Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

15X12X7MM 6DEG CERVICAL SPACER

Facility

$8,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704207
Hospital Revenue Code	278
Min. Negotiated Rate	$227.20
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$252.80
Rate for Payer: Wellpoint Medicaid Managed Care	$227.20

15X12X7MM 6DEG CERVICAL SPACER

Facility

$8,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704207
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

15X12X7MM TITANIUM STATIC CAGE

Facility

$6,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270704088
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

15X12X7MM TITANIUM STATIC CAGE

Facility

$6,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270704088
Hospital Revenue Code	278
Min. Negotiated Rate	$191.70
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,565.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Community & State	$213.30
Rate for Payer: Wellpoint Medicaid Managed Care	$191.70

15X12X8MM TITANIUM STATIC CAGE

Facility

$6,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270704089
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

15X12X8MM TITANIUM STATIC CAGE

Facility

$6,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270704089
Hospital Revenue Code	278
Min. Negotiated Rate	$191.70
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,565.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Community & State	$213.30
Rate for Payer: Wellpoint Medicaid Managed Care	$191.70

15X17MM COVER PLATE

Facility

$12,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705502
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$2,904.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

15X17MM COVER PLATE

Facility

$12,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705502
Hospital Revenue Code	278
Min. Negotiated Rate	$340.80
Max. Negotiated Rate	$6,000.00
Rate for Payer: Aetna Commercial	$4,560.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Community & State	$379.20
Rate for Payer: Wellpoint Medicaid Managed Care	$340.80

16FR REPLACEMENT G-TUBE

Facility

$138.40

Hospital Charge Code	270663494
Hospital Revenue Code	272
Min. Negotiated Rate	$20.76
Max. Negotiated Rate	$20.76
Rate for Payer: Qualcare PPO/HMO/WC	$20.76

16FR REPLACEMENT G-TUBE

Facility

$138.40

Hospital Charge Code	270663494
Hospital Revenue Code	272
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$69.20
Rate for Payer: Aetna Commercial	$52.59
Rate for Payer: Aetna Medicare Advantage	$41.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.29
Rate for Payer: Cigna Commercial	$69.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.98
Rate for Payer: Oxford Commercial	$27.68
Rate for Payer: Qualcare PPO/HMO/WC	$20.76
Rate for Payer: UnitedHealthcare Commercial	$27.68
Rate for Payer: UnitedHealthcare Community & State	$4.37
Rate for Payer: Wellpoint Medicaid Managed Care	$3.93

16FX24 CMSPLIT CATH 19 TO CUFF

Facility

$1,540.00

Hospital Charge Code	270681346
Hospital Revenue Code	272
Min. Negotiated Rate	$43.74
Max. Negotiated Rate	$770.00
Rate for Payer: Aetna Commercial	$585.20
Rate for Payer: Aetna Medicare Advantage	$462.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$392.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$392.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$392.70
Rate for Payer: Cigna Commercial	$770.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$400.40
Rate for Payer: Oxford Commercial	$308.00
Rate for Payer: Qualcare PPO/HMO/WC	$231.00
Rate for Payer: UnitedHealthcare Commercial	$308.00
Rate for Payer: UnitedHealthcare Community & State	$48.66
Rate for Payer: Wellpoint Medicaid Managed Care	$43.74

16FX24 CMSPLIT CATH 19 TO CUFF

Facility

$1,540.00

Hospital Charge Code	270681346
Hospital Revenue Code	272
Min. Negotiated Rate	$231.00
Max. Negotiated Rate	$231.00
Rate for Payer: Qualcare PPO/HMO/WC	$231.00

16FX28CM SPLIT CATH 23 TO CUFF

Facility

$1,540.00

Hospital Charge Code	270681347
Hospital Revenue Code	272
Min. Negotiated Rate	$231.00
Max. Negotiated Rate	$231.00
Rate for Payer: Qualcare PPO/HMO/WC	$231.00

16FX28CM SPLIT CATH 23 TO CUFF

Facility

$1,540.00

Hospital Charge Code	270681347
Hospital Revenue Code	272
Min. Negotiated Rate	$43.74
Max. Negotiated Rate	$770.00
Rate for Payer: Aetna Commercial	$585.20
Rate for Payer: Aetna Medicare Advantage	$462.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$392.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$392.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$392.70
Rate for Payer: Cigna Commercial	$770.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$400.40
Rate for Payer: Oxford Commercial	$308.00
Rate for Payer: Qualcare PPO/HMO/WC	$231.00
Rate for Payer: UnitedHealthcare Commercial	$308.00
Rate for Payer: UnitedHealthcare Community & State	$48.66
Rate for Payer: Wellpoint Medicaid Managed Care	$43.74

