Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SCRW 4.0X12 CNCLCK 8161-40-012

Facility

$850.00

Service Code	HCPCS C1713
Hospital Charge Code	270661580
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

SCRW 4.0X12 CNCLCK 8161-40-012

Facility

$850.00

Service Code	HCPCS C1713
Hospital Charge Code	270661580
Hospital Revenue Code	278
Min. Negotiated Rate	$24.14
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Community & State	$26.86
Rate for Payer: Wellpoint Medicaid Managed Care	$24.14

SCRW 4.0X14 CNCLCK 8161-40-014

Facility

$632.50

Service Code	HCPCS C1713
Hospital Charge Code	270661577
Hospital Revenue Code	278
Min. Negotiated Rate	$94.88
Max. Negotiated Rate	$153.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$126.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.06
Rate for Payer: Qualcare PPO/HMO/WC	$94.88

SCRW 4.0X14 CNCLCK 8161-40-014

Facility

$632.50

Service Code	HCPCS C1713
Hospital Charge Code	270661577
Hospital Revenue Code	278
Min. Negotiated Rate	$17.96
Max. Negotiated Rate	$316.25
Rate for Payer: Aetna Commercial	$240.35
Rate for Payer: Aetna Medicare Advantage	$189.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$161.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$161.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$126.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$161.29
Rate for Payer: Cigna Commercial	$316.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.06
Rate for Payer: Qualcare PPO/HMO/WC	$94.88
Rate for Payer: UnitedHealthcare Community & State	$19.99
Rate for Payer: Wellpoint Medicaid Managed Care	$17.96

SCRW 4.0X16 CNCLCK 8161-40-016

Facility

$850.00

Service Code	HCPCS C1713
Hospital Charge Code	270661578
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

SCRW 4.0X16 CNCLCK 8161-40-016

Facility

$850.00

Service Code	HCPCS C1713
Hospital Charge Code	270661578
Hospital Revenue Code	278
Min. Negotiated Rate	$24.14
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Community & State	$26.86
Rate for Payer: Wellpoint Medicaid Managed Care	$24.14

SCRW 4.0X18 CNCLCK 8161-40-018

Facility

$850.00

Service Code	HCPCS C1713
Hospital Charge Code	270661579
Hospital Revenue Code	278
Min. Negotiated Rate	$24.14
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Community & State	$26.86
Rate for Payer: Wellpoint Medicaid Managed Care	$24.14

SCRW 4.0X18 CNCLCK 8161-40-018

Facility

$850.00

Service Code	HCPCS C1713
Hospital Charge Code	270661579
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

SCRW AFFIXS CORT BONE 5.0X38MM

Facility

$722.30

Service Code	HCPCS C1713
Hospital Charge Code	270679372
Hospital Revenue Code	278
Min. Negotiated Rate	$108.34
Max. Negotiated Rate	$174.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$144.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.80
Rate for Payer: Qualcare PPO/HMO/WC	$108.34

SCRW AFFIXS CORT BONE 5.0X38MM

Facility

$722.30

Service Code	HCPCS C1713
Hospital Charge Code	270679372
Hospital Revenue Code	278
Min. Negotiated Rate	$20.51
Max. Negotiated Rate	$361.15
Rate for Payer: Aetna Commercial	$274.47
Rate for Payer: Aetna Medicare Advantage	$216.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$144.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.19
Rate for Payer: Cigna Commercial	$361.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.80
Rate for Payer: Qualcare PPO/HMO/WC	$108.34
Rate for Payer: UnitedHealthcare Community & State	$22.82
Rate for Payer: Wellpoint Medicaid Managed Care	$20.51

SCRW CANC FT 4.0 X 65MM NS

Facility

$850.00

Service Code	HCPCS C1713
Hospital Charge Code	270704929
Hospital Revenue Code	278
Min. Negotiated Rate	$24.14
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Community & State	$26.86
Rate for Payer: Wellpoint Medicaid Managed Care	$24.14

SCRW CANC FT 4.0 X 65MM NS

Facility

$850.00

Service Code	HCPCS C1713
Hospital Charge Code	270704929
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

SCRW COMP HEADLES 2.4x18MM LNG

Facility

$1,709.15

Service Code	HCPCS C1713
Hospital Charge Code	270681290
Hospital Revenue Code	278
Min. Negotiated Rate	$48.54
Max. Negotiated Rate	$854.58
Rate for Payer: Aetna Commercial	$649.48
Rate for Payer: Aetna Medicare Advantage	$512.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$435.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$435.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$341.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$435.83
Rate for Payer: Cigna Commercial	$854.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$413.61
Rate for Payer: Qualcare PPO/HMO/WC	$256.37
Rate for Payer: UnitedHealthcare Community & State	$54.01
Rate for Payer: Wellpoint Medicaid Managed Care	$48.54

SCRW COMP HEADLES 2.4x18MM LNG

Facility

$1,709.15

Service Code	HCPCS C1713
Hospital Charge Code	270681290
Hospital Revenue Code	278
Min. Negotiated Rate	$256.37
Max. Negotiated Rate	$413.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$341.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$413.61
Rate for Payer: Qualcare PPO/HMO/WC	$256.37

