Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SCREW FULL THREAD 3.5X12MM

Facility

$1,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270695343
Hospital Revenue Code	278
Min. Negotiated Rate	$153.75
Max. Negotiated Rate	$248.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.05
Rate for Payer: Qualcare PPO/HMO/WC	$153.75

SCREW FULL THREAD 3.5X14MM

Facility

$1,880.00

Service Code	HCPCS C1713
Hospital Charge Code	270695345
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

SCREW FULL THREAD 3.5X14MM

Facility

$1,880.00

Service Code	HCPCS C1713
Hospital Charge Code	270695345
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

SCREW FULL THREAD 3.5X22MM

Facility

$1,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270695346
Hospital Revenue Code	278
Min. Negotiated Rate	$153.75
Max. Negotiated Rate	$248.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.05
Rate for Payer: Qualcare PPO/HMO/WC	$153.75

SCREW FULL THREAD 3.5X22MM

Facility

$1,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270695346
Hospital Revenue Code	278
Min. Negotiated Rate	$29.11
Max. Negotiated Rate	$512.50
Rate for Payer: Aetna Commercial	$389.50
Rate for Payer: Aetna Medicare Advantage	$307.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$261.38
Rate for Payer: Cigna Commercial	$512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.05
Rate for Payer: Qualcare PPO/HMO/WC	$153.75
Rate for Payer: UnitedHealthcare Community & State	$32.39
Rate for Payer: Wellpoint Medicaid Managed Care	$29.11

SCREW FULL THREAD T10 3.5X20MM

Facility

$1,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270694742
Hospital Revenue Code	278
Min. Negotiated Rate	$29.11
Max. Negotiated Rate	$512.50
Rate for Payer: Aetna Commercial	$389.50
Rate for Payer: Aetna Medicare Advantage	$307.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$261.38
Rate for Payer: Cigna Commercial	$512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.05
Rate for Payer: Qualcare PPO/HMO/WC	$153.75
Rate for Payer: UnitedHealthcare Community & State	$32.39
Rate for Payer: Wellpoint Medicaid Managed Care	$29.11

SCREW FULL THREAD T10 3.5X20MM

Facility

$1,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270694742
Hospital Revenue Code	278
Min. Negotiated Rate	$153.75
Max. Negotiated Rate	$248.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.05
Rate for Payer: Qualcare PPO/HMO/WC	$153.75

SCREW FULLY THREAD 20.13MM

Facility

$962.50

Service Code	HCPCS C1713
Hospital Charge Code	270700859
Hospital Revenue Code	278
Min. Negotiated Rate	$27.34
Max. Negotiated Rate	$481.25
Rate for Payer: Aetna Commercial	$365.75
Rate for Payer: Aetna Medicare Advantage	$288.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$245.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$245.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$245.44
Rate for Payer: Cigna Commercial	$481.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.93
Rate for Payer: Qualcare PPO/HMO/WC	$144.38
Rate for Payer: UnitedHealthcare Community & State	$30.41
Rate for Payer: Wellpoint Medicaid Managed Care	$27.34

SCREW FULLY THREAD 20.13MM

Facility

$962.50

Service Code	HCPCS C1713
Hospital Charge Code	270700859
Hospital Revenue Code	278
Min. Negotiated Rate	$144.38
Max. Negotiated Rate	$232.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$192.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.93
Rate for Payer: Qualcare PPO/HMO/WC	$144.38

SCREW FULLY THREADED 2.5X 12MM

Facility

$962.50

Service Code	HCPCS C1713
Hospital Charge Code	270700858
Hospital Revenue Code	278
Min. Negotiated Rate	$144.38
Max. Negotiated Rate	$232.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$192.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.93
Rate for Payer: Qualcare PPO/HMO/WC	$144.38

SCREW FULLY THREADED 2.5X 12MM

Facility

$962.50

Service Code	HCPCS C1713
Hospital Charge Code	270700858
Hospital Revenue Code	278
Min. Negotiated Rate	$27.34
Max. Negotiated Rate	$481.25
Rate for Payer: Aetna Commercial	$365.75
Rate for Payer: Aetna Medicare Advantage	$288.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$245.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$245.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$245.44
Rate for Payer: Cigna Commercial	$481.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.93
Rate for Payer: Qualcare PPO/HMO/WC	$144.38
Rate for Payer: UnitedHealthcare Community & State	$30.41
Rate for Payer: Wellpoint Medicaid Managed Care	$27.34

