Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DOUGHNUT HEADREST 9 PINS

Facility

$5.40

Hospital Charge Code	270654881
Hospital Revenue Code	270
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$2.70
Rate for Payer: Aetna Commercial	$2.05
Rate for Payer: Aetna Medicare Advantage	$1.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.38
Rate for Payer: Cigna Commercial	$2.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.40
Rate for Payer: Oxford Commercial	$1.08
Rate for Payer: Qualcare PPO/HMO/WC	$0.81
Rate for Payer: UnitedHealthcare Commercial	$1.08
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

DOUGHNUT HEADREST 9 PINS

Facility

$5.40

Hospital Charge Code	270654881
Hospital Revenue Code	270
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$0.81
Rate for Payer: Qualcare PPO/HMO/WC	$0.81

DOWEL 10 MM CANNULATED

Facility

$5,737.50

Service Code	HCPCS C1713
Hospital Charge Code	270688476
Hospital Revenue Code	278
Min. Negotiated Rate	$162.94
Max. Negotiated Rate	$2,868.75
Rate for Payer: Aetna Commercial	$2,180.25
Rate for Payer: Aetna Medicare Advantage	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,463.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,463.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,463.06
Rate for Payer: Cigna Commercial	$2,868.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,388.47
Rate for Payer: Qualcare PPO/HMO/WC	$860.62
Rate for Payer: UnitedHealthcare Community & State	$181.31
Rate for Payer: Wellpoint Medicaid Managed Care	$162.94

DOWEL 10 MM CANNULATED

Facility

$5,737.50

Service Code	HCPCS C1713
Hospital Charge Code	270688476
Hospital Revenue Code	278
Min. Negotiated Rate	$860.62
Max. Negotiated Rate	$1,388.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,388.47
Rate for Payer: Qualcare PPO/HMO/WC	$860.62

DOWEL 11 MM CANNULATED

Facility

$5,737.50

Service Code	HCPCS C1713
Hospital Charge Code	270688475
Hospital Revenue Code	278
Min. Negotiated Rate	$162.94
Max. Negotiated Rate	$2,868.75
Rate for Payer: Aetna Commercial	$2,180.25
Rate for Payer: Aetna Medicare Advantage	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,463.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,463.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,463.06
Rate for Payer: Cigna Commercial	$2,868.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,388.47
Rate for Payer: Qualcare PPO/HMO/WC	$860.62
Rate for Payer: UnitedHealthcare Community & State	$181.31
Rate for Payer: Wellpoint Medicaid Managed Care	$162.94

DOWEL 11 MM CANNULATED

Facility

$5,737.50

Service Code	HCPCS C1713
Hospital Charge Code	270688475
Hospital Revenue Code	278
Min. Negotiated Rate	$860.62
Max. Negotiated Rate	$1,388.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,388.47
Rate for Payer: Qualcare PPO/HMO/WC	$860.62

DOWEL 9 MM CANNULATED

Facility

$5,737.50

Service Code	HCPCS C1713
Hospital Charge Code	270688477
Hospital Revenue Code	278
Min. Negotiated Rate	$860.62
Max. Negotiated Rate	$1,388.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,388.47
Rate for Payer: Qualcare PPO/HMO/WC	$860.62

DOWEL 9 MM CANNULATED

Facility

$5,737.50

Service Code	HCPCS C1713
Hospital Charge Code	270688477
Hospital Revenue Code	278
Min. Negotiated Rate	$162.94
Max. Negotiated Rate	$2,868.75
Rate for Payer: Aetna Commercial	$2,180.25
Rate for Payer: Aetna Medicare Advantage	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,463.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,463.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,463.06
Rate for Payer: Cigna Commercial	$2,868.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,388.47
Rate for Payer: Qualcare PPO/HMO/WC	$860.62
Rate for Payer: UnitedHealthcare Community & State	$181.31
Rate for Payer: Wellpoint Medicaid Managed Care	$162.94

DOWEL ALLOGRAFT CORTICAL 5.0MM

Facility

$16,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270696629
Hospital Revenue Code	278
Min. Negotiated Rate	$2,437.50
Max. Negotiated Rate	$3,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,932.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,437.50

