Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ROD TI MIS VI2 LORDOT 5.5X50MM

Facility

$1,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270698058
Hospital Revenue Code	278
Min. Negotiated Rate	$39.05
Max. Negotiated Rate	$687.50
Rate for Payer: Aetna Commercial	$522.50
Rate for Payer: Aetna Medicare Advantage	$412.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$350.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$350.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$350.62
Rate for Payer: Cigna Commercial	$687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$332.75
Rate for Payer: Qualcare PPO/HMO/WC	$206.25
Rate for Payer: UnitedHealthcare Community & State	$43.45
Rate for Payer: Wellpoint Medicaid Managed Care	$39.05

ROD TI PREBENT TBOLT 5.5X100MM

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695215
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 TI PREBENT TBOLT 5.5X100MM

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695215
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 TI STR 3.5X60MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694192
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 TI STR 3.5X60MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694192
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 TI STRAIGHT 70MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270691934
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 TI STRAIGHT 70MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270691934
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 TO ROD 40MM

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270704440
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 TO ROD 40MM

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270704440
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 TO ROD 45MM

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270704439
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 TO ROD 45MM

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270704439
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 TO ROD DELTA COUPLING

Facility

$3,373.90

Service Code	HCPCS C1713
Hospital Charge Code	270648624
Hospital Revenue Code	278
Min. Negotiated Rate	$95.82
Max. Negotiated Rate	$1,686.95
Rate for Payer: Aetna Commercial	$1,282.08
Rate for Payer: Aetna Medicare Advantage	$1,012.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$674.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$860.34
Rate for Payer: Cigna Commercial	$1,686.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$816.48
Rate for Payer: Qualcare PPO/HMO/WC	$506.08
Rate for Payer: UnitedHealthcare Community & State	$106.62
Rate for Payer: Wellpoint Medicaid Managed Care	$95.82

ROD TO ROD DELTA COUPLING

Facility

$3,373.90

Service Code	HCPCS C1713
Hospital Charge Code	270648624
Hospital Revenue Code	278
Min. Negotiated Rate	$506.08
Max. Negotiated Rate	$816.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$674.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$816.48
Rate for Payer: Qualcare PPO/HMO/WC	$506.08

RODVALENBULLNOSECURVE5.5X55MM

Facility

$3,350.00

Service Code	HCPCS C1713
Hospital Charge Code	270698327
Hospital Revenue Code	278
Min. Negotiated Rate	$502.50
Max. Negotiated Rate	$810.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$670.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$810.70
Rate for Payer: Qualcare PPO/HMO/WC	$502.50

RODVALENBULLNOSECURVE5.5X55MM

Facility

$3,350.00

Service Code	HCPCS C1713
Hospital Charge Code	270698327
Hospital Revenue Code	278
Min. Negotiated Rate	$95.14
Max. Negotiated Rate	$1,675.00
Rate for Payer: Aetna Commercial	$1,273.00
Rate for Payer: Aetna Medicare Advantage	$1,005.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$854.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$854.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$670.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$854.25
Rate for Payer: Cigna Commercial	$1,675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$810.70
Rate for Payer: Qualcare PPO/HMO/WC	$502.50
Rate for Payer: UnitedHealthcare Community & State	$105.86
Rate for Payer: Wellpoint Medicaid Managed Care	$95.14

ROD VALENCIA CRV BULL 5.5X40MM

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695258
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 VALENCIA CRV BULL 5.5X40MM

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695258
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 VALENCIA CURVED 5.5X50MM

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695038
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 VALENCIA CURVED 5.5X50MM

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695038
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 W/LINE 40MM PRE-LORDOSE

Facility

$3,075.00

Hospital Charge Code	270667359
Hospital Revenue Code	278
Min. Negotiated Rate	$461.25
Max. Negotiated Rate	$744.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$615.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$744.15
Rate for Payer: Qualcare PPO/HMO/WC	$461.25

ROD W/LINE 40MM PRE-LORDOSE

Facility

$3,075.00

Hospital Charge Code	270667359
Hospital Revenue Code	278
Min. Negotiated Rate	$87.33
Max. Negotiated Rate	$1,537.50
Rate for Payer: Aetna Commercial	$1,168.50
Rate for Payer: Aetna Medicare Advantage	$922.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$784.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$784.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$615.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$784.12
Rate for Payer: Cigna Commercial	$1,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$744.15
Rate for Payer: Qualcare PPO/HMO/WC	$461.25
Rate for Payer: UnitedHealthcare Community & State	$97.17
Rate for Payer: Wellpoint Medicaid Managed Care	$87.33

ROFLUMILAST 250MCG TAB

Facility

$46.23

Service Code	NDC 310008828
Hospital Charge Code	606390303
Hospital Revenue Code	250
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$23.11
Rate for Payer: Aetna Commercial	$17.57
Rate for Payer: Aetna Medicare Advantage	$13.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.79
Rate for Payer: Cigna Commercial	$23.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.02
Rate for Payer: Oxford Commercial	$9.25
Rate for Payer: Qualcare PPO/HMO/WC	$6.93
Rate for Payer: UnitedHealthcare Commercial	$9.25
Rate for Payer: UnitedHealthcare Community & State	$1.46
Rate for Payer: Wellpoint Medicaid Managed Care	$1.31

ROFLUMILAST 250MCG TAB

Facility

$46.23

Service Code	NDC 310008828
Hospital Charge Code	606390303
Hospital Revenue Code	250
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$6.93
Rate for Payer: Qualcare PPO/HMO/WC	$6.93

ROFLUMILAST 500 MCG TAB

Facility

$46.23

Service Code	NDC 310009530
Hospital Charge Code	60630089
Hospital Revenue Code	250
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$6.93
Rate for Payer: Qualcare PPO/HMO/WC	$6.93

ROFLUMILAST 500 MCG TAB

Facility

$46.23

Service Code	NDC 310009530
Hospital Charge Code	60630089
Hospital Revenue Code	250
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$23.11
Rate for Payer: Aetna Commercial	$17.57
Rate for Payer: Aetna Medicare Advantage	$13.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.79
Rate for Payer: Cigna Commercial	$23.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.02
Rate for Payer: Oxford Commercial	$9.25
Rate for Payer: Qualcare PPO/HMO/WC	$6.93
Rate for Payer: UnitedHealthcare Commercial	$9.25
Rate for Payer: UnitedHealthcare Community & State	$1.46
Rate for Payer: Wellpoint Medicaid Managed Care	$1.31

Know your out-of-pocket cost for care.

All Charges