Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SCREW POLYAXIAL 5.5MM X 45M

Facility

$8,900.00

Hospital Charge Code	270661265
Hospital Revenue Code	278
Min. Negotiated Rate	$252.76
Max. Negotiated Rate	$4,450.00
Rate for Payer: Aetna Commercial	$3,382.00
Rate for Payer: Aetna Medicare Advantage	$2,670.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,269.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,269.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,780.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,269.50
Rate for Payer: Cigna Commercial	$4,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,153.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,335.00
Rate for Payer: UnitedHealthcare Community & State	$281.24
Rate for Payer: Wellpoint Medicaid Managed Care	$252.76

SCREW POLYAXIAL 5.5MM X 45M

Facility

$8,900.00

Hospital Charge Code	270661265
Hospital Revenue Code	278
Min. Negotiated Rate	$1,335.00
Max. Negotiated Rate	$2,153.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,780.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,153.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,335.00

SCREW POLYAXIAL 6.5 MM X 45 MM

Facility

$5,425.00

Service Code	HCPCS C1713
Hospital Charge Code	270691013
Hospital Revenue Code	278
Min. Negotiated Rate	$813.75
Max. Negotiated Rate	$1,312.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,085.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,312.85
Rate for Payer: Qualcare PPO/HMO/WC	$813.75

SCREW POLYAXIAL 6.5 MM X 45 MM

Facility

$5,425.00

Service Code	HCPCS C1713
Hospital Charge Code	270691013
Hospital Revenue Code	278
Min. Negotiated Rate	$154.07
Max. Negotiated Rate	$2,712.50
Rate for Payer: Aetna Commercial	$2,061.50
Rate for Payer: Aetna Medicare Advantage	$1,627.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,383.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,383.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,085.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,383.38
Rate for Payer: Cigna Commercial	$2,712.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,312.85
Rate for Payer: Qualcare PPO/HMO/WC	$813.75
Rate for Payer: UnitedHealthcare Community & State	$171.43
Rate for Payer: Wellpoint Medicaid Managed Care	$154.07

SCREW POLYAXIAL 6.5 X 30 MM

Facility

$10,855.00

Service Code	HCPCS C1713
Hospital Charge Code	270691423
Hospital Revenue Code	278
Min. Negotiated Rate	$1,628.25
Max. Negotiated Rate	$2,626.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,171.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,626.91
Rate for Payer: Qualcare PPO/HMO/WC	$1,628.25

SCREW POLYAXIAL 6.5 X 30 MM

Facility

$10,855.00

Service Code	HCPCS C1713
Hospital Charge Code	270691423
Hospital Revenue Code	278
Min. Negotiated Rate	$308.28
Max. Negotiated Rate	$5,427.50
Rate for Payer: Aetna Commercial	$4,124.90
Rate for Payer: Aetna Medicare Advantage	$3,256.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,768.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,768.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,171.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,768.03
Rate for Payer: Cigna Commercial	$5,427.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,626.91
Rate for Payer: Qualcare PPO/HMO/WC	$1,628.25
Rate for Payer: UnitedHealthcare Community & State	$343.02
Rate for Payer: Wellpoint Medicaid Managed Care	$308.28

SCREW POLYAXIAL 6.5 X 40 MM

Facility

$10,855.00

Service Code	HCPCS C1713
Hospital Charge Code	270691422
Hospital Revenue Code	278
Min. Negotiated Rate	$308.28
Max. Negotiated Rate	$5,427.50
Rate for Payer: Aetna Commercial	$4,124.90
Rate for Payer: Aetna Medicare Advantage	$3,256.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,768.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,768.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,171.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,768.03
Rate for Payer: Cigna Commercial	$5,427.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,626.91
Rate for Payer: Qualcare PPO/HMO/WC	$1,628.25
Rate for Payer: UnitedHealthcare Community & State	$343.02
Rate for Payer: Wellpoint Medicaid Managed Care	$308.28

SCREW POLYAXIAL 6.5 X 40 MM

Facility

$10,855.00

Service Code	HCPCS C1713
Hospital Charge Code	270691422
Hospital Revenue Code	278
Min. Negotiated Rate	$1,628.25
Max. Negotiated Rate	$2,626.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,171.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,626.91
Rate for Payer: Qualcare PPO/HMO/WC	$1,628.25

SCREW POLYAXIAL 6.5 X 45 MM

Facility

$6,740.00

Service Code	HCPCS C1713
Hospital Charge Code	270694185
Hospital Revenue Code	278
Min. Negotiated Rate	$1,011.00
Max. Negotiated Rate	$1,631.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,348.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,631.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,011.00

SCREW POLYAXIAL 6.5 X 45 MM

Facility

$6,740.00

Service Code	HCPCS C1713
Hospital Charge Code	270694185
Hospital Revenue Code	278
Min. Negotiated Rate	$191.42
Max. Negotiated Rate	$3,370.00
Rate for Payer: Aetna Commercial	$2,561.20
Rate for Payer: Aetna Medicare Advantage	$2,022.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,718.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,718.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,348.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,718.70
Rate for Payer: Cigna Commercial	$3,370.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,631.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,011.00
Rate for Payer: UnitedHealthcare Community & State	$212.98
Rate for Payer: Wellpoint Medicaid Managed Care	$191.42

SCREW POLYAXIAL 7.5 MM X 80 MM

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270685951
Hospital Revenue Code	278
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