DOWEL ALLOGRAFT CORTICAL 5.0MM

Facility

$16,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270696629
Hospital Revenue Code	278
Min. Negotiated Rate	$461.50
Max. Negotiated Rate	$8,125.00
Rate for Payer: Aetna Commercial	$6,175.00
Rate for Payer: Aetna Medicare Advantage	$4,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,143.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,143.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,143.75
Rate for Payer: Cigna Commercial	$8,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,932.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,437.50
Rate for Payer: UnitedHealthcare Community & State	$513.50
Rate for Payer: Wellpoint Medicaid Managed Care	$461.50

DOWEL CANNUALTED 14 MMX 35 MM

Facility

$5,737.50

Service Code	HCPCS C1713
Hospital Charge Code	270688473
Hospital Revenue Code	278
Min. Negotiated Rate	$860.62
Max. Negotiated Rate	$1,388.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,388.47
Rate for Payer: Qualcare PPO/HMO/WC	$860.62

DOWEL CANNUALTED 14 MMX 35 MM

Facility

$5,737.50

Service Code	HCPCS C1713
Hospital Charge Code	270688473
Hospital Revenue Code	278
Min. Negotiated Rate	$162.94
Max. Negotiated Rate	$2,868.75
Rate for Payer: Aetna Commercial	$2,180.25
Rate for Payer: Aetna Medicare Advantage	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,463.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,463.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,463.06
Rate for Payer: Cigna Commercial	$2,868.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,388.47
Rate for Payer: Qualcare PPO/HMO/WC	$860.62
Rate for Payer: UnitedHealthcare Community & State	$181.31
Rate for Payer: Wellpoint Medicaid Managed Care	$162.94

DOWEL CANNULATED 12 MM

Facility

$5,737.50

Service Code	HCPCS C1713
Hospital Charge Code	270688474
Hospital Revenue Code	278
Min. Negotiated Rate	$860.62
Max. Negotiated Rate	$1,388.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,388.47
Rate for Payer: Qualcare PPO/HMO/WC	$860.62

DOWEL CANNULATED 12 MM

Facility

$5,737.50

Service Code	HCPCS C1713
Hospital Charge Code	270688474
Hospital Revenue Code	278
Min. Negotiated Rate	$162.94
Max. Negotiated Rate	$2,868.75
Rate for Payer: Aetna Commercial	$2,180.25
Rate for Payer: Aetna Medicare Advantage	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,463.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,463.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,463.06
Rate for Payer: Cigna Commercial	$2,868.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,388.47
Rate for Payer: Qualcare PPO/HMO/WC	$860.62
Rate for Payer: UnitedHealthcare Community & State	$181.31
Rate for Payer: Wellpoint Medicaid Managed Care	$162.94

DOWEL CANNUL REVISION 11X27MM

Facility

$4,887.50

Service Code	HCPCS C1713
Hospital Charge Code	270693717
Hospital Revenue Code	278
Min. Negotiated Rate	$733.12
Max. Negotiated Rate	$1,182.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,182.78
Rate for Payer: Qualcare PPO/HMO/WC	$733.12

DOWEL CANNUL REVISION 11X27MM

Facility

$4,887.50

Service Code	HCPCS C1713
Hospital Charge Code	270693717
Hospital Revenue Code	278
Min. Negotiated Rate	$138.81
Max. Negotiated Rate	$2,443.75
Rate for Payer: Aetna Commercial	$1,857.25
Rate for Payer: Aetna Medicare Advantage	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,246.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,246.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$977.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,246.31
Rate for Payer: Cigna Commercial	$2,443.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,182.78
Rate for Payer: Qualcare PPO/HMO/WC	$733.12
Rate for Payer: UnitedHealthcare Community & State	$154.44
Rate for Payer: Wellpoint Medicaid Managed Care	$138.81

DOWEL CANNUL REVISION 12X28MM

Facility

$4,887.50

Service Code	HCPCS C1713
Hospital Charge Code	270693718
Hospital Revenue Code	278
Min. Negotiated Rate	$138.81
Max. Negotiated Rate	$2,443.75
Rate for Payer: Aetna Commercial	$1,857.25
Rate for Payer: Aetna Medicare Advantage	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,246.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,246.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$977.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,246.31
Rate for Payer: Cigna Commercial	$2,443.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,182.78
Rate for Payer: Qualcare PPO/HMO/WC	$733.12
Rate for Payer: UnitedHealthcare Community & State	$154.44
Rate for Payer: Wellpoint Medicaid Managed Care	$138.81

