Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

3D MAX Right Medium (Mesh)

Facility

$1,162.50

Service Code	HCPCS C1781
Hospital Charge Code	270686358
Hospital Revenue Code	278
Min. Negotiated Rate	$174.38
Max. Negotiated Rate	$281.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.32
Rate for Payer: Qualcare PPO/HMO/WC	$174.38

3D RENDER W/INTRP POSTPROCES

Facility

$5,100.00

Service Code	HCPCS 76377
Hospital Charge Code	366876377
Hospital Revenue Code	320
Min. Negotiated Rate	$132.20
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

3D RENDER W/INTRP POSTPROCES

Facility

$5,100.00

Service Code	HCPCS 76377
Hospital Charge Code	411076377
Hospital Revenue Code	320
Min. Negotiated Rate	$132.20
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

3D RENDER W/INTRP POSTPROCES

Facility

$5,100.00

Service Code	HCPCS 76377
Hospital Charge Code	366876377
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

3D RENDER W/INTRP POSTPROCES

Facility

$5,100.00

Service Code	HCPCS 76377
Hospital Charge Code	411076377
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

3 LVL PLATE 45MM

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704424
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

3 LVL PLATE 45MM

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704424
Hospital Revenue Code	278
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$158.00
Rate for Payer: Wellpoint Medicaid Managed Care	$142.00

3 MG 180 RINGS

Facility

$5,775.00

Hospital Charge Code	270339494
Hospital Revenue Code	272
Min. Negotiated Rate	$866.25
Max. Negotiated Rate	$866.25
Rate for Payer: Qualcare PPO/HMO/WC	$866.25

3 MG 180 RINGS

Facility

$5,775.00

Hospital Charge Code	270339494
Hospital Revenue Code	272
Min. Negotiated Rate	$164.01
Max. Negotiated Rate	$2,887.50
Rate for Payer: Aetna Commercial	$2,194.50
Rate for Payer: Aetna Medicare Advantage	$1,732.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,472.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,472.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,472.62
Rate for Payer: Cigna Commercial	$2,887.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,501.50
Rate for Payer: Oxford Commercial	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$866.25
Rate for Payer: UnitedHealthcare Commercial	$1,155.00
Rate for Payer: UnitedHealthcare Community & State	$182.49
Rate for Payer: Wellpoint Medicaid Managed Care	$164.01

3MM DRILLBIT FOR 4.5MM SCREW

Facility

$785.00

Hospital Charge Code	270703979
Hospital Revenue Code	279
Min. Negotiated Rate	$117.75
Max. Negotiated Rate	$117.75
Rate for Payer: Qualcare PPO/HMO/WC	$117.75

3MM DRILLBIT FOR 4.5MM SCREW

Facility

$785.00

Hospital Charge Code	270703979
Hospital Revenue Code	279
Min. Negotiated Rate	$22.29
Max. Negotiated Rate	$392.50
Rate for Payer: Aetna Commercial	$298.30
Rate for Payer: Aetna Medicare Advantage	$235.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$200.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$200.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$200.18
Rate for Payer: Cigna Commercial	$392.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.10
Rate for Payer: Oxford Commercial	$157.00
Rate for Payer: Qualcare PPO/HMO/WC	$117.75
Rate for Payer: UnitedHealthcare Commercial	$157.00
Rate for Payer: UnitedHealthcare Community & State	$24.81
Rate for Payer: Wellpoint Medicaid Managed Care	$22.29

3 PEG PATELLA/7.2MM THICKNESS

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270668734
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

3 PEG PATELLA/7.2MM THICKNESS

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270668734
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

3 SHELF METRO DEEP LEDGE UTILI

Facility

$1,325.25

Hospital Charge Code	270662655
Hospital Revenue Code	270
Min. Negotiated Rate	$198.79
Max. Negotiated Rate	$198.79
Rate for Payer: Qualcare PPO/HMO/WC	$198.79

3 SHELF METRO DEEP LEDGE UTILI

Facility

$1,325.25

Hospital Charge Code	270662655
Hospital Revenue Code	270
Min. Negotiated Rate	$37.64
Max. Negotiated Rate	$662.62
Rate for Payer: Aetna Commercial	$503.60
Rate for Payer: Aetna Medicare Advantage	$397.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$337.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$337.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$337.94
Rate for Payer: Cigna Commercial	$662.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$344.56
Rate for Payer: Oxford Commercial	$265.05
Rate for Payer: Qualcare PPO/HMO/WC	$198.79
Rate for Payer: UnitedHealthcare Commercial	$265.05
Rate for Payer: UnitedHealthcare Community & State	$41.88
Rate for Payer: Wellpoint Medicaid Managed Care	$37.64

3X12MM HYBRID SCREW

Facility

$643.75

Service Code	HCPCS C1713
Hospital Charge Code	270705522
Hospital Revenue Code	278
Min. Negotiated Rate	$96.56
Max. Negotiated Rate	$155.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$128.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.79
Rate for Payer: Qualcare PPO/HMO/WC	$96.56

