5X45MM

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270696795
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 PREBENT TBOLT TI 5.5X45MM

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270696795
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 PREBENT TBOLT TI 5.5X70MM

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695408
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 PREBENT TBOLT TI 5.5X70MM

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695408
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 PREBENT W HEX AND TAP 55MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270692302
Hospital Revenue Code	278
Min. Negotiated Rate	$28.40
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$31.60
Rate for Payer: Wellpoint Medicaid Managed Care	$28.40

ROD PREBENT W HEX AND TAP 55MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270692302
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

Know your out-of-pocket cost for care.

All Charges