Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SCREW ZIM CANN 16 7 70 114670

Facility

$981.65

Service Code	HCPCS C1713
Hospital Charge Code	270605975
Hospital Revenue Code	278
Min. Negotiated Rate	$27.88
Max. Negotiated Rate	$490.82
Rate for Payer: Aetna Commercial	$373.03
Rate for Payer: Aetna Medicare Advantage	$294.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$250.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$250.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$196.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$250.32
Rate for Payer: Cigna Commercial	$490.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$237.56
Rate for Payer: Qualcare PPO/HMO/WC	$147.25
Rate for Payer: UnitedHealthcare Community & State	$31.02
Rate for Payer: Wellpoint Medicaid Managed Care	$27.88

SCREW ZIM CANN 16 7 70 114670

Facility

$981.65

Service Code	HCPCS C1713
Hospital Charge Code	270605975
Hospital Revenue Code	278
Min. Negotiated Rate	$147.25
Max. Negotiated Rate	$237.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$196.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$237.56
Rate for Payer: Qualcare PPO/HMO/WC	$147.25

SCREW ZIM CORT 4.5 230643

Facility

$52.00

Service Code	HCPCS C1713
Hospital Charge Code	270607256
Hospital Revenue Code	278
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$26.00
Rate for Payer: Aetna Commercial	$19.76
Rate for Payer: Aetna Medicare Advantage	$15.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.26
Rate for Payer: Cigna Commercial	$26.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.58
Rate for Payer: Qualcare PPO/HMO/WC	$7.80
Rate for Payer: UnitedHealthcare Community & State	$1.64
Rate for Payer: Wellpoint Medicaid Managed Care	$1.48

SCREW ZIM CORT 4.5 230643

Facility

$52.00

Service Code	HCPCS C1713
Hospital Charge Code	270607256
Hospital Revenue Code	278
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$12.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.58
Rate for Payer: Qualcare PPO/HMO/WC	$7.80

SCREW ZIM CORT 4.5 46 230647

Facility

$34.85

Service Code	HCPCS C1713
Hospital Charge Code	270610340
Hospital Revenue Code	278
Min. Negotiated Rate	$5.23
Max. Negotiated Rate	$8.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.43
Rate for Payer: Qualcare PPO/HMO/WC	$5.23

SCREW ZIM CORT 4.5 46 230647

Facility

$34.85

Service Code	HCPCS C1713
Hospital Charge Code	270610340
Hospital Revenue Code	278
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$17.43
Rate for Payer: Aetna Commercial	$13.24
Rate for Payer: Aetna Medicare Advantage	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.89
Rate for Payer: Cigna Commercial	$17.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.43
Rate for Payer: Qualcare PPO/HMO/WC	$5.23
Rate for Payer: UnitedHealthcare Community & State	$1.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.99

SCREW ZIM CORT 4.5 50 230651

Facility

$40.00

Service Code	HCPCS C1713
Hospital Charge Code	270610343
Hospital Revenue Code	278
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna Commercial	$15.20
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.20
Rate for Payer: Cigna Commercial	$20.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.68
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Community & State	$1.26
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

SCREW ZIM CORT 4.5 50 230651

Facility

$40.00

Service Code	HCPCS C1713
Hospital Charge Code	270610343
Hospital Revenue Code	278
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$9.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.68
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

SCREW ZIM CORT 6.5X15MM

Facility

$621.65

Service Code	HCPCS C1713
Hospital Charge Code	270608925
Hospital Revenue Code	278
Min. Negotiated Rate	$17.65
Max. Negotiated Rate	$310.82
Rate for Payer: Aetna Commercial	$236.23
Rate for Payer: Aetna Medicare Advantage	$186.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$158.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$158.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$158.52
Rate for Payer: Cigna Commercial	$310.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.44
Rate for Payer: Qualcare PPO/HMO/WC	$93.25
Rate for Payer: UnitedHealthcare Community & State	$19.64
Rate for Payer: Wellpoint Medicaid Managed Care	$17.65

SCREW ZIM CORT 6.5X15MM

Facility

$621.65

Service Code	HCPCS C1713
Hospital Charge Code	270608925
Hospital Revenue Code	278
Min. Negotiated Rate	$93.25
Max. Negotiated Rate	$150.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.44
Rate for Payer: Qualcare PPO/HMO/WC	$93.25

SCR LINEUM 3.5C12MM 14-524212

Facility

$11,735.00

Service Code	HCPCS C1713
Hospital Charge Code	270698916
Hospital Revenue Code	278
Min. Negotiated Rate	$333.27
Max. Negotiated Rate	$5,867.50
Rate for Payer: Aetna Commercial	$4,459.30
Rate for Payer: Aetna Medicare Advantage	$3,520.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,992.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,992.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,347.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,992.43
Rate for Payer: Cigna Commercial	$5,867.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,839.87
Rate for Payer: Qualcare PPO/HMO/WC	$1,760.25
Rate for Payer: UnitedHealthcare Community & State	$370.83
Rate for Payer: Wellpoint Medicaid Managed Care	$333.27