3X12MM HYBRID SCREW

Facility

$643.75

Service Code	HCPCS C1713
Hospital Charge Code	270705522
Hospital Revenue Code	278
Min. Negotiated Rate	$18.28
Max. Negotiated Rate	$321.88
Rate for Payer: Aetna Commercial	$244.62
Rate for Payer: Aetna Medicare Advantage	$193.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$128.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$164.16
Rate for Payer: Cigna Commercial	$321.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.79
Rate for Payer: Qualcare PPO/HMO/WC	$96.56
Rate for Payer: UnitedHealthcare Community & State	$20.34
Rate for Payer: Wellpoint Medicaid Managed Care	$18.28

4.0/2.5MM SELF-DR SCHANZ SCRW

Facility

$735.20

Service Code	HCPCS C1713
Hospital Charge Code	270680657
Hospital Revenue Code	278
Min. Negotiated Rate	$20.88
Max. Negotiated Rate	$367.60
Rate for Payer: Aetna Commercial	$279.38
Rate for Payer: Aetna Medicare Advantage	$220.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$187.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$187.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$147.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$187.48
Rate for Payer: Cigna Commercial	$367.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.92
Rate for Payer: Qualcare PPO/HMO/WC	$110.28
Rate for Payer: UnitedHealthcare Community & State	$23.23
Rate for Payer: Wellpoint Medicaid Managed Care	$20.88

4.0/2.5MM SELF-DR SCHANZ SCRW

Facility

$735.20

Service Code	HCPCS C1713
Hospital Charge Code	270680657
Hospital Revenue Code	278
Min. Negotiated Rate	$110.28
Max. Negotiated Rate	$177.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$147.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.92
Rate for Payer: Qualcare PPO/HMO/WC	$110.28

4.0/3.0MM SCHANZ SCREW

Facility

$735.20

Service Code	HCPCS C1713
Hospital Charge Code	270619756
Hospital Revenue Code	278
Min. Negotiated Rate	$110.28
Max. Negotiated Rate	$177.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$147.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.92
Rate for Payer: Qualcare PPO/HMO/WC	$110.28

4.0/3.0MM SCHANZ SCREW

Facility

$735.20

Service Code	HCPCS C1713
Hospital Charge Code	270619756
Hospital Revenue Code	278
Min. Negotiated Rate	$20.88
Max. Negotiated Rate	$367.60
Rate for Payer: Aetna Commercial	$279.38
Rate for Payer: Aetna Medicare Advantage	$220.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$187.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$187.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$147.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$187.48
Rate for Payer: Cigna Commercial	$367.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.92
Rate for Payer: Qualcare PPO/HMO/WC	$110.28
Rate for Payer: UnitedHealthcare Community & State	$23.23
Rate for Payer: Wellpoint Medicaid Managed Care	$20.88

4.0 CAN BEV HL COM SCR 38MM L

Facility

$4,075.00

Hospital Charge Code	270703231
Hospital Revenue Code	278
Min. Negotiated Rate	$611.25
Max. Negotiated Rate	$986.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$815.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$986.15
Rate for Payer: Qualcare PPO/HMO/WC	$611.25

4.0 CAN BEV HL COM SCR 38MM L

Facility

$4,075.00

Hospital Charge Code	270703231
Hospital Revenue Code	278
Min. Negotiated Rate	$115.73
Max. Negotiated Rate	$2,037.50
Rate for Payer: Aetna Commercial	$1,548.50
Rate for Payer: Aetna Medicare Advantage	$1,222.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,039.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,039.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,039.12
Rate for Payer: Cigna Commercial	$2,037.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$986.15
Rate for Payer: Qualcare PPO/HMO/WC	$611.25
Rate for Payer: UnitedHealthcare Community & State	$128.77
Rate for Payer: Wellpoint Medicaid Managed Care	$115.73

4.0 CANN CANC LAG SCR 44MM

Facility

$797.50

Service Code	HCPCS C1713
Hospital Charge Code	270682616
Hospital Revenue Code	278
Min. Negotiated Rate	$22.65
Max. Negotiated Rate	$398.75
Rate for Payer: Aetna Commercial	$303.05
Rate for Payer: Aetna Medicare Advantage	$239.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$203.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$203.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$159.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$203.36
Rate for Payer: Cigna Commercial	$398.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.00
Rate for Payer: Qualcare PPO/HMO/WC	$119.62
Rate for Payer: UnitedHealthcare Community & State	$25.20
Rate for Payer: Wellpoint Medicaid Managed Care	$22.65

4.0 CANN CANC LAG SCR 44MM

Facility

$797.50

Service Code	HCPCS C1713
Hospital Charge Code	270682616
Hospital Revenue Code	278
Min. Negotiated Rate	$119.62
Max. Negotiated Rate	$193.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$159.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.00
Rate for Payer: Qualcare PPO/HMO/WC	$119.62

Know your out-of-pocket cost for care.

All Charges