Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SCREW RELINE MAS, 8.5X50 MM

Facility

$9,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270686450
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, 8.5X50 MM

Facility

$9,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270686450
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 O MOD 6.5 X 40

Facility

$10,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270691444
Hospital Revenue Code	278
Min. Negotiated Rate	$298.20
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$331.80
Rate for Payer: Wellpoint Medicaid Managed Care	$298.20

SCREW RELINE O MOD 6.5 X 40

Facility

$10,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270691444
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

SCREW RELINE-O MOD 6.5X45MM 2S

Facility

$10,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270695243
Hospital Revenue Code	278
Min. Negotiated Rate	$298.20
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$331.80
Rate for Payer: Wellpoint Medicaid Managed Care	$298.20

SCREW RELINE-O MOD 6.5X45MM 2S

Facility

$10,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270695243
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

SCREW RELINE POLY 5.5X45MM 2C

Facility

$6,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270691364
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 POLY 5.5X45MM 2C

Facility

$6,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270691364
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 REM INST TORQ DEFINING

Facility

$1,160.00

Hospital Charge Code	270669494
Hospital Revenue Code	278
Min. Negotiated Rate	$174.00
Max. Negotiated Rate	$280.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$280.72
Rate for Payer: Qualcare PPO/HMO/WC	$174.00

SCREW REM INST TORQ DEFINING

Facility

$1,160.00

Hospital Charge Code	270669494
Hospital Revenue Code	278
Min. Negotiated Rate	$32.94
Max. Negotiated Rate	$580.00
Rate for Payer: Aetna Commercial	$440.80
Rate for Payer: Aetna Medicare Advantage	$348.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$295.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$295.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$295.80
Rate for Payer: Cigna Commercial	$580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$280.72
Rate for Payer: Qualcare PPO/HMO/WC	$174.00
Rate for Payer: UnitedHealthcare Community & State	$36.66
Rate for Payer: Wellpoint Medicaid Managed Care	$32.94

SCREW RESCUE 3.7X12

Facility

$6,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693875
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

SCREW RESCUE 3.7X12

Facility

$6,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693875
Hospital Revenue Code	278
Min. Negotiated Rate	$191.70
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,565.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Community & State	$213.30
Rate for Payer: Wellpoint Medicaid Managed Care	$191.70

SCREW RESCUE 5.2X16MM

Facility

$1,365.90

Service Code	HCPCS C1713
Hospital Charge Code	270694154
Hospital Revenue Code	278
Min. Negotiated Rate	$38.79
Max. Negotiated Rate	$682.95
Rate for Payer: Aetna Commercial	$519.04
Rate for Payer: Aetna Medicare Advantage	$409.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$348.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$348.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$273.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$348.30
Rate for Payer: Cigna Commercial	$682.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$330.55
Rate for Payer: Qualcare PPO/HMO/WC	$204.88
Rate for Payer: UnitedHealthcare Community & State	$43.16
Rate for Payer: Wellpoint Medicaid Managed Care	$38.79

SCREW RESCUE 5.2X16MM

Facility

$1,365.90

Service Code	HCPCS C1713
Hospital Charge Code	270694154
Hospital Revenue Code	278
Min. Negotiated Rate	$204.88
Max. Negotiated Rate	$330.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$273.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$330.55
Rate for Payer: Qualcare PPO/HMO/WC	$204.88

SCREW RESCUE VARIABLE 4.5X12MM

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270699100
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

SCREW RESCUE VARIABLE 4.5X12MM

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270699100
Hospital Revenue Code	278
Min. Negotiated Rate	$85.20
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$94.80
Rate for Payer: Wellpoint Medicaid Managed Care	$85.20

SCREW RETAINER 3.5MMX12MM

Facility

$917.50

Service Code	HCPCS C1713
Hospital Charge Code	270692983
Hospital Revenue Code	278
Min. Negotiated Rate	$26.06
Max. Negotiated Rate	$458.75
Rate for Payer: Aetna Commercial	$348.65
Rate for Payer: Aetna Medicare Advantage	$275.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$233.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$233.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$183.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$233.96
Rate for Payer: Cigna Commercial	$458.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$222.03
Rate for Payer: Qualcare PPO/HMO/WC	$137.62
Rate for Payer: UnitedHealthcare Community & State	$28.99
Rate for Payer: Wellpoint Medicaid Managed Care	$26.06

SCREW RETAINER 3.5MMX12MM

Facility

$917.50

Service Code	HCPCS C1713
Hospital Charge Code	270692983
Hospital Revenue Code	278
Min. Negotiated Rate	$137.62
Max. Negotiated Rate	$222.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$183.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$222.03
Rate for Payer: Qualcare PPO/HMO/WC	$137.62

SCREW RETAINER 3.5X14MM

Facility

$917.50

Service Code	HCPCS C1713
Hospital Charge Code	270692631
Hospital Revenue Code	278
Min. Negotiated Rate	$137.62
Max. Negotiated Rate	$222.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$183.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$222.03
Rate for Payer: Qualcare PPO/HMO/WC	$137.62

SCREW RETAINER 3.5X14MM

Facility

$917.50

Service Code	HCPCS C1713
Hospital Charge Code	270692631
Hospital Revenue Code	278
Min. Negotiated Rate	$26.06
Max. Negotiated Rate	$458.75
Rate for Payer: Aetna Commercial	$348.65
Rate for Payer: Aetna Medicare Advantage	$275.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$233.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$233.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$183.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$233.96
Rate for Payer: Cigna Commercial	$458.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$222.03
Rate for Payer: Qualcare PPO/HMO/WC	$137.62
Rate for Payer: UnitedHealthcare Community & State	$28.99
Rate for Payer: Wellpoint Medicaid Managed Care	$26.06

SCREW REUNION CTRPERI 6.5X24MM

Facility

$2,135.00

Service Code	HCPCS C1713
Hospital Charge Code	270700594
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 REUNION CTRPERI 6.5X24MM

Facility

$2,135.00

Service Code	HCPCS C1713
Hospital Charge Code	270700594
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 REUNION PERIPH 4.5X36MM

Facility

$2,135.00

Service Code	HCPCS C1713
Hospital Charge Code	270700593
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 REUNION PERIPH 4.5X36MM

Facility

$2,135.00

Service Code	HCPCS C1713
Hospital Charge Code	270700593
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 RND TAPERED INTF 8X28MM

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270675573
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

Know your out-of-pocket cost for care.

All Charges