Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SCREW SHANK 5.5X40MM

Facility

$3,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270691366
Hospital Revenue Code	278
Min. Negotiated Rate	$453.75
Max. Negotiated Rate	$732.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$605.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.05
Rate for Payer: Qualcare PPO/HMO/WC	$453.75

SCREW SHANK 6.5X40MM 2C

Facility

$3,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270691779
Hospital Revenue Code	278
Min. Negotiated Rate	$453.75
Max. Negotiated Rate	$732.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$605.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.05
Rate for Payer: Qualcare PPO/HMO/WC	$453.75

SCREW SHANK 6.5X40MM 2C

Facility

$3,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270691779
Hospital Revenue Code	278
Min. Negotiated Rate	$85.91
Max. Negotiated Rate	$1,512.50
Rate for Payer: Aetna Commercial	$1,149.50
Rate for Payer: Aetna Medicare Advantage	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$771.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$771.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$771.38
Rate for Payer: Cigna Commercial	$1,512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.05
Rate for Payer: Qualcare PPO/HMO/WC	$453.75
Rate for Payer: UnitedHealthcare Community & State	$95.59
Rate for Payer: Wellpoint Medicaid Managed Care	$85.91

SCREW SHANK 6.5X40MM MODULA

Facility

$4,865.00

Service Code	HCPCS C1713
Hospital Charge Code	270660948
Hospital Revenue Code	278
Min. Negotiated Rate	$138.17
Max. Negotiated Rate	$2,432.50
Rate for Payer: Aetna Commercial	$1,848.70
Rate for Payer: Aetna Medicare Advantage	$1,459.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,240.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,240.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$973.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,240.58
Rate for Payer: Cigna Commercial	$2,432.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,177.33
Rate for Payer: Qualcare PPO/HMO/WC	$729.75
Rate for Payer: UnitedHealthcare Community & State	$153.73
Rate for Payer: Wellpoint Medicaid Managed Care	$138.17

SCREW SHANK 6.5X40MM MODULA

Facility

$4,865.00

Service Code	HCPCS C1713
Hospital Charge Code	270660948
Hospital Revenue Code	278
Min. Negotiated Rate	$729.75
Max. Negotiated Rate	$1,177.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$973.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,177.33
Rate for Payer: Qualcare PPO/HMO/WC	$729.75

SCREW SHANK 6.5X45MM 2C

Facility

$3,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270691456
Hospital Revenue Code	278
Min. Negotiated Rate	$453.75
Max. Negotiated Rate	$732.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$605.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.05
Rate for Payer: Qualcare PPO/HMO/WC	$453.75

SCREW SHANK 6.5X45MM 2C

Facility

$3,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270691456
Hospital Revenue Code	278
Min. Negotiated Rate	$85.91
Max. Negotiated Rate	$1,512.50
Rate for Payer: Aetna Commercial	$1,149.50
Rate for Payer: Aetna Medicare Advantage	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$771.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$771.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$771.38
Rate for Payer: Cigna Commercial	$1,512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.05
Rate for Payer: Qualcare PPO/HMO/WC	$453.75
Rate for Payer: UnitedHealthcare Community & State	$95.59
Rate for Payer: Wellpoint Medicaid Managed Care	$85.91

SCREW SHANK 7.5 X 40 MM 2C

Facility

$3,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270691818
Hospital Revenue Code	278
Min. Negotiated Rate	$453.75
Max. Negotiated Rate	$732.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$605.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.05
Rate for Payer: Qualcare PPO/HMO/WC	$453.75

SCREW SHANK 7.5 X 40 MM 2C

Facility

$3,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270691818
Hospital Revenue Code	278
Min. Negotiated Rate	$85.91
Max. Negotiated Rate	$1,512.50
Rate for Payer: Aetna Commercial	$1,149.50
Rate for Payer: Aetna Medicare Advantage	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$771.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$771.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$771.38
Rate for Payer: Cigna Commercial	$1,512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.05
Rate for Payer: Qualcare PPO/HMO/WC	$453.75
Rate for Payer: UnitedHealthcare Community & State	$95.59
Rate for Payer: Wellpoint Medicaid Managed Care	$85.91

SCREW SHANK MODULAR 7.5X55MM

Facility

$6,740.00

Service Code	HCPCS C1713
Hospital Charge Code	270698159
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 SHANK MODULAR 7.5X55MM

Facility

$6,740.00

Service Code	HCPCS C1713
Hospital Charge Code	270698159
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 SHANK PRECEPT MOD 6.5X45

Facility

$500.00

Hospital Charge Code	270659977
Hospital Revenue Code	278
Min. Negotiated Rate	$14.20
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$15.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

SCREW SHANK PRECEPT MOD 6.5X45

Facility

$500.00

Hospital Charge Code	270659977
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

SCREW SHANK RELINE 5.5X45MM 2C

Facility

$3,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270691362
Hospital Revenue Code	278
Min. Negotiated Rate	$453.75
Max. Negotiated Rate	$732.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$605.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.05
Rate for Payer: Qualcare PPO/HMO/WC	$453.75