SCR LINEUM 3.5C12MM 14-524212

Facility

$11,735.00

Service Code	HCPCS C1713
Hospital Charge Code	270698916
Hospital Revenue Code	278
Min. Negotiated Rate	$1,760.25
Max. Negotiated Rate	$2,839.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,347.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,839.87
Rate for Payer: Qualcare PPO/HMO/WC	$1,760.25

SCR LOC Ti 4.0 W/T25 01005412S

Facility

$880.00

Service Code	HCPCS C1713
Hospital Charge Code	270637802
Hospital Revenue Code	278
Min. Negotiated Rate	$132.00
Max. Negotiated Rate	$212.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$176.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.96
Rate for Payer: Qualcare PPO/HMO/WC	$132.00

SCR LOC Ti 4.0 W/T25 01005412S

Facility

$880.00

Service Code	HCPCS C1713
Hospital Charge Code	270637802
Hospital Revenue Code	278
Min. Negotiated Rate	$24.99
Max. Negotiated Rate	$440.00
Rate for Payer: Aetna Commercial	$334.40
Rate for Payer: Aetna Medicare Advantage	$264.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$224.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$224.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$176.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$224.40
Rate for Payer: Cigna Commercial	$440.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.96
Rate for Payer: Qualcare PPO/HMO/WC	$132.00
Rate for Payer: UnitedHealthcare Community & State	$27.81
Rate for Payer: Wellpoint Medicaid Managed Care	$24.99

SCR MAMMO UNI INC CAD

Facility

$4,500.00

Service Code	HCPCS 7706752
Hospital Charge Code	94061498
Hospital Revenue Code	403
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

SCR MAMMO UNI INC CAD

Facility

$4,500.00

Service Code	HCPCS 7706752
Hospital Charge Code	2709038
Hospital Revenue Code	403
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

SCR MAMMO UNI INC CAD

Facility

$4,500.00

Service Code	HCPCS 7706752
Hospital Charge Code	94061498
Hospital Revenue Code	403
Min. Negotiated Rate	$127.80
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,170.00
Rate for Payer: Oxford Commercial	$1,688.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$1,884.00
Rate for Payer: UnitedHealthcare Community & State	$142.20
Rate for Payer: Wellpoint Medicaid Managed Care	$127.80

SCR MAMMO UNI INC CAD

Facility

$4,500.00

Service Code	HCPCS 7706752
Hospital Charge Code	85000904
Hospital Revenue Code	403
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

SCR MAMMO UNI INC CAD

Facility

$4,500.00

Service Code	HCPCS 7706752
Hospital Charge Code	9406406
Hospital Revenue Code	403
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

SCR MAMMO UNI INC CAD

Facility

$4,500.00

Service Code	HCPCS 7706752
Hospital Charge Code	85000904
Hospital Revenue Code	403
Min. Negotiated Rate	$127.80
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,170.00
Rate for Payer: Oxford Commercial	$1,688.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$1,884.00
Rate for Payer: UnitedHealthcare Community & State	$142.20
Rate for Payer: Wellpoint Medicaid Managed Care	$127.80

SCR MAMMO UNI INC CAD

Facility

$4,500.00

Service Code	HCPCS 7706752
Hospital Charge Code	2709038
Hospital Revenue Code	403
Min. Negotiated Rate	$127.80
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,170.00
Rate for Payer: Oxford Commercial	$1,688.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$1,884.00
Rate for Payer: UnitedHealthcare Community & State	$142.20
Rate for Payer: Wellpoint Medicaid Managed Care	$127.80

SCR MAMMO UNI INC CAD

Facility

$4,500.00

Service Code	HCPCS 7706752
Hospital Charge Code	9406406
Hospital Revenue Code	403
Min. Negotiated Rate	$127.80
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,170.00
Rate for Payer: Oxford Commercial	$1,688.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$1,884.00
Rate for Payer: UnitedHealthcare Community & State	$142.20
Rate for Payer: Wellpoint Medicaid Managed Care	$127.80

SCROTAL SUPPORT XL

Facility

$52.50

Hospital Charge Code	270647599
Hospital Revenue Code	270
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$7.88
Rate for Payer: Qualcare PPO/HMO/WC	$7.88

SCROTAL SUPPORT XL

Facility

$52.50

Hospital Charge Code	270647599
Hospital Revenue Code	270
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$26.25
Rate for Payer: Aetna Commercial	$19.95
Rate for Payer: Aetna Medicare Advantage	$15.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.39
Rate for Payer: Cigna Commercial	$26.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.65
Rate for Payer: Oxford Commercial	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.88
Rate for Payer: UnitedHealthcare Commercial	$10.50
Rate for Payer: UnitedHealthcare Community & State	$1.66
Rate for Payer: Wellpoint Medicaid Managed Care	$1.49

SCROTOPLASTY

Facility

$20,308.55

Service Code	HCPCS 55175
Hospital Charge Code	1600000791
Hospital Revenue Code	360
Min. Negotiated Rate	$3,046.28
Max. Negotiated Rate	$3,046.28
Rate for Payer: Qualcare PPO/HMO/WC	$3,046.28

Know your out-of-pocket cost for care.

All Charges