Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SCREW SYNTHES 5.0 COVE 25 MM

Facility

$1,099.05

Service Code	HCPCS C1713
Hospital Charge Code	270691606
Hospital Revenue Code	278
Min. Negotiated Rate	$31.21
Max. Negotiated Rate	$549.52
Rate for Payer: Aetna Commercial	$417.64
Rate for Payer: Aetna Medicare Advantage	$329.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$280.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$280.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$219.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$280.26
Rate for Payer: Cigna Commercial	$549.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$265.97
Rate for Payer: Qualcare PPO/HMO/WC	$164.86
Rate for Payer: UnitedHealthcare Community & State	$34.73
Rate for Payer: Wellpoint Medicaid Managed Care	$31.21

SCREW SYNTHES 5.0 COVE 25 MM

Facility

$1,099.05

Service Code	HCPCS C1713
Hospital Charge Code	270691606
Hospital Revenue Code	278
Min. Negotiated Rate	$164.86
Max. Negotiated Rate	$265.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$219.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$265.97
Rate for Payer: Qualcare PPO/HMO/WC	$164.86

SCREW SYNTHES 5.0 COVE 30 MM

Facility

$1,098.90

Service Code	HCPCS C1713
Hospital Charge Code	270691594
Hospital Revenue Code	278
Min. Negotiated Rate	$31.21
Max. Negotiated Rate	$549.45
Rate for Payer: Aetna Commercial	$417.58
Rate for Payer: Aetna Medicare Advantage	$329.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$280.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$280.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$219.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$280.22
Rate for Payer: Cigna Commercial	$549.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$265.93
Rate for Payer: Qualcare PPO/HMO/WC	$164.84
Rate for Payer: UnitedHealthcare Community & State	$34.73
Rate for Payer: Wellpoint Medicaid Managed Care	$31.21

SCREW SYNTHES 5.0 COVE 30 MM

Facility

$1,098.90

Service Code	HCPCS C1713
Hospital Charge Code	270691594
Hospital Revenue Code	278
Min. Negotiated Rate	$164.84
Max. Negotiated Rate	$265.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$219.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$265.93
Rate for Payer: Qualcare PPO/HMO/WC	$164.84

SCREW SYNTHES 5.0 COVE 55 MM

Facility

$1,098.90

Service Code	HCPCS C1713
Hospital Charge Code	270691595
Hospital Revenue Code	278
Min. Negotiated Rate	$164.84
Max. Negotiated Rate	$265.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$219.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$265.93
Rate for Payer: Qualcare PPO/HMO/WC	$164.84

SCREW SYNTHES 5.0 COVE 55 MM

Facility

$1,098.90

Service Code	HCPCS C1713
Hospital Charge Code	270691595
Hospital Revenue Code	278
Min. Negotiated Rate	$31.21
Max. Negotiated Rate	$549.45
Rate for Payer: Aetna Commercial	$417.58
Rate for Payer: Aetna Medicare Advantage	$329.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$280.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$280.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$219.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$280.22
Rate for Payer: Cigna Commercial	$549.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$265.93
Rate for Payer: Qualcare PPO/HMO/WC	$164.84
Rate for Payer: UnitedHealthcare Community & State	$34.73
Rate for Payer: Wellpoint Medicaid Managed Care	$31.21

SCREW SYN TTN 3.5X24MM

Facility

$36.00

Service Code	HCPCS C1713
Hospital Charge Code	270601849
Hospital Revenue Code	278
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$8.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.71
Rate for Payer: Qualcare PPO/HMO/WC	$5.40

SCREW SYN TTN 3.5X24MM

Facility

$36.00

Service Code	HCPCS C1713
Hospital Charge Code	270601849
Hospital Revenue Code	278
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna Commercial	$13.68
Rate for Payer: Aetna Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.18
Rate for Payer: Cigna Commercial	$18.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.71
Rate for Payer: Qualcare PPO/HMO/WC	$5.40
Rate for Payer: UnitedHealthcare Community & State	$1.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1.02

SCREW T10 3.5MM X 36 MM

Facility

$2,015.00

Service Code	HCPCS C1713
Hospital Charge Code	270701154
Hospital Revenue Code	278
Min. Negotiated Rate	$57.23
Max. Negotiated Rate	$1,007.50
Rate for Payer: Aetna Commercial	$765.70
Rate for Payer: Aetna Medicare Advantage	$604.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$513.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$513.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$403.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$513.83
Rate for Payer: Cigna Commercial	$1,007.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$487.63
Rate for Payer: Qualcare PPO/HMO/WC	$302.25
Rate for Payer: UnitedHealthcare Community & State	$63.67
Rate for Payer: Wellpoint Medicaid Managed Care	$57.23

SCREW T10 3.5MM X 36 MM

Facility

$2,015.00

Service Code	HCPCS C1713
Hospital Charge Code	270701154
Hospital Revenue Code	278
Min. Negotiated Rate	$302.25
Max. Negotiated Rate	$487.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$403.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$487.63
Rate for Payer: Qualcare PPO/HMO/WC	$302.25

