Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SCREW MIS ALT VALENC 6.5X35MM

Facility

$10,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695410
Hospital Revenue Code	278
Min. Negotiated Rate	$305.30
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$4,085.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50
Rate for Payer: UnitedHealthcare Community & State	$339.70
Rate for Payer: Wellpoint Medicaid Managed Care	$305.30

SCREW MIS ALT VALENCI 6.5X35MM

Facility

$10,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693535
Hospital Revenue Code	278
Min. Negotiated Rate	$305.30
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$4,085.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50
Rate for Payer: UnitedHealthcare Community & State	$339.70
Rate for Payer: Wellpoint Medicaid Managed Care	$305.30

SCREW MIS ALT VALENCI 6.5X35MM

Facility

$10,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693535
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

SCREW MIS CAN PEDICLE 5.5X40MM

Facility

$23,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270698198
Hospital Revenue Code	278
Min. Negotiated Rate	$660.30
Max. Negotiated Rate	$11,625.00
Rate for Payer: Aetna Commercial	$8,835.00
Rate for Payer: Aetna Medicare Advantage	$6,975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,928.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,928.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,928.75
Rate for Payer: Cigna Commercial	$11,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,626.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,487.50
Rate for Payer: UnitedHealthcare Community & State	$734.70
Rate for Payer: Wellpoint Medicaid Managed Care	$660.30

SCREW MIS CAN PEDICLE 5.5X40MM

Facility

$23,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270698198
Hospital Revenue Code	278
Min. Negotiated Rate	$3,487.50
Max. Negotiated Rate	$5,626.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,626.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,487.50

SCREW MIS CAN PEDICLE 5.5X45MM

Facility

$23,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270698197
Hospital Revenue Code	278
Min. Negotiated Rate	$660.30
Max. Negotiated Rate	$11,625.00
Rate for Payer: Aetna Commercial	$8,835.00
Rate for Payer: Aetna Medicare Advantage	$6,975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,928.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,928.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,928.75
Rate for Payer: Cigna Commercial	$11,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,626.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,487.50
Rate for Payer: UnitedHealthcare Community & State	$734.70
Rate for Payer: Wellpoint Medicaid Managed Care	$660.30

SCREW MIS CAN PEDICLE 5.5X45MM

Facility

$23,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270698197
Hospital Revenue Code	278
Min. Negotiated Rate	$3,487.50
Max. Negotiated Rate	$5,626.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,626.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,487.50

SCREW MIS EXT TAB 8.5X50MM

Facility

$4,200.00

Service Code	HCPCS C1713
Hospital Charge Code	270696482
Hospital Revenue Code	278
Min. Negotiated Rate	$119.28
Max. Negotiated Rate	$2,100.00
Rate for Payer: Aetna Commercial	$1,596.00
Rate for Payer: Aetna Medicare Advantage	$1,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,071.00
Rate for Payer: Cigna Commercial	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,016.40
Rate for Payer: Qualcare PPO/HMO/WC	$630.00
Rate for Payer: UnitedHealthcare Community & State	$132.72
Rate for Payer: Wellpoint Medicaid Managed Care	$119.28

SCREW MIS EXT TAB 8.5X50MM

Facility

$4,200.00

Service Code	HCPCS C1713
Hospital Charge Code	270696482
Hospital Revenue Code	278
Min. Negotiated Rate	$630.00
Max. Negotiated Rate	$1,016.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$840.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,016.40
Rate for Payer: Qualcare PPO/HMO/WC	$630.00

SCREW MIS EXT TAB TULIP TI

Facility

$6,140.80

Service Code	HCPCS C1713
Hospital Charge Code	270695963
Hospital Revenue Code	278
Min. Negotiated Rate	$174.40
Max. Negotiated Rate	$3,070.40
Rate for Payer: Aetna Commercial	$2,333.50
Rate for Payer: Aetna Medicare Advantage	$1,842.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,565.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,565.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,228.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,565.90
Rate for Payer: Cigna Commercial	$3,070.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,486.07
Rate for Payer: Qualcare PPO/HMO/WC	$921.12
Rate for Payer: UnitedHealthcare Community & State	$194.05
Rate for Payer: Wellpoint Medicaid Managed Care	$174.40

SCREW MIS EXT TAB TULIP TI

Facility

$6,140.80

Service Code	HCPCS C1713
Hospital Charge Code	270695963
Hospital Revenue Code	278
Min. Negotiated Rate	$921.12
Max. Negotiated Rate	$1,486.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,228.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,486.07
Rate for Payer: Qualcare PPO/HMO/WC	$921.12

