Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SCREW REFO TI MOD CAN 6.5X30MM

Facility

$6,740.00

Service Code	HCPCS C1713
Hospital Charge Code	270696976
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 REF TI MOD CANN 5.5X45MM

Facility

$6,740.00

Service Code	HCPCS C1713
Hospital Charge Code	270697640
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 REF TI MOD CANN 5.5X45MM

Facility

$6,740.00

Service Code	HCPCS C1713
Hospital Charge Code	270697640
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 RELINE 5.5MM OPEN TULIP

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270682866
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

SCREW RELINE 5.5MM OPEN TULIP

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270682866
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

SCREW RELINE 6.5X40MM TRA POLY

Facility

$6,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270696721
Hospital Revenue Code	278
Min. Negotiated Rate	$195.25
Max. Negotiated Rate	$3,437.50
Rate for Payer: Aetna Commercial	$2,612.50
Rate for Payer: Aetna Medicare Advantage	$2,062.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,753.12
Rate for Payer: Cigna Commercial	$3,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,663.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25
Rate for Payer: UnitedHealthcare Community & State	$217.25
Rate for Payer: Wellpoint Medicaid Managed Care	$195.25

SCREW RELINE 6.5X40MM TRA POLY

Facility

$6,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270696721
Hospital Revenue Code	278
Min. Negotiated Rate	$1,031.25
Max. Negotiated Rate	$1,663.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,663.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25

SCREW RELINE 6.5X45MM TRA POLY

Facility

$6,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270696722
Hospital Revenue Code	278
Min. Negotiated Rate	$1,031.25
Max. Negotiated Rate	$1,663.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,663.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25

SCREW RELINE 6.5X45MM TRA POLY

Facility

$6,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270696722
Hospital Revenue Code	278
Min. Negotiated Rate	$195.25
Max. Negotiated Rate	$3,437.50
Rate for Payer: Aetna Commercial	$2,612.50
Rate for Payer: Aetna Medicare Advantage	$2,062.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,753.12
Rate for Payer: Cigna Commercial	$3,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,663.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25
Rate for Payer: UnitedHealthcare Community & State	$217.25
Rate for Payer: Wellpoint Medicaid Managed Care	$195.25

SCREW RELINE 8.5X80MM 2S POLY

Facility

$6,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270696720
Hospital Revenue Code	278
Min. Negotiated Rate	$1,031.25
Max. Negotiated Rate	$1,663.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,663.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25

SCREW RELINE 8.5X80MM 2S POLY

Facility

$6,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270696720
Hospital Revenue Code	278
Min. Negotiated Rate	$195.25
Max. Negotiated Rate	$3,437.50
Rate for Payer: Aetna Commercial	$2,612.50
Rate for Payer: Aetna Medicare Advantage	$2,062.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,753.12
Rate for Payer: Cigna Commercial	$3,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,663.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25
Rate for Payer: UnitedHealthcare Community & State	$217.25
Rate for Payer: Wellpoint Medicaid Managed Care	$195.25

SCREW RELINE 8.5X90MM 2S POLY

Facility

$6,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270696719
Hospital Revenue Code	278
Min. Negotiated Rate	$1,031.25
Max. Negotiated Rate	$1,663.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,663.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25

SCREW RELINE 8.5X90MM 2S POLY

Facility

$6,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270696719
Hospital Revenue Code	278
Min. Negotiated Rate	$195.25
Max. Negotiated Rate	$3,437.50
Rate for Payer: Aetna Commercial	$2,612.50
Rate for Payer: Aetna Medicare Advantage	$2,062.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,753.12
Rate for Payer: Cigna Commercial	$3,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,663.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25
Rate for Payer: UnitedHealthcare Community & State	$217.25
Rate for Payer: Wellpoint Medicaid Managed Care	$195.25

SCREW RELINE MAS, 5.5 X40 MM

Facility

$9,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270686448
Hospital Revenue Code	278
Min. Negotiated Rate	$255.60
Max. Negotiated Rate	$4,500.00
Rate for Payer: Aetna Commercial	$3,420.00
Rate for Payer: Aetna Medicare Advantage	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,295.00
Rate for Payer: Cigna Commercial	$4,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00
Rate for Payer: UnitedHealthcare Community & State	$284.40
Rate for Payer: Wellpoint Medicaid Managed Care	$255.60

