Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ROD PRE LORDOT BULLET 5.5X45MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270698072
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

ROD PRE LORDOT BULLET 5.5X55MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270698073
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 PRE LORDOT BULLET 5.5X55MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270698073
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

ROD PRE-LORDOT BULLET 5.5X60MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270698584
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 PRE-LORDOT BULLET 5.5X60MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270698584
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

ROD RAD DIA 6 MM 40 MM

Facility

$2,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270691421
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 RAD DIA 6 MM 40 MM

Facility

$2,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270691421
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 RAD DIAM 6 MM X 45 MM

Facility

$2,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270691012
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 RAD DIAM 6 MM X 45 MM

Facility

$2,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270691012
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 REAMING 3MM OFFSET BALL ST

Facility

$714.00

Hospital Charge Code	270652133
Hospital Revenue Code	272
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$107.10
Rate for Payer: Qualcare PPO/HMO/WC	$107.10

ROD REAMING 3MM OFFSET BALL ST

Facility

$714.00

Hospital Charge Code	270652133
Hospital Revenue Code	272
Min. Negotiated Rate	$20.28
Max. Negotiated Rate	$357.00
Rate for Payer: Aetna Commercial	$271.32
Rate for Payer: Aetna Medicare Advantage	$214.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$182.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$182.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$182.07
Rate for Payer: Cigna Commercial	$357.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$185.64
Rate for Payer: Oxford Commercial	$142.80
Rate for Payer: Qualcare PPO/HMO/WC	$107.10
Rate for Payer: UnitedHealthcare Commercial	$142.80
Rate for Payer: UnitedHealthcare Community & State	$22.56
Rate for Payer: Wellpoint Medicaid Managed Care	$20.28

ROD REAMING BALL TIP 2.5x1150M

Facility

$607.90

Service Code	HCPCS C1713
Hospital Charge Code	270680628
Hospital Revenue Code	278
Min. Negotiated Rate	$91.19
Max. Negotiated Rate	$147.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$121.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.11
Rate for Payer: Qualcare PPO/HMO/WC	$91.19

ROD REAMING BALL TIP 2.5x1150M

Facility

$607.90

Service Code	HCPCS C1713
Hospital Charge Code	270680628
Hospital Revenue Code	278
Min. Negotiated Rate	$17.26
Max. Negotiated Rate	$303.95
Rate for Payer: Aetna Commercial	$231.00
Rate for Payer: Aetna Medicare Advantage	$182.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$121.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.01
Rate for Payer: Cigna Commercial	$303.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.11
Rate for Payer: Qualcare PPO/HMO/WC	$91.19
Rate for Payer: UnitedHealthcare Community & State	$19.21
Rate for Payer: Wellpoint Medicaid Managed Care	$17.26

ROD REAMING BALL TIP 2.5x600MM

Facility

$534.65

Hospital Charge Code	270680380
Hospital Revenue Code	272
Min. Negotiated Rate	$80.20
Max. Negotiated Rate	$80.20
Rate for Payer: Qualcare PPO/HMO/WC	$80.20

ROD REAMING BALL TIP 2.5x600MM

Facility

$534.65

Hospital Charge Code	270680380
Hospital Revenue Code	272
Min. Negotiated Rate	$15.18
Max. Negotiated Rate	$267.32
Rate for Payer: Aetna Commercial	$203.17
Rate for Payer: Aetna Medicare Advantage	$160.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$136.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$136.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$136.34
Rate for Payer: Cigna Commercial	$267.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.01
Rate for Payer: Oxford Commercial	$106.93
Rate for Payer: Qualcare PPO/HMO/WC	$80.20
Rate for Payer: UnitedHealthcare Commercial	$106.93
Rate for Payer: UnitedHealthcare Community & State	$16.89
Rate for Payer: Wellpoint Medicaid Managed Care	$15.18

ROD REAMING BALL TIP 2.5x950MM

Facility

$502.85

Service Code	HCPCS C1713
Hospital Charge Code	270645687
Hospital Revenue Code	278
Min. Negotiated Rate	$75.43
Max. Negotiated Rate	$121.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.69
Rate for Payer: Qualcare PPO/HMO/WC	$75.43

ROD REAMING BALL TIP 2.5x950MM

Facility

$502.85

Service Code	HCPCS C1713
Hospital Charge Code	270645687
Hospital Revenue Code	278
Min. Negotiated Rate	$14.28
Max. Negotiated Rate	$251.43
Rate for Payer: Aetna Commercial	$191.08
Rate for Payer: Aetna Medicare Advantage	$150.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.23
Rate for Payer: Cigna Commercial	$251.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.69
Rate for Payer: Qualcare PPO/HMO/WC	$75.43
Rate for Payer: UnitedHealthcare Community & State	$15.89
Rate for Payer: Wellpoint Medicaid Managed Care	$14.28

ROD REAMING CALIBR 2.5x850mm

Facility

$666.00

Hospital Charge Code	270656625
Hospital Revenue Code	278
Min. Negotiated Rate	$99.90
Max. Negotiated Rate	$161.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$133.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$161.17
Rate for Payer: Qualcare PPO/HMO/WC	$99.90

ROD REAMING CALIBR 2.5x850mm

Facility

$666.00

Hospital Charge Code	270656625
Hospital Revenue Code	278
Min. Negotiated Rate	$18.91
Max. Negotiated Rate	$333.00
Rate for Payer: Aetna Commercial	$253.08
Rate for Payer: Aetna Medicare Advantage	$199.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$169.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$169.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$133.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$169.83
Rate for Payer: Cigna Commercial	$333.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$161.17
Rate for Payer: Qualcare PPO/HMO/WC	$99.90
Rate for Payer: UnitedHealthcare Community & State	$21.05
Rate for Payer: Wellpoint Medicaid Managed Care	$18.91

ROD REFORM 30MM 39-LT-5030

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270696104
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 REFORM 30MM 39-LT-5030

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270696104
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 REFORM LORDOT TI 3.5X80MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270696962
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 REFORM LORDOT TI 3.5X80MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270696962
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 REFORM POCT 3.5X120MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694815
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 REFORM POCT 3.5X120MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694815
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

Know your out-of-pocket cost for care.

All Charges