SCREW MIS EXT TAB TULIP TOWER

Facility

$6,140.80

Service Code	HCPCS C1713
Hospital Charge Code	270695296
Hospital Revenue Code	278
Min. Negotiated Rate	$921.12
Max. Negotiated Rate	$1,486.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,228.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,486.07
Rate for Payer: Qualcare PPO/HMO/WC	$921.12

SCREW MIS EXT TAB TULIP TOWER

Facility

$6,140.80

Service Code	HCPCS C1713
Hospital Charge Code	270695296
Hospital Revenue Code	278
Min. Negotiated Rate	$174.40
Max. Negotiated Rate	$3,070.40
Rate for Payer: Aetna Commercial	$2,333.50
Rate for Payer: Aetna Medicare Advantage	$1,842.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,565.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,565.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,228.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,565.90
Rate for Payer: Cigna Commercial	$3,070.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,486.07
Rate for Payer: Qualcare PPO/HMO/WC	$921.12
Rate for Payer: UnitedHealthcare Community & State	$194.05
Rate for Payer: Wellpoint Medicaid Managed Care	$174.40

SCREW MIS NON-MOD CANN 6.5X40

Facility

$10,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270694160
Hospital Revenue Code	278
Min. Negotiated Rate	$305.30
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$4,085.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50
Rate for Payer: UnitedHealthcare Community & State	$339.70
Rate for Payer: Wellpoint Medicaid Managed Care	$305.30

SCREW MIS NON-MOD CANN 6.5X40

Facility

$10,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270694160
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

SCREW MIS PEDICLE 6.5X45MM

Facility

$7,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693202
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

SCREW MIS PEDICLE 6.5X45MM

Facility

$7,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693202
Hospital Revenue Code	278
Min. Negotiated Rate	$220.10
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,945.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50
Rate for Payer: UnitedHealthcare Community & State	$244.90
Rate for Payer: Wellpoint Medicaid Managed Care	$220.10

SCREW MIS PEDICLE 6.5X50MM

Facility

$7,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693205
Hospital Revenue Code	278
Min. Negotiated Rate	$220.10
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,945.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50
Rate for Payer: UnitedHealthcare Community & State	$244.90
Rate for Payer: Wellpoint Medicaid Managed Care	$220.10

SCREW MIS PEDICLE 6.5X50MM

Facility

$7,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693205
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

SCREW MIS POL EXT TAB 7.5X35MM

Facility

$4,200.00

Service Code	HCPCS C1713
Hospital Charge Code	270697645
Hospital Revenue Code	278
Min. Negotiated Rate	$630.00
Max. Negotiated Rate	$1,016.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$840.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,016.40
Rate for Payer: Qualcare PPO/HMO/WC	$630.00

SCREW MIS POL EXT TAB 7.5X35MM

Facility

$4,200.00

Service Code	HCPCS C1713
Hospital Charge Code	270697645
Hospital Revenue Code	278
Min. Negotiated Rate	$119.28
Max. Negotiated Rate	$2,100.00
Rate for Payer: Aetna Commercial	$1,596.00
Rate for Payer: Aetna Medicare Advantage	$1,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,071.00
Rate for Payer: Cigna Commercial	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,016.40
Rate for Payer: Qualcare PPO/HMO/WC	$630.00
Rate for Payer: UnitedHealthcare Community & State	$132.72
Rate for Payer: Wellpoint Medicaid Managed Care	$119.28

SCREW MIS REDUCTION

Facility

$5,000.00

Hospital Charge Code	270703023
Hospital Revenue Code	270
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,300.00
Rate for Payer: Oxford Commercial	$1,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Commercial	$1,000.00
Rate for Payer: UnitedHealthcare Community & State	$158.00
Rate for Payer: Wellpoint Medicaid Managed Care	$142.00

SCREW MIS REDUCTION

Facility

$5,000.00

Hospital Charge Code	270703023
Hospital Revenue Code	270
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

SCREW MNTR F/A 3.5x10MM

Facility

$6,600.00

Hospital Charge Code	270663774
Hospital Revenue Code	278
Min. Negotiated Rate	$990.00
Max. Negotiated Rate	$1,597.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: Qualcare PPO/HMO/WC	$990.00

SCREW MNTR F/A 3.5x10MM

Facility

$6,600.00

Hospital Charge Code	270663774
Hospital Revenue Code	278
Min. Negotiated Rate	$187.44
Max. Negotiated Rate	$3,300.00
Rate for Payer: Aetna Commercial	$2,508.00
Rate for Payer: Aetna Medicare Advantage	$1,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.00
Rate for Payer: Cigna Commercial	$3,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: Qualcare PPO/HMO/WC	$990.00
Rate for Payer: UnitedHealthcare Community & State	$208.56
Rate for Payer: Wellpoint Medicaid Managed Care	$187.44

Know your out-of-pocket cost for care.

All Charges