Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

COUNTERSINK CANN FOR 3.5MM/4MM

Facility

$1,416.00

Service Code	HCPCS C1713
Hospital Charge Code	270656227
Hospital Revenue Code	278
Min. Negotiated Rate	$40.21
Max. Negotiated Rate	$708.00
Rate for Payer: Aetna Commercial	$538.08
Rate for Payer: Aetna Medicare Advantage	$424.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$361.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$361.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$283.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$361.08
Rate for Payer: Cigna Commercial	$708.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$342.67
Rate for Payer: Qualcare PPO/HMO/WC	$212.40
Rate for Payer: UnitedHealthcare Community & State	$44.75
Rate for Payer: Wellpoint Medicaid Managed Care	$40.21

COUNTERSINK CANN FOR 3.5MM/4MM

Facility

$1,416.00

Service Code	HCPCS C1713
Hospital Charge Code	270656227
Hospital Revenue Code	278
Min. Negotiated Rate	$212.40
Max. Negotiated Rate	$342.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$283.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$342.67
Rate for Payer: Qualcare PPO/HMO/WC	$212.40

COUNTERSINK CANN SCREW 2/2.4MM

Facility

$1,800.00

Service Code	HCPCS C1713
Hospital Charge Code	270662575
Hospital Revenue Code	278
Min. Negotiated Rate	$270.00
Max. Negotiated Rate	$435.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$360.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$435.60
Rate for Payer: Qualcare PPO/HMO/WC	$270.00

COUNTERSINK CANN SCREW 2/2.4MM

Facility

$1,800.00

Service Code	HCPCS C1713
Hospital Charge Code	270662575
Hospital Revenue Code	278
Min. Negotiated Rate	$51.12
Max. Negotiated Rate	$900.00
Rate for Payer: Aetna Commercial	$684.00
Rate for Payer: Aetna Medicare Advantage	$540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$459.00
Rate for Payer: Cigna Commercial	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$435.60
Rate for Payer: Qualcare PPO/HMO/WC	$270.00
Rate for Payer: UnitedHealthcare Community & State	$56.88
Rate for Payer: Wellpoint Medicaid Managed Care	$51.12

COUNTERSINK CANNULATED 4.0MM

Facility

$772.50

Service Code	HCPCS C1713
Hospital Charge Code	270703752
Hospital Revenue Code	278
Min. Negotiated Rate	$115.88
Max. Negotiated Rate	$186.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$154.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.94
Rate for Payer: Qualcare PPO/HMO/WC	$115.88

COUNTERSINK CANNULATED 4.0MM

Facility

$772.50

Service Code	HCPCS C1713
Hospital Charge Code	270703752
Hospital Revenue Code	278
Min. Negotiated Rate	$21.94
Max. Negotiated Rate	$386.25
Rate for Payer: Aetna Commercial	$293.55
Rate for Payer: Aetna Medicare Advantage	$231.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$196.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$196.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$154.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$196.99
Rate for Payer: Cigna Commercial	$386.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.94
Rate for Payer: Qualcare PPO/HMO/WC	$115.88
Rate for Payer: UnitedHealthcare Community & State	$24.41
Rate for Payer: Wellpoint Medicaid Managed Care	$21.94

COUNTERSINK CANNULATED 4.0MM

Facility

$2,553.40

Service Code	HCPCS C1713
Hospital Charge Code	270663658
Hospital Revenue Code	278
Min. Negotiated Rate	$72.52
Max. Negotiated Rate	$1,276.70
Rate for Payer: Aetna Commercial	$970.29
Rate for Payer: Aetna Medicare Advantage	$766.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$651.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$651.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$510.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$651.12
Rate for Payer: Cigna Commercial	$1,276.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$617.92
Rate for Payer: Qualcare PPO/HMO/WC	$383.01
Rate for Payer: UnitedHealthcare Community & State	$80.69
Rate for Payer: Wellpoint Medicaid Managed Care	$72.52

COUNTERSINK CANNULATED 4.0MM

Facility

$2,553.40

Service Code	HCPCS C1713
Hospital Charge Code	270663658
Hospital Revenue Code	278
Min. Negotiated Rate	$383.01
Max. Negotiated Rate	$617.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$510.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$617.92
Rate for Payer: Qualcare PPO/HMO/WC	$383.01

COUNTERSINK F/2 & 2.4MM SCREW

Facility

$463.50

Service Code	HCPCS C1713
Hospital Charge Code	270641315
Hospital Revenue Code	278
Min. Negotiated Rate	$69.53
Max. Negotiated Rate	$112.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$92.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.17
Rate for Payer: Qualcare PPO/HMO/WC	$69.53

COUNTERSINK F/2 & 2.4MM SCREW

Facility

$463.50

Service Code	HCPCS C1713
Hospital Charge Code	270641315
Hospital Revenue Code	278
Min. Negotiated Rate	$13.16
Max. Negotiated Rate	$231.75
Rate for Payer: Aetna Commercial	$176.13
Rate for Payer: Aetna Medicare Advantage	$139.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$118.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$118.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$92.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$118.19
Rate for Payer: Cigna Commercial	$231.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.17
Rate for Payer: Qualcare PPO/HMO/WC	$69.53
Rate for Payer: UnitedHealthcare Community & State	$14.65
Rate for Payer: Wellpoint Medicaid Managed Care	$13.16

COUNTERSINK F/3.5 & 4.0 MM CTX

Facility

$624.20

Service Code	HCPCS C1713
Hospital Charge Code	270617326
Hospital Revenue Code	278
Min. Negotiated Rate	$93.63
Max. Negotiated Rate	$151.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.06
Rate for Payer: Qualcare PPO/HMO/WC	$93.63

