Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ROD REFORM TI PED 5.5X60MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270696107
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 TI PED 5.5X60MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270696107
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 RELINE-O TI LORDO 5.5X35MM

Facility

$3,960.00

Service Code	HCPCS C1713
Hospital Charge Code	270695242
Hospital Revenue Code	278
Min. Negotiated Rate	$112.46
Max. Negotiated Rate	$1,980.00
Rate for Payer: Aetna Commercial	$1,504.80
Rate for Payer: Aetna Medicare Advantage	$1,188.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,009.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,009.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$792.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,009.80
Rate for Payer: Cigna Commercial	$1,980.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$958.32
Rate for Payer: Qualcare PPO/HMO/WC	$594.00
Rate for Payer: UnitedHealthcare Community & State	$125.14
Rate for Payer: Wellpoint Medicaid Managed Care	$112.46

ROD RELINE-O TI LORDO 5.5X35MM

Facility

$3,960.00

Service Code	HCPCS C1713
Hospital Charge Code	270695242
Hospital Revenue Code	278
Min. Negotiated Rate	$594.00
Max. Negotiated Rate	$958.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$792.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$958.32
Rate for Payer: Qualcare PPO/HMO/WC	$594.00

ROD RELINE TI 5.5X60MM LORDOT

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693812
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 RELINE TI 5.5X60MM LORDOT

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693812
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 RING/THD CONNECTING M6 NUT

Facility

$161.65

Service Code	HCPCS C1713
Hospital Charge Code	270674288
Hospital Revenue Code	272
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$80.83
Rate for Payer: Aetna Commercial	$61.43
Rate for Payer: Aetna Medicare Advantage	$48.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.22
Rate for Payer: Cigna Commercial	$80.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.03
Rate for Payer: Oxford Commercial	$32.33
Rate for Payer: Qualcare PPO/HMO/WC	$24.25
Rate for Payer: UnitedHealthcare Commercial	$32.33
Rate for Payer: UnitedHealthcare Community & State	$5.11
Rate for Payer: Wellpoint Medicaid Managed Care	$4.59

ROD RING/THD CONNECTING M6 NUT

Facility

$161.65

Service Code	HCPCS C1713
Hospital Charge Code	270674288
Hospital Revenue Code	272
Min. Negotiated Rate	$24.25
Max. Negotiated Rate	$24.25
Rate for Payer: Qualcare PPO/HMO/WC	$24.25

RODS 25MM

Facility

$1,880.00

Service Code	HCPCS C1713
Hospital Charge Code	270690487
Hospital Revenue Code	278
Min. Negotiated Rate	$53.39
Max. Negotiated Rate	$940.00
Rate for Payer: Aetna Commercial	$714.40
Rate for Payer: Aetna Medicare Advantage	$564.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$479.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$479.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$376.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$479.40
Rate for Payer: Cigna Commercial	$940.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$454.96
Rate for Payer: Qualcare PPO/HMO/WC	$282.00
Rate for Payer: UnitedHealthcare Community & State	$59.41
Rate for Payer: Wellpoint Medicaid Managed Care	$53.39

RODS 25MM

Facility

$1,880.00

Service Code	HCPCS C1713
Hospital Charge Code	270690487
Hospital Revenue Code	278
Min. Negotiated Rate	$282.00
Max. Negotiated Rate	$454.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$376.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$454.96
Rate for Payer: Qualcare PPO/HMO/WC	$282.00

ROD SEMI CIRCULAR 11X220MM

Facility

$3,300.00

Hospital Charge Code	270669874
Hospital Revenue Code	278
Min. Negotiated Rate	$495.00
Max. Negotiated Rate	$798.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$660.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$798.60
Rate for Payer: Qualcare PPO/HMO/WC	$495.00

ROD SEMI CIRCULAR 11X220MM

Facility

$3,300.00

Hospital Charge Code	270669874
Hospital Revenue Code	278
Min. Negotiated Rate	$93.72
Max. Negotiated Rate	$1,650.00
Rate for Payer: Aetna Commercial	$1,254.00
Rate for Payer: Aetna Medicare Advantage	$990.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$841.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$841.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$660.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$841.50
Rate for Payer: Cigna Commercial	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$798.60
Rate for Payer: Qualcare PPO/HMO/WC	$495.00
Rate for Payer: UnitedHealthcare Community & State	$104.28
Rate for Payer: Wellpoint Medicaid Managed Care	$93.72

ROD SEMI CURVED

Facility

$2,165.00

Hospital Charge Code	270662208
Hospital Revenue Code	278
Min. Negotiated Rate	$61.49
Max. Negotiated Rate	$1,082.50
Rate for Payer: Aetna Commercial	$822.70
Rate for Payer: Aetna Medicare Advantage	$649.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$552.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$552.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$433.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$552.08
Rate for Payer: Cigna Commercial	$1,082.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$523.93
Rate for Payer: Qualcare PPO/HMO/WC	$324.75
Rate for Payer: UnitedHealthcare Community & State	$68.41
Rate for Payer: Wellpoint Medicaid Managed Care	$61.49