1.6 GUIDE WIRE WITH TIP

Facility

$4,730.00

Service Code	HCPCS C1769
Hospital Charge Code	270680978
Hospital Revenue Code	278
Min. Negotiated Rate	$709.50
Max. Negotiated Rate	$1,144.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$946.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,144.66
Rate for Payer: Qualcare PPO/HMO/WC	$709.50

1.6 GUIDE WIRE WITH TIP

Facility

$4,730.00

Service Code	HCPCS C1769
Hospital Charge Code	270680978
Hospital Revenue Code	278
Min. Negotiated Rate	$134.33
Max. Negotiated Rate	$2,365.00
Rate for Payer: Aetna Commercial	$1,797.40
Rate for Payer: Aetna Medicare Advantage	$1,419.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,206.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,206.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$946.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,206.15
Rate for Payer: Cigna Commercial	$2,365.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,144.66
Rate for Payer: Qualcare PPO/HMO/WC	$709.50
Rate for Payer: UnitedHealthcare Community & State	$149.47
Rate for Payer: Wellpoint Medicaid Managed Care	$134.33

1.6 K WIRE

Facility

$392.70

Service Code	HCPCS C1713
Hospital Charge Code	270691336
Hospital Revenue Code	278
Min. Negotiated Rate	$58.91
Max. Negotiated Rate	$95.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.03
Rate for Payer: Qualcare PPO/HMO/WC	$58.91

1.6 K WIRE

Facility

$392.70

Service Code	HCPCS C1713
Hospital Charge Code	270691336
Hospital Revenue Code	278
Min. Negotiated Rate	$11.15
Max. Negotiated Rate	$196.35
Rate for Payer: Aetna Commercial	$149.23
Rate for Payer: Aetna Medicare Advantage	$117.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.14
Rate for Payer: Cigna Commercial	$196.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.03
Rate for Payer: Qualcare PPO/HMO/WC	$58.91
Rate for Payer: UnitedHealthcare Community & State	$12.41
Rate for Payer: Wellpoint Medicaid Managed Care	$11.15

1.6 K-WIRE

Facility

$75.00

Service Code	HCPCS C1769
Hospital Charge Code	270656528
Hospital Revenue Code	278
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$18.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

1.6 K-WIRE

Facility

$75.00

Service Code	HCPCS C1769
Hospital Charge Code	270656528
Hospital Revenue Code	278
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Community & State	$2.37
Rate for Payer: Wellpoint Medicaid Managed Care	$2.13

16MM CANNULATED PERC FLEX DRIL

Facility

$4,016.60

Hospital Charge Code	270681682
Hospital Revenue Code	272
Min. Negotiated Rate	$114.07
Max. Negotiated Rate	$2,008.30
Rate for Payer: Aetna Commercial	$1,526.31
Rate for Payer: Aetna Medicare Advantage	$1,204.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,024.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,024.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,024.23
Rate for Payer: Cigna Commercial	$2,008.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,044.32
Rate for Payer: Oxford Commercial	$803.32
Rate for Payer: Qualcare PPO/HMO/WC	$602.49
Rate for Payer: UnitedHealthcare Commercial	$803.32
Rate for Payer: UnitedHealthcare Community & State	$126.92
Rate for Payer: Wellpoint Medicaid Managed Care	$114.07

16MM CANNULATED PERC FLEX DRIL

Facility

$4,016.60

Hospital Charge Code	270681682
Hospital Revenue Code	272
Min. Negotiated Rate	$602.49
Max. Negotiated Rate	$602.49
Rate for Payer: Qualcare PPO/HMO/WC	$602.49

16MM FIXED SELF DRILLSCREW

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270705108
Hospital Revenue Code	278
Min. Negotiated Rate	$35.50
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Community & State	$39.50
Rate for Payer: Wellpoint Medicaid Managed Care	$35.50

16MM FIXED SELF DRILLSCREW

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270705108
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

16MM SD FIXED SCREWS

Facility

$600.00

Service Code	HCPCS C1713
Hospital Charge Code	270703880
Hospital Revenue Code	278
Min. Negotiated Rate	$17.04
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$228.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Community & State	$18.96
Rate for Payer: Wellpoint Medicaid Managed Care	$17.04

Know your out-of-pocket cost for care.

All Charges