Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ANKLE/FT ORTHOSIS LEFT SZ 7-9

Facility

$122.70

Service Code	HCPCS L1930
Hospital Charge Code	270669746
Hospital Revenue Code	274
Min. Negotiated Rate	$18.41
Max. Negotiated Rate	$29.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.69
Rate for Payer: Qualcare PPO/HMO/WC	$18.41

ANKLE JT TARSI IMP HYPROC SZ5

Facility

$7,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270663697
Hospital Revenue Code	278
Min. Negotiated Rate	$205.90
Max. Negotiated Rate	$3,625.00
Rate for Payer: Aetna Commercial	$2,755.00
Rate for Payer: Aetna Medicare Advantage	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,848.75
Rate for Payer: Cigna Commercial	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50
Rate for Payer: UnitedHealthcare Community & State	$229.10
Rate for Payer: Wellpoint Medicaid Managed Care	$205.90

ANKLE JT TARSI IMP HYPROC SZ5

Facility

$7,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270663697
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

ANKLE TIB INSERT PROLONG SZ 4

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270695544
Hospital Revenue Code	278
Min. Negotiated Rate	$326.60
Max. Negotiated Rate	$5,750.00
Rate for Payer: Aetna Commercial	$4,370.00
Rate for Payer: Aetna Medicare Advantage	$3,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,932.50
Rate for Payer: Cigna Commercial	$5,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,783.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,725.00
Rate for Payer: UnitedHealthcare Community & State	$363.40
Rate for Payer: Wellpoint Medicaid Managed Care	$326.60

ANKLE TIB INSERT PROLONG SZ 4

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270695544
Hospital Revenue Code	278
Min. Negotiated Rate	$1,725.00
Max. Negotiated Rate	$2,783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,783.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,725.00

ANKLE TOTAL TALUS TM RT SZ 4

Facility

$29,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270695543
Hospital Revenue Code	278
Min. Negotiated Rate	$4,350.00
Max. Negotiated Rate	$7,018.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,350.00

ANKLE TOTAL TALUS TM RT SZ 4

Facility

$29,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270695543
Hospital Revenue Code	278
Min. Negotiated Rate	$823.60
Max. Negotiated Rate	$14,500.00
Rate for Payer: Aetna Commercial	$11,020.00
Rate for Payer: Aetna Medicare Advantage	$8,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,395.00
Rate for Payer: Cigna Commercial	$14,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,350.00
Rate for Payer: UnitedHealthcare Community & State	$916.40
Rate for Payer: Wellpoint Medicaid Managed Care	$823.60

ANKLE,TPLE ARTHRODESIS/SUBTALR

Facility

$77,285.00

Service Code	HCPCS 27815
Hospital Charge Code	160000246
Hospital Revenue Code	360
Min. Negotiated Rate	$11,592.75
Max. Negotiated Rate	$11,592.75
Rate for Payer: Qualcare PPO/HMO/WC	$11,592.75

ANKLE,TPLE ARTHRODESIS/SUBTALR

Facility

$77,285.00

Service Code	HCPCS 27815
Hospital Charge Code	160000246
Hospital Revenue Code	360
Min. Negotiated Rate	$2,194.89
Max. Negotiated Rate	$38,642.50
Rate for Payer: Aetna Commercial	$29,368.30
Rate for Payer: Aetna Medicare Advantage	$23,185.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19,707.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19,707.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19,707.67
Rate for Payer: Cigna Commercial	$38,642.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20,094.10
Rate for Payer: Qualcare PPO/HMO/WC	$11,592.75
Rate for Payer: UnitedHealthcare Community & State	$2,442.21
Rate for Payer: Wellpoint Medicaid Managed Care	$2,194.89

ANN BLUNT TIP