ROD SEMI CURVED

Facility

$2,165.00

Hospital Charge Code	270662208
Hospital Revenue Code	278
Min. Negotiated Rate	$324.75
Max. Negotiated Rate	$523.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$433.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$523.93
Rate for Payer: Qualcare PPO/HMO/WC	$324.75

RODS JOINTED 3.5X12MM 72MM

Facility

$9,303.00

Service Code	HCPCS C1713
Hospital Charge Code	270694401
Hospital Revenue Code	278
Min. Negotiated Rate	$264.21
Max. Negotiated Rate	$4,651.50
Rate for Payer: Aetna Commercial	$3,535.14
Rate for Payer: Aetna Medicare Advantage	$2,790.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,372.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,372.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,860.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,372.26
Rate for Payer: Cigna Commercial	$4,651.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,251.33
Rate for Payer: Qualcare PPO/HMO/WC	$1,395.45
Rate for Payer: UnitedHealthcare Community & State	$293.97
Rate for Payer: Wellpoint Medicaid Managed Care	$264.21

RODS JOINTED 3.5X12MM 72MM

Facility

$9,303.00

Service Code	HCPCS C1713
Hospital Charge Code	270694401
Hospital Revenue Code	278
Min. Negotiated Rate	$1,395.45
Max. Negotiated Rate	$2,251.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,860.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,251.33
Rate for Payer: Qualcare PPO/HMO/WC	$1,395.45

ROD SMALL EXT FIX 4.0mm x 80mm

Facility

$139.05

Service Code	HCPCS C1713
Hospital Charge Code	270640372
Hospital Revenue Code	278
Min. Negotiated Rate	$20.86
Max. Negotiated Rate	$33.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.65
Rate for Payer: Qualcare PPO/HMO/WC	$20.86

ROD SMALL EXT FIX 4.0mm x 80mm

Facility

$139.05

Service Code	HCPCS C1713
Hospital Charge Code	270640372
Hospital Revenue Code	278
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$69.53
Rate for Payer: Aetna Commercial	$52.84
Rate for Payer: Aetna Medicare Advantage	$41.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.46
Rate for Payer: Cigna Commercial	$69.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.65
Rate for Payer: Qualcare PPO/HMO/WC	$20.86
Rate for Payer: UnitedHealthcare Community & State	$4.39
Rate for Payer: Wellpoint Medicaid Managed Care	$3.95

ROD SMALL EXT FIX 4x120mm

Facility

$139.05

Service Code	HCPCS C1713
Hospital Charge Code	270620408
Hospital Revenue Code	278
Min. Negotiated Rate	$20.86
Max. Negotiated Rate	$33.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.65
Rate for Payer: Qualcare PPO/HMO/WC	$20.86

ROD SMALL EXT FIX 4x120mm

Facility

$139.05

Service Code	HCPCS C1713
Hospital Charge Code	270620408
Hospital Revenue Code	278
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$69.53
Rate for Payer: Aetna Commercial	$52.84
Rate for Payer: Aetna Medicare Advantage	$41.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.46
Rate for Payer: Cigna Commercial	$69.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.65
Rate for Payer: Qualcare PPO/HMO/WC	$20.86
Rate for Payer: UnitedHealthcare Community & State	$4.39
Rate for Payer: Wellpoint Medicaid Managed Care	$3.95

ROD SOLERA 5.5CMX35MM

Facility

$6,850.00

Service Code	HCPCS C1713
Hospital Charge Code	270695304
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 SOLERA 5.5CMX35MM

Facility

$6,850.00

Service Code	HCPCS C1713
Hospital Charge Code	270695304
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 SPINAL 5.5mm X 80 mm

Facility

$1,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270680579
Hospital Revenue Code	278
Min. Negotiated Rate	$46.15
Max. Negotiated Rate	$812.50
Rate for Payer: Aetna Commercial	$617.50
Rate for Payer: Aetna Medicare Advantage	$487.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$414.38
Rate for Payer: Cigna Commercial	$812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.25
Rate for Payer: Qualcare PPO/HMO/WC	$243.75
Rate for Payer: UnitedHealthcare Community & State	$51.35
Rate for Payer: Wellpoint Medicaid Managed Care	$46.15

ROD SPINAL 5.5mm X 80 mm

Facility

$1,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270680579
Hospital Revenue Code	278
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$393.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.25
Rate for Payer: Qualcare PPO/HMO/WC	$243.75

ROD SPIN CD HORZ 4.75X30MM

Facility

$6,850.00

Service Code	HCPCS C1713
Hospital Charge Code	270697030
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

Know your out-of-pocket cost for care.

All Charges