SCREW POLYAXIAL 7.5 MM X 80 MM

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270685951
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

SCREW POLYAXIAL 7.5X35MM

Facility

$6,740.00

Service Code	HCPCS C1713
Hospital Charge Code	270695325
Hospital Revenue Code	278
Min. Negotiated Rate	$191.42
Max. Negotiated Rate	$3,370.00
Rate for Payer: Aetna Commercial	$2,561.20
Rate for Payer: Aetna Medicare Advantage	$2,022.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,718.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,718.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,348.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,718.70
Rate for Payer: Cigna Commercial	$3,370.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,631.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,011.00
Rate for Payer: UnitedHealthcare Community & State	$212.98
Rate for Payer: Wellpoint Medicaid Managed Care	$191.42

SCREW POLYAXIAL 7.5X35MM

Facility

$6,740.00

Service Code	HCPCS C1713
Hospital Charge Code	270695325
Hospital Revenue Code	278
Min. Negotiated Rate	$1,011.00
Max. Negotiated Rate	$1,631.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,348.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,631.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,011.00

SCREW POLYAXIAL 7.5X 40 MM

Facility

$6,740.00

Service Code	HCPCS C1713
Hospital Charge Code	270694186
Hospital Revenue Code	278
Min. Negotiated Rate	$191.42
Max. Negotiated Rate	$3,370.00
Rate for Payer: Aetna Commercial	$2,561.20
Rate for Payer: Aetna Medicare Advantage	$2,022.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,718.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,718.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,348.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,718.70
Rate for Payer: Cigna Commercial	$3,370.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,631.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,011.00
Rate for Payer: UnitedHealthcare Community & State	$212.98
Rate for Payer: Wellpoint Medicaid Managed Care	$191.42

SCREW POLYAXIAL 7.5X 40 MM

Facility

$6,740.00

Service Code	HCPCS C1713
Hospital Charge Code	270694186
Hospital Revenue Code	278
Min. Negotiated Rate	$1,011.00
Max. Negotiated Rate	$1,631.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,348.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,631.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,011.00

SCREW POLYAXIAL 7.5X45 MM

Facility

$7,845.00

Service Code	HCPCS C1713
Hospital Charge Code	270692204
Hospital Revenue Code	278
Min. Negotiated Rate	$222.80
Max. Negotiated Rate	$3,922.50
Rate for Payer: Aetna Commercial	$2,981.10
Rate for Payer: Aetna Medicare Advantage	$2,353.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,000.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,000.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,569.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,000.47
Rate for Payer: Cigna Commercial	$3,922.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,898.49
Rate for Payer: Qualcare PPO/HMO/WC	$1,176.75
Rate for Payer: UnitedHealthcare Community & State	$247.90
Rate for Payer: Wellpoint Medicaid Managed Care	$222.80

SCREW POLYAXIAL 7.5X45 MM

Facility

$7,845.00

Service Code	HCPCS C1713
Hospital Charge Code	270692204
Hospital Revenue Code	278
Min. Negotiated Rate	$1,176.75
Max. Negotiated Rate	$1,898.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,569.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,898.49
Rate for Payer: Qualcare PPO/HMO/WC	$1,176.75

SCREW POLYAXIAL 7.5X 70MM

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270685950
Hospital Revenue Code	278
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

SCREW POLYAXIAL 7.5X 70MM

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270685950
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

SCREW POLYAXIAL 8.5X45MM

Facility

$6,740.00

Service Code	HCPCS C1713
Hospital Charge Code	270695324
Hospital Revenue Code	278
Min. Negotiated Rate	$191.42
Max. Negotiated Rate	$3,370.00
Rate for Payer: Aetna Commercial	$2,561.20
Rate for Payer: Aetna Medicare Advantage	$2,022.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,718.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,718.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,348.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,718.70
Rate for Payer: Cigna Commercial	$3,370.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,631.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,011.00
Rate for Payer: UnitedHealthcare Community & State	$212.98
Rate for Payer: Wellpoint Medicaid Managed Care	$191.42

SCREW POLYAXIAL 8.5X45MM

Facility

$6,740.00

Service Code	HCPCS C1713
Hospital Charge Code	270695324
Hospital Revenue Code	278
Min. Negotiated Rate	$1,011.00
Max. Negotiated Rate	$1,631.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,348.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,631.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,011.00

SCREW POLYAXIAL NL TI 3.5X24MM

Facility

$945.00

Service Code	HCPCS C1713
Hospital Charge Code	270698956
Hospital Revenue Code	278
Min. Negotiated Rate	$141.75
Max. Negotiated Rate	$228.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$189.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$228.69
Rate for Payer: Qualcare PPO/HMO/WC	$141.75

SCREW POLYAXIAL NL TI 3.5X24MM

Facility

$945.00

Service Code	HCPCS C1713
Hospital Charge Code	270698956
Hospital Revenue Code	278
Min. Negotiated Rate	$26.84
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna Commercial	$359.10
Rate for Payer: Aetna Medicare Advantage	$283.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$240.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$240.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$189.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$240.97
Rate for Payer: Cigna Commercial	$472.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$228.69
Rate for Payer: Qualcare PPO/HMO/WC	$141.75
Rate for Payer: UnitedHealthcare Community & State	$29.86
Rate for Payer: Wellpoint Medicaid Managed Care	$26.84

SCREW POLYAXIAL TBOLT 6.5X45MM

Facility

$10,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695213
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

Know your out-of-pocket cost for care.

All Charges