Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

8.5X35MM SCREW

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703976
Hospital Revenue Code	278
Min. Negotiated Rate	$56.80
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$63.20
Rate for Payer: Wellpoint Medicaid Managed Care	$56.80

8.5X35MM SCREW

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703976
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

88141,PAP W/MD INTERP

Facility

$139.25

Service Code	HCPCS 88141
Hospital Charge Code	39900310
Hospital Revenue Code	311
Min. Negotiated Rate	$20.89
Max. Negotiated Rate	$20.89
Rate for Payer: Qualcare PPO/HMO/WC	$20.89

88141,PAP W/MD INTERP

Facility

$139.25

Service Code	HCPCS 88141
Hospital Charge Code	39900310
Hospital Revenue Code	311
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$52.91
Rate for Payer: Aetna Medicare Advantage	$41.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.51
Rate for Payer: Cigna Commercial	$69.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.20
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.89
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$19.39
Rate for Payer: Wellpoint Medicaid Managed Care	$3.95

8 FR DIGNITY MID-SIZED CT PORT

Facility

$950.00

Service Code	HCPCS C1788
Hospital Charge Code	270680658
Hospital Revenue Code	278
Min. Negotiated Rate	$142.50
Max. Negotiated Rate	$229.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.90
Rate for Payer: Qualcare PPO/HMO/WC	$142.50

8 FR DIGNITY MID-SIZED CT PORT

Facility

$950.00

Service Code	HCPCS C1788
Hospital Charge Code	270680658
Hospital Revenue Code	278
Min. Negotiated Rate	$26.98
Max. Negotiated Rate	$475.00
Rate for Payer: Aetna Commercial	$361.00
Rate for Payer: Aetna Medicare Advantage	$285.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.25
Rate for Payer: Cigna Commercial	$475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.90
Rate for Payer: Qualcare PPO/HMO/WC	$142.50
Rate for Payer: UnitedHealthcare Community & State	$30.02
Rate for Payer: Wellpoint Medicaid Managed Care	$26.98

8 FR PRO-FUSECT PORT

Facility

$8.82

Service Code	HCPCS C1751
Hospital Charge Code	270680569
Hospital Revenue Code	278
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$4.41
Rate for Payer: Aetna Commercial	$3.35
Rate for Payer: Aetna Medicare Advantage	$2.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.25
Rate for Payer: Cigna Commercial	$4.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.13
Rate for Payer: Qualcare PPO/HMO/WC	$1.32
Rate for Payer: UnitedHealthcare Community & State	$0.28
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

8 FR PRO-FUSECT PORT

Facility

$950.00

Service Code	HCPCS C1788
Hospital Charge Code	270680659
Hospital Revenue Code	278
Min. Negotiated Rate	$26.98
Max. Negotiated Rate	$475.00
Rate for Payer: Aetna Commercial	$361.00
Rate for Payer: Aetna Medicare Advantage	$285.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.25
Rate for Payer: Cigna Commercial	$475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.90
Rate for Payer: Qualcare PPO/HMO/WC	$142.50
Rate for Payer: UnitedHealthcare Community & State	$30.02
Rate for Payer: Wellpoint Medicaid Managed Care	$26.98

8 FR PRO-FUSECT PORT

Facility

$8.82

Service Code	HCPCS C1751
Hospital Charge Code	270680569
Hospital Revenue Code	278
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$2.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.13
Rate for Payer: Qualcare PPO/HMO/WC	$1.32

8 FR PRO-FUSECT PORT

Facility

$950.00

Service Code	HCPCS C1788
Hospital Charge Code	270680659
Hospital Revenue Code	278
Min. Negotiated Rate	$142.50
Max. Negotiated Rate	$229.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.90
Rate for Payer: Qualcare PPO/HMO/WC	$142.50

8 HOLE PERI PROX HUMERUS

Facility

$7,511.15

Service Code	HCPCS C1713
Hospital Charge Code	270686573
Hospital Revenue Code	278
Min. Negotiated Rate	$1,126.67
Max. Negotiated Rate	$1,817.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,502.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,817.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,126.67

8 HOLE PERI PROX HUMERUS

Facility

$7,511.15

Service Code	HCPCS C1713
Hospital Charge Code	270686573
Hospital Revenue Code	278
Min. Negotiated Rate	$213.32
Max. Negotiated Rate	$3,755.57
Rate for Payer: Aetna Commercial	$2,854.24
Rate for Payer: Aetna Medicare Advantage	$2,253.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,915.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,915.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,502.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,915.34
Rate for Payer: Cigna Commercial	$3,755.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,817.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,126.67
Rate for Payer: UnitedHealthcare Community & State	$237.35
Rate for Payer: Wellpoint Medicaid Managed Care	$213.32

8 HOLE VDF PLATE

Facility

$5,430.00

Hospital Charge Code	270665463
Hospital Revenue Code	278
Min. Negotiated Rate	$814.50
Max. Negotiated Rate	$1,314.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,086.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,314.06
Rate for Payer: Qualcare PPO/HMO/WC	$814.50