SCREW FULLY THREADED 4.0 X4

Facility

$2,135.00

Hospital Charge Code	270667928
Hospital Revenue Code	278
Min. Negotiated Rate	$320.25
Max. Negotiated Rate	$516.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$427.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$516.67
Rate for Payer: Qualcare PPO/HMO/WC	$320.25

SCREW FULLY THREADED 4.0 X4

Facility

$2,135.00

Hospital Charge Code	270667928
Hospital Revenue Code	278
Min. Negotiated Rate	$60.63
Max. Negotiated Rate	$1,067.50
Rate for Payer: Aetna Commercial	$811.30
Rate for Payer: Aetna Medicare Advantage	$640.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$544.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$544.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$427.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$544.42
Rate for Payer: Cigna Commercial	$1,067.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$516.67
Rate for Payer: Qualcare PPO/HMO/WC	$320.25
Rate for Payer: UnitedHealthcare Community & State	$67.47
Rate for Payer: Wellpoint Medicaid Managed Care	$60.63

SCREW G7 6.5MM 15MM

Facility

$125.00

Service Code	HCPCS C1713
Hospital Charge Code	270681466
Hospital Revenue Code	278
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Community & State	$3.95
Rate for Payer: Wellpoint Medicaid Managed Care	$3.55

SCREW G7 6.5MM 15MM

Facility

$125.00

Service Code	HCPCS C1713
Hospital Charge Code	270681466
Hospital Revenue Code	278
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$30.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

SCREW G7 6.5MM 25MM

Facility

$125.00

Service Code	HCPCS C1713
Hospital Charge Code	270681467
Hospital Revenue Code	278
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Community & State	$3.95
Rate for Payer: Wellpoint Medicaid Managed Care	$3.55

SCREW G7 6.5MM 25MM

Facility

$125.00

Service Code	HCPCS C1713
Hospital Charge Code	270681467
Hospital Revenue Code	278
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$30.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

SCREW GL 2.4mmx12MM

Facility

$475.00

Service Code	HCPCS C1713
Hospital Charge Code	270680719
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

SCREW GL 2.4mmx12MM

Facility

$475.00

Service Code	HCPCS C1713
Hospital Charge Code	270680719
Hospital Revenue Code	278
Min. Negotiated Rate	$13.49
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Community & State	$15.01
Rate for Payer: Wellpoint Medicaid Managed Care	$13.49

SCREW GL 3.0mmx14MM

Facility

$475.00

Service Code	HCPCS C1713
Hospital Charge Code	270680720
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

SCREW GL 3.0mmx14MM

Facility

$475.00

Service Code	HCPCS C1713
Hospital Charge Code	270680720
Hospital Revenue Code	278
Min. Negotiated Rate	$13.49
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Community & State	$15.01
Rate for Payer: Wellpoint Medicaid Managed Care	$13.49

SCREW GLENOID POLYAX LKG L22

Facility

$125.00

Service Code	HCPCS C1713
Hospital Charge Code	270691234
Hospital Revenue Code	278
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Community & State	$3.95
Rate for Payer: Wellpoint Medicaid Managed Care	$3.55

SCREW GLENOID POLYAX LKG L22

Facility

$125.00

Service Code	HCPCS C1713
Hospital Charge Code	270691234
Hospital Revenue Code	278
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$30.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

SCREW GLENOID POLYAX LOCKING 3

Facility

$125.00

Hospital Charge Code	270703559
Hospital Revenue Code	278
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Community & State	$3.95
Rate for Payer: Wellpoint Medicaid Managed Care	$3.55

SCREW GLENOID POLYAX LOCKING 3

Facility

$125.00

Hospital Charge Code	270703559
Hospital Revenue Code	278
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$30.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

Know your out-of-pocket cost for care.

All Charges