SCRW COMP HEADLES 2.4x20MM LG

Facility

$1,709.15

Service Code	HCPCS C1713
Hospital Charge Code	270681289
Hospital Revenue Code	278
Min. Negotiated Rate	$256.37
Max. Negotiated Rate	$413.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$341.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$413.61
Rate for Payer: Qualcare PPO/HMO/WC	$256.37

SCRW COMP HEADLES 2.4x20MM LG

Facility

$1,709.15

Service Code	HCPCS C1713
Hospital Charge Code	270681289
Hospital Revenue Code	278
Min. Negotiated Rate	$48.54
Max. Negotiated Rate	$854.58
Rate for Payer: Aetna Commercial	$649.48
Rate for Payer: Aetna Medicare Advantage	$512.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$435.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$435.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$341.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$435.83
Rate for Payer: Cigna Commercial	$854.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$413.61
Rate for Payer: Qualcare PPO/HMO/WC	$256.37
Rate for Payer: UnitedHealthcare Community & State	$54.01
Rate for Payer: Wellpoint Medicaid Managed Care	$48.54

SCRW COMP HEADLES 2.4x20MM SRT

Facility

$1,410.00

Service Code	HCPCS C1713
Hospital Charge Code	270663957
Hospital Revenue Code	278
Min. Negotiated Rate	$211.50
Max. Negotiated Rate	$341.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$282.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$341.22
Rate for Payer: Qualcare PPO/HMO/WC	$211.50

SCRW COMP HEADLES 2.4x20MM SRT

Facility

$1,410.00

Service Code	HCPCS C1713
Hospital Charge Code	270663957
Hospital Revenue Code	278
Min. Negotiated Rate	$40.04
Max. Negotiated Rate	$705.00
Rate for Payer: Aetna Commercial	$535.80
Rate for Payer: Aetna Medicare Advantage	$423.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$359.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$359.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$282.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$359.55
Rate for Payer: Cigna Commercial	$705.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$341.22
Rate for Payer: Qualcare PPO/HMO/WC	$211.50
Rate for Payer: UnitedHealthcare Community & State	$44.56
Rate for Payer: Wellpoint Medicaid Managed Care	$40.04

SCRW COMP HEADLES 2.4x22MM LNG

Facility

$1,709.15

Service Code	HCPCS C1713
Hospital Charge Code	270681288
Hospital Revenue Code	278
Min. Negotiated Rate	$256.37
Max. Negotiated Rate	$413.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$341.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$413.61
Rate for Payer: Qualcare PPO/HMO/WC	$256.37

SCRW COMP HEADLES 2.4x22MM LNG

Facility

$1,709.15

Service Code	HCPCS C1713
Hospital Charge Code	270681288
Hospital Revenue Code	278
Min. Negotiated Rate	$48.54
Max. Negotiated Rate	$854.58
Rate for Payer: Aetna Commercial	$649.48
Rate for Payer: Aetna Medicare Advantage	$512.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$435.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$435.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$341.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$435.83
Rate for Payer: Cigna Commercial	$854.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$413.61
Rate for Payer: Qualcare PPO/HMO/WC	$256.37
Rate for Payer: UnitedHealthcare Community & State	$54.01
Rate for Payer: Wellpoint Medicaid Managed Care	$48.54

SCRW COMP HEDLES SHRT 3.0X36MM

Facility

$1,452.30

Service Code	HCPCS C1713
Hospital Charge Code	270680184
Hospital Revenue Code	278
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$726.15
Rate for Payer: Aetna Commercial	$551.87
Rate for Payer: Aetna Medicare Advantage	$435.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$370.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$370.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$290.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$370.34
Rate for Payer: Cigna Commercial	$726.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$351.46
Rate for Payer: Qualcare PPO/HMO/WC	$217.84
Rate for Payer: UnitedHealthcare Community & State	$45.89
Rate for Payer: Wellpoint Medicaid Managed Care	$41.25

SCRW COMP HEDLES SHRT 3.0X36MM

Facility

$1,452.30

Service Code	HCPCS C1713
Hospital Charge Code	270680184
Hospital Revenue Code	278
Min. Negotiated Rate	$217.84
Max. Negotiated Rate	$351.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$290.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$351.46
Rate for Payer: Qualcare PPO/HMO/WC	$217.84

SCRW COMP KREULOK 2.7X22MM

Facility

$1,500.00

Hospital Charge Code	270703178
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

SCRW COMP KREULOK 2.7X22MM

Facility

$1,500.00

Hospital Charge Code	270703178
Hospital Revenue Code	278
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

SCRW COMP VAL KRELCK TI 3.5X10

Facility

$1,625.00

Hospital Charge Code	270703730
Hospital Revenue Code	278
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$393.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.25
Rate for Payer: Qualcare PPO/HMO/WC	$243.75

Know your out-of-pocket cost for care.

All Charges