8 HOLE VDF PLATE

Facility

$5,430.00

Hospital Charge Code	270665463
Hospital Revenue Code	278
Min. Negotiated Rate	$154.21
Max. Negotiated Rate	$2,715.00
Rate for Payer: Aetna Commercial	$2,063.40
Rate for Payer: Aetna Medicare Advantage	$1,629.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,384.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,384.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,086.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,384.65
Rate for Payer: Cigna Commercial	$2,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,314.06
Rate for Payer: Qualcare PPO/HMO/WC	$814.50
Rate for Payer: UnitedHealthcare Community & State	$171.59
Rate for Payer: Wellpoint Medicaid Managed Care	$154.21

8MM 10DEG ZAVATION CAGE

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270705535
Hospital Revenue Code	278
Min. Negotiated Rate	$134.90
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,805.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50
Rate for Payer: UnitedHealthcare Community & State	$150.10
Rate for Payer: Wellpoint Medicaid Managed Care	$134.90

8MM 10DEG ZAVATION CAGE

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270705535
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

8MM CERVICAL SPEAR BONE GRAFT

Facility

$1,649.00

Hospital Charge Code	270335669
Hospital Revenue Code	278
Min. Negotiated Rate	$46.83
Max. Negotiated Rate	$824.50
Rate for Payer: Aetna Commercial	$626.62
Rate for Payer: Aetna Medicare Advantage	$494.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$420.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$420.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$329.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$420.50
Rate for Payer: Cigna Commercial	$824.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.06
Rate for Payer: Qualcare PPO/HMO/WC	$247.35
Rate for Payer: UnitedHealthcare Community & State	$52.11
Rate for Payer: Wellpoint Medicaid Managed Care	$46.83

8MM CERVICAL SPEAR BONE GRAFT

Facility

$1,649.00

Hospital Charge Code	270335669
Hospital Revenue Code	278
Min. Negotiated Rate	$247.35
Max. Negotiated Rate	$399.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$329.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.06
Rate for Payer: Qualcare PPO/HMO/WC	$247.35

8MM MATISSE CAGE

Facility

$9,150.00

Service Code	HCPCS C1765
Hospital Charge Code	270703818
Hospital Revenue Code	278
Min. Negotiated Rate	$1,372.50
Max. Negotiated Rate	$2,214.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,830.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,214.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,372.50

8MM MATISSE CAGE

Facility

$9,150.00

Service Code	HCPCS C1765
Hospital Charge Code	270703818
Hospital Revenue Code	278
Min. Negotiated Rate	$259.86
Max. Negotiated Rate	$4,575.00
Rate for Payer: Aetna Commercial	$3,477.00
Rate for Payer: Aetna Medicare Advantage	$2,745.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,333.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,333.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,830.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,333.25
Rate for Payer: Cigna Commercial	$4,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,214.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,372.50
Rate for Payer: UnitedHealthcare Community & State	$289.14
Rate for Payer: Wellpoint Medicaid Managed Care	$259.86

8X42X30MM 15DEGREE ALIF SPACER

Facility

$33,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270704085
Hospital Revenue Code	278
Min. Negotiated Rate	$940.75
Max. Negotiated Rate	$16,562.50
Rate for Payer: Aetna Commercial	$12,587.50
Rate for Payer: Aetna Medicare Advantage	$9,937.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,446.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,446.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,446.88
Rate for Payer: Cigna Commercial	$16,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,016.25
Rate for Payer: Qualcare PPO/HMO/WC	$4,968.75
Rate for Payer: UnitedHealthcare Community & State	$1,046.75
Rate for Payer: Wellpoint Medicaid Managed Care	$940.75

8X42X30MM 15DEGREE ALIF SPACER

Facility

$33,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270704085
Hospital Revenue Code	278
Min. Negotiated Rate	$4,968.75
Max. Negotiated Rate	$8,016.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,016.25
Rate for Payer: Qualcare PPO/HMO/WC	$4,968.75

90 DEGREE QUICK PASS LASSO

Facility

$800.00

Hospital Charge Code	270656485
Hospital Revenue Code	271
Min. Negotiated Rate	$22.72
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna Commercial	$304.00
Rate for Payer: Aetna Medicare Advantage	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.00
Rate for Payer: Cigna Commercial	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.00
Rate for Payer: Oxford Commercial	$160.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00
Rate for Payer: UnitedHealthcare Commercial	$160.00
Rate for Payer: UnitedHealthcare Community & State	$25.28
Rate for Payer: Wellpoint Medicaid Managed Care	$22.72

90 DEGREE QUICK PASS LASSO

Facility

$800.00

Hospital Charge Code	270656485
Hospital Revenue Code	271
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$120.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00

90 DEGRESS ABLATOR

Facility

$1,075.00

Hospital Charge Code	270703224
Hospital Revenue Code	270
Min. Negotiated Rate	$161.25
Max. Negotiated Rate	$161.25
Rate for Payer: Qualcare PPO/HMO/WC	$161.25

Know your out-of-pocket cost for care.

All Charges