COUNTERSINK F/3.5 & 4.0 MM CTX

Facility

$624.20

Service Code	HCPCS C1713
Hospital Charge Code	270617326
Hospital Revenue Code	278
Min. Negotiated Rate	$17.73
Max. Negotiated Rate	$312.10
Rate for Payer: Aetna Commercial	$237.20
Rate for Payer: Aetna Medicare Advantage	$187.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.17
Rate for Payer: Cigna Commercial	$312.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.06
Rate for Payer: Qualcare PPO/HMO/WC	$93.63
Rate for Payer: UnitedHealthcare Community & State	$19.72
Rate for Payer: Wellpoint Medicaid Managed Care	$17.73

COUNTERSINK HD 2.0MM

Facility

$852.50

Service Code	HCPCS C1713
Hospital Charge Code	270700628
Hospital Revenue Code	278
Min. Negotiated Rate	$127.88
Max. Negotiated Rate	$206.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$206.31
Rate for Payer: Qualcare PPO/HMO/WC	$127.88

COUNTERSINK HD 2.0MM

Facility

$852.50

Service Code	HCPCS C1713
Hospital Charge Code	270700628
Hospital Revenue Code	278
Min. Negotiated Rate	$24.21
Max. Negotiated Rate	$426.25
Rate for Payer: Aetna Commercial	$323.95
Rate for Payer: Aetna Medicare Advantage	$255.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$217.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$217.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$217.39
Rate for Payer: Cigna Commercial	$426.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$206.31
Rate for Payer: Qualcare PPO/HMO/WC	$127.88
Rate for Payer: UnitedHealthcare Community & State	$26.94
Rate for Payer: Wellpoint Medicaid Managed Care	$24.21

COUNTERSINK HEADLESS

Facility

$375.00

Hospital Charge Code	270677346
Hospital Revenue Code	278
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$90.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

COUNTERSINK HEADLESS

Facility

$375.00

Hospital Charge Code	270677346
Hospital Revenue Code	278
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Community & State	$11.85
Rate for Payer: Wellpoint Medicaid Managed Care	$10.65

COUNTERSINK MAXTORQUE 4MM

Facility

$845.00

Hospital Charge Code	270700798
Hospital Revenue Code	272
Min. Negotiated Rate	$126.75
Max. Negotiated Rate	$126.75
Rate for Payer: Qualcare PPO/HMO/WC	$126.75

COUNTERSINK MAXTORQUE 4MM

Facility

$845.00

Hospital Charge Code	270700798
Hospital Revenue Code	272
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$422.50
Rate for Payer: Aetna Commercial	$321.10
Rate for Payer: Aetna Medicare Advantage	$253.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.47
Rate for Payer: Cigna Commercial	$422.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$219.70
Rate for Payer: Oxford Commercial	$169.00
Rate for Payer: Qualcare PPO/HMO/WC	$126.75
Rate for Payer: UnitedHealthcare Commercial	$169.00
Rate for Payer: UnitedHealthcare Community & State	$26.70
Rate for Payer: Wellpoint Medicaid Managed Care	$24.00

COUNTERSINK SCRW LAGPOST 3.5MM

Facility

$595.00

Hospital Charge Code	270698472
Hospital Revenue Code	272
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$297.50
Rate for Payer: Aetna Commercial	$226.10
Rate for Payer: Aetna Medicare Advantage	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.72
Rate for Payer: Cigna Commercial	$297.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.70
Rate for Payer: Oxford Commercial	$119.00
Rate for Payer: Qualcare PPO/HMO/WC	$89.25
Rate for Payer: UnitedHealthcare Commercial	$119.00
Rate for Payer: UnitedHealthcare Community & State	$18.80
Rate for Payer: Wellpoint Medicaid Managed Care	$16.90

COUNTERSINK SCRW LAGPOST 3.5MM

Facility

$595.00

Hospital Charge Code	270698472
Hospital Revenue Code	272
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$89.25
Rate for Payer: Qualcare PPO/HMO/WC	$89.25

COUNTERSNK CANN SCRW 2.0/2.4MM

Facility

$1,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270686731
Hospital Revenue Code	278
Min. Negotiated Rate	$29.11
Max. Negotiated Rate	$512.50
Rate for Payer: Aetna Commercial	$389.50
Rate for Payer: Aetna Medicare Advantage	$307.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$261.38
Rate for Payer: Cigna Commercial	$512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.05
Rate for Payer: Qualcare PPO/HMO/WC	$153.75
Rate for Payer: UnitedHealthcare Community & State	$32.39
Rate for Payer: Wellpoint Medicaid Managed Care	$29.11

COUNTERSNK CANN SCRW 2.0/2.4MM

Facility

$1,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270686731
Hospital Revenue Code	278
Min. Negotiated Rate	$153.75
Max. Negotiated Rate	$248.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.05
Rate for Payer: Qualcare PPO/HMO/WC	$153.75

COUNTER SPONGE POCKET

Facility

$3.05

Hospital Charge Code	270661369
Hospital Revenue Code	272
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$1.52
Rate for Payer: Aetna Commercial	$1.16
Rate for Payer: Aetna Medicare Advantage	$0.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.78
Rate for Payer: Cigna Commercial	$1.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.79
Rate for Payer: Oxford Commercial	$0.61
Rate for Payer: Qualcare PPO/HMO/WC	$0.46
Rate for Payer: UnitedHealthcare Commercial	$0.61
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.09

COUNTER SPONGE POCKET

Facility

$3.05

Hospital Charge Code	270661369
Hospital Revenue Code	272
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.46
Rate for Payer: Qualcare PPO/HMO/WC	$0.46

COUPLER 20MM

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270695590
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$1,754.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

Know your out-of-pocket cost for care.

All Charges