SCREW SHANK RELINE 5.5X45MM 2C

Facility

$3,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270691362
Hospital Revenue Code	278
Min. Negotiated Rate	$85.91
Max. Negotiated Rate	$1,512.50
Rate for Payer: Aetna Commercial	$1,149.50
Rate for Payer: Aetna Medicare Advantage	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$771.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$771.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$771.38
Rate for Payer: Cigna Commercial	$1,512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.05
Rate for Payer: Qualcare PPO/HMO/WC	$453.75
Rate for Payer: UnitedHealthcare Community & State	$95.59
Rate for Payer: Wellpoint Medicaid Managed Care	$85.91

SCREW SHANK RELINE 6.5X50MM 2C

Facility

$3,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270692444
Hospital Revenue Code	278
Min. Negotiated Rate	$85.91
Max. Negotiated Rate	$1,512.50
Rate for Payer: Aetna Commercial	$1,149.50
Rate for Payer: Aetna Medicare Advantage	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$771.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$771.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$771.38
Rate for Payer: Cigna Commercial	$1,512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.05
Rate for Payer: Qualcare PPO/HMO/WC	$453.75
Rate for Payer: UnitedHealthcare Community & State	$95.59
Rate for Payer: Wellpoint Medicaid Managed Care	$85.91

SCREW SHANK RELINE 6.5X50MM 2C

Facility

$3,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270692444
Hospital Revenue Code	278
Min. Negotiated Rate	$453.75
Max. Negotiated Rate	$732.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$605.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.05
Rate for Payer: Qualcare PPO/HMO/WC	$453.75

SCREW SHANK RELINE 6.5X50 POLY

Facility

$3,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270692448
Hospital Revenue Code	278
Min. Negotiated Rate	$85.91
Max. Negotiated Rate	$1,512.50
Rate for Payer: Aetna Commercial	$1,149.50
Rate for Payer: Aetna Medicare Advantage	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$771.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$771.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$771.38
Rate for Payer: Cigna Commercial	$1,512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.05
Rate for Payer: Qualcare PPO/HMO/WC	$453.75
Rate for Payer: UnitedHealthcare Community & State	$95.59
Rate for Payer: Wellpoint Medicaid Managed Care	$85.91

SCREW SHANK RELINE 6.5X50 POLY

Facility

$3,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270692448
Hospital Revenue Code	278
Min. Negotiated Rate	$453.75
Max. Negotiated Rate	$732.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$605.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.05
Rate for Payer: Qualcare PPO/HMO/WC	$453.75

SCREW SHANK RELINE 7.5X45MM 2C

Facility

$3,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270692445
Hospital Revenue Code	278
Min. Negotiated Rate	$453.75
Max. Negotiated Rate	$732.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$605.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.05
Rate for Payer: Qualcare PPO/HMO/WC	$453.75

SCREW SHANK RELINE 7.5X45MM 2C

Facility

$3,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270692445
Hospital Revenue Code	278
Min. Negotiated Rate	$85.91
Max. Negotiated Rate	$1,512.50
Rate for Payer: Aetna Commercial	$1,149.50
Rate for Payer: Aetna Medicare Advantage	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$771.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$771.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$771.38
Rate for Payer: Cigna Commercial	$1,512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.05
Rate for Payer: Qualcare PPO/HMO/WC	$453.75
Rate for Payer: UnitedHealthcare Community & State	$95.59
Rate for Payer: Wellpoint Medicaid Managed Care	$85.91

SCREW SHEATH 4.0 75MM

Facility

$2,695.00

Service Code	HCPCS C1713
Hospital Charge Code	270687082
Hospital Revenue Code	278
Min. Negotiated Rate	$76.54
Max. Negotiated Rate	$1,347.50
Rate for Payer: Aetna Commercial	$1,024.10
Rate for Payer: Aetna Medicare Advantage	$808.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$687.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$687.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$539.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$687.23
Rate for Payer: Cigna Commercial	$1,347.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$652.19
Rate for Payer: Qualcare PPO/HMO/WC	$404.25
Rate for Payer: UnitedHealthcare Community & State	$85.16
Rate for Payer: Wellpoint Medicaid Managed Care	$76.54

SCREW SHEATH 4.0 75MM

Facility

$2,695.00

Service Code	HCPCS C1713
Hospital Charge Code	270687082
Hospital Revenue Code	278
Min. Negotiated Rate	$404.25
Max. Negotiated Rate	$652.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$539.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$652.19
Rate for Payer: Qualcare PPO/HMO/WC	$404.25

SCREW SHEATH 4.0 X 50MM

Facility

$2,680.00

Service Code	HCPCS C1713
Hospital Charge Code	270687086
Hospital Revenue Code	278
Min. Negotiated Rate	$402.00
Max. Negotiated Rate	$648.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$536.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$648.56
Rate for Payer: Qualcare PPO/HMO/WC	$402.00

SCREW SHEATH 4.0 X 50MM

Facility

$2,680.00

Service Code	HCPCS C1713
Hospital Charge Code	270687086
Hospital Revenue Code	278
Min. Negotiated Rate	$76.11
Max. Negotiated Rate	$1,340.00
Rate for Payer: Aetna Commercial	$1,018.40
Rate for Payer: Aetna Medicare Advantage	$804.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$683.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$683.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$683.40
Rate for Payer: Cigna Commercial	$1,340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$648.56
Rate for Payer: Qualcare PPO/HMO/WC	$402.00
Rate for Payer: UnitedHealthcare Community & State	$84.69
Rate for Payer: Wellpoint Medicaid Managed Care	$76.11

Know your out-of-pocket cost for care.

All Charges