SCREW RELINE MAS, 5.5 X40 MM

Facility

$9,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270686448
Hospital Revenue Code	278
Min. Negotiated Rate	$1,350.00
Max. Negotiated Rate	$2,178.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00

SCREW RELINE MAS, 5.5X50MM LRD

Facility

$5,245.00

Service Code	HCPCS C1713
Hospital Charge Code	270686451
Hospital Revenue Code	278
Min. Negotiated Rate	$148.96
Max. Negotiated Rate	$2,622.50
Rate for Payer: Aetna Commercial	$1,993.10
Rate for Payer: Aetna Medicare Advantage	$1,573.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,337.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,337.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,049.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,337.47
Rate for Payer: Cigna Commercial	$2,622.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,269.29
Rate for Payer: Qualcare PPO/HMO/WC	$786.75
Rate for Payer: UnitedHealthcare Community & State	$165.74
Rate for Payer: Wellpoint Medicaid Managed Care	$148.96

SCREW RELINE MAS, 5.5X50MM LRD

Facility

$5,245.00

Service Code	HCPCS C1713
Hospital Charge Code	270686451
Hospital Revenue Code	278
Min. Negotiated Rate	$786.75
Max. Negotiated Rate	$1,269.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,049.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,269.29
Rate for Payer: Qualcare PPO/HMO/WC	$786.75

SCREW RELINE MAS 5.5X55MM LRD

Facility

$5,245.00

Service Code	HCPCS C1713
Hospital Charge Code	270686452
Hospital Revenue Code	278
Min. Negotiated Rate	$148.96
Max. Negotiated Rate	$2,622.50
Rate for Payer: Aetna Commercial	$1,993.10
Rate for Payer: Aetna Medicare Advantage	$1,573.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,337.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,337.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,049.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,337.47
Rate for Payer: Cigna Commercial	$2,622.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,269.29
Rate for Payer: Qualcare PPO/HMO/WC	$786.75
Rate for Payer: UnitedHealthcare Community & State	$165.74
Rate for Payer: Wellpoint Medicaid Managed Care	$148.96

SCREW RELINE MAS 5.5X55MM LRD

Facility

$5,245.00

Service Code	HCPCS C1713
Hospital Charge Code	270686452
Hospital Revenue Code	278
Min. Negotiated Rate	$786.75
Max. Negotiated Rate	$1,269.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,049.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,269.29
Rate for Payer: Qualcare PPO/HMO/WC	$786.75

SCREW RELINE MAS 6.5X40MM

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693950
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

SCREW RELINE MAS 6.5X40MM

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693950
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

SCREW RELINE MAS, 7.5 X 45 MM

Facility

$9,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270686449
Hospital Revenue Code	278
Min. Negotiated Rate	$255.60
Max. Negotiated Rate	$4,500.00
Rate for Payer: Aetna Commercial	$3,420.00
Rate for Payer: Aetna Medicare Advantage	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,295.00
Rate for Payer: Cigna Commercial	$4,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00
Rate for Payer: UnitedHealthcare Community & State	$284.40
Rate for Payer: Wellpoint Medicaid Managed Care	$255.60

SCREW RELINE MAS, 7.5 X 45 MM

Facility

$9,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270686449
Hospital Revenue Code	278
Min. Negotiated Rate	$1,350.00
Max. Negotiated Rate	$2,178.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00

SCREW RELINE MAS7.5X45MMPOLY2C

Facility

$17,310.00

Service Code	HCPCS C1713
Hospital Charge Code	270692907
Hospital Revenue Code	278
Min. Negotiated Rate	$2,596.50
Max. Negotiated Rate	$4,189.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,462.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,189.02
Rate for Payer: Qualcare PPO/HMO/WC	$2,596.50

SCREW RELINE MAS7.5X45MMPOLY2C

Facility

$17,310.00

Service Code	HCPCS C1713
Hospital Charge Code	270692907
Hospital Revenue Code	278
Min. Negotiated Rate	$491.60
Max. Negotiated Rate	$8,655.00
Rate for Payer: Aetna Commercial	$6,577.80
Rate for Payer: Aetna Medicare Advantage	$5,193.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,414.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,414.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,462.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,414.05
Rate for Payer: Cigna Commercial	$8,655.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,189.02
Rate for Payer: Qualcare PPO/HMO/WC	$2,596.50
Rate for Payer: UnitedHealthcare Community & State	$547.00
Rate for Payer: Wellpoint Medicaid Managed Care	$491.60

Know your out-of-pocket cost for care.

All Charges