SCREW T15 3.5 X 16 MUL PAK

Facility

$1,000.00

Hospital Charge Code	270703588
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

SCREW T15 3.5 X 16 MUL PAK

Facility

$1,000.00

Hospital Charge Code	270703588
Hospital Revenue Code	278
Min. Negotiated Rate	$28.40
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$31.60
Rate for Payer: Wellpoint Medicaid Managed Care	$28.40

SCREW T15 CORTEX 3.5 X 18MM

Facility

$700.00

Hospital Charge Code	270703587
Hospital Revenue Code	278
Min. Negotiated Rate	$19.88
Max. Negotiated Rate	$350.00
Rate for Payer: Aetna Commercial	$266.00
Rate for Payer: Aetna Medicare Advantage	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.50
Rate for Payer: Cigna Commercial	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: Qualcare PPO/HMO/WC	$105.00
Rate for Payer: UnitedHealthcare Community & State	$22.12
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

SCREW T15 CORTEX 3.5 X 18MM

Facility

$700.00

Hospital Charge Code	270703587
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$169.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: Qualcare PPO/HMO/WC	$105.00

SCREW T15 LP CORT 3.5 X 14 MM

Facility

$700.00

Hospital Charge Code	270703585
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$169.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: Qualcare PPO/HMO/WC	$105.00

SCREW T15 LP CORT 3.5 X 14 MM

Facility

$700.00

Hospital Charge Code	270703585
Hospital Revenue Code	278
Min. Negotiated Rate	$19.88
Max. Negotiated Rate	$350.00
Rate for Payer: Aetna Commercial	$266.00
Rate for Payer: Aetna Medicare Advantage	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.50
Rate for Payer: Cigna Commercial	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: Qualcare PPO/HMO/WC	$105.00
Rate for Payer: UnitedHealthcare Community & State	$22.12
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

SCREW T15 LP CORT 3.5 X 16MM

Facility

$700.00

Hospital Charge Code	270703586
Hospital Revenue Code	278
Min. Negotiated Rate	$19.88
Max. Negotiated Rate	$350.00
Rate for Payer: Aetna Commercial	$266.00
Rate for Payer: Aetna Medicare Advantage	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.50
Rate for Payer: Cigna Commercial	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: Qualcare PPO/HMO/WC	$105.00
Rate for Payer: UnitedHealthcare Community & State	$22.12
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

SCREW T15 LP CORT 3.5 X 16MM

Facility

$700.00

Hospital Charge Code	270703586
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$169.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: Qualcare PPO/HMO/WC	$105.00

SCREW T15 LP CORT 3.5X20MM NS

Facility

$275.00

Service Code	HCPCS C1713
Hospital Charge Code	270686579
Hospital Revenue Code	278
Min. Negotiated Rate	$7.81
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$104.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.55
Rate for Payer: Qualcare PPO/HMO/WC	$41.25
Rate for Payer: UnitedHealthcare Community & State	$8.69
Rate for Payer: Wellpoint Medicaid Managed Care	$7.81

SCREW T15 LP CORT 3.5X20MM NS

Facility

$275.00

Service Code	HCPCS C1713
Hospital Charge Code	270686579
Hospital Revenue Code	278
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$66.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.55
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

SCREW T15 LP CORT 3.5X24MM NS

Facility

$234.00

Service Code	HCPCS C1713
Hospital Charge Code	270680845
Hospital Revenue Code	278
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$56.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.63
Rate for Payer: Qualcare PPO/HMO/WC	$35.10

SCREW T15 LP CORT 3.5X24MM NS

Facility

$234.00

Service Code	HCPCS C1713
Hospital Charge Code	270680845
Hospital Revenue Code	278
Min. Negotiated Rate	$6.65
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna Commercial	$88.92
Rate for Payer: Aetna Medicare Advantage	$70.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.67
Rate for Payer: Cigna Commercial	$117.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.63
Rate for Payer: Qualcare PPO/HMO/WC	$35.10
Rate for Payer: UnitedHealthcare Community & State	$7.39
Rate for Payer: Wellpoint Medicaid Managed Care	$6.65

SCREW T15 LP CORT 3.5X26MM NS

Facility

$275.00

Service Code	HCPCS C1713
Hospital Charge Code	270680678
Hospital Revenue Code	278
Min. Negotiated Rate	$7.81
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$104.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.55
Rate for Payer: Qualcare PPO/HMO/WC	$41.25
Rate for Payer: UnitedHealthcare Community & State	$8.69
Rate for Payer: Wellpoint Medicaid Managed Care	$7.81

SCREW T15 LP CORT 3.5X26MM NS

Facility

$275.00

Service Code	HCPCS C1713
Hospital Charge Code	270680678
Hospital Revenue Code	278
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$66.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.55
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

SCREW T15 LP CORT 3.5X30MM NS

Facility

$275.00

Service Code	HCPCS C1713
Hospital Charge Code	270680677
Hospital Revenue Code	278
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$66.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.55
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

Know your out-of-pocket cost for care.

All Charges