DOWEL CANNUL REVISION 12X28MM

Facility

$4,887.50

Service Code	HCPCS C1713
Hospital Charge Code	270693718
Hospital Revenue Code	278
Min. Negotiated Rate	$733.12
Max. Negotiated Rate	$1,182.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,182.78
Rate for Payer: Qualcare PPO/HMO/WC	$733.12

DOWEL CANNUL REVISION 13X29MM

Facility

$4,887.50

Service Code	HCPCS C1713
Hospital Charge Code	270693719
Hospital Revenue Code	278
Min. Negotiated Rate	$138.81
Max. Negotiated Rate	$2,443.75
Rate for Payer: Aetna Commercial	$1,857.25
Rate for Payer: Aetna Medicare Advantage	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,246.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,246.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$977.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,246.31
Rate for Payer: Cigna Commercial	$2,443.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,182.78
Rate for Payer: Qualcare PPO/HMO/WC	$733.12
Rate for Payer: UnitedHealthcare Community & State	$154.44
Rate for Payer: Wellpoint Medicaid Managed Care	$138.81

DOWEL CANNUL REVISION 13X29MM

Facility

$4,887.50

Service Code	HCPCS C1713
Hospital Charge Code	270693719
Hospital Revenue Code	278
Min. Negotiated Rate	$733.12
Max. Negotiated Rate	$1,182.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,182.78
Rate for Payer: Qualcare PPO/HMO/WC	$733.12

DOWEL CANNUL REVISION 14X29MM

Facility

$4,887.50

Service Code	HCPCS C1713
Hospital Charge Code	270693720
Hospital Revenue Code	278
Min. Negotiated Rate	$733.12
Max. Negotiated Rate	$1,182.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,182.78
Rate for Payer: Qualcare PPO/HMO/WC	$733.12

DOWEL CANNUL REVISION 14X29MM

Facility

$4,887.50

Service Code	HCPCS C1713
Hospital Charge Code	270693720
Hospital Revenue Code	278
Min. Negotiated Rate	$138.81
Max. Negotiated Rate	$2,443.75
Rate for Payer: Aetna Commercial	$1,857.25
Rate for Payer: Aetna Medicare Advantage	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,246.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,246.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$977.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,246.31
Rate for Payer: Cigna Commercial	$2,443.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,182.78
Rate for Payer: Qualcare PPO/HMO/WC	$733.12
Rate for Payer: UnitedHealthcare Community & State	$154.44
Rate for Payer: Wellpoint Medicaid Managed Care	$138.81

DOWEL CANNUL REVISION 16X35MM

Facility

$5,737.50

Service Code	HCPCS C1713
Hospital Charge Code	270693721
Hospital Revenue Code	278
Min. Negotiated Rate	$860.62
Max. Negotiated Rate	$1,388.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,388.47
Rate for Payer: Qualcare PPO/HMO/WC	$860.62

DOWEL CANNUL REVISION 16X35MM

Facility

$5,737.50

Service Code	HCPCS C1713
Hospital Charge Code	270693721
Hospital Revenue Code	278
Min. Negotiated Rate	$162.94
Max. Negotiated Rate	$2,868.75
Rate for Payer: Aetna Commercial	$2,180.25
Rate for Payer: Aetna Medicare Advantage	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,463.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,463.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,463.06
Rate for Payer: Cigna Commercial	$2,868.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,388.47
Rate for Payer: Qualcare PPO/HMO/WC	$860.62
Rate for Payer: UnitedHealthcare Community & State	$181.31
Rate for Payer: Wellpoint Medicaid Managed Care	$162.94

DOWEL FACET BACFAST HD 5MM

Facility

$16,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270695407
Hospital Revenue Code	278
Min. Negotiated Rate	$2,437.50
Max. Negotiated Rate	$3,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,932.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,437.50

Know your out-of-pocket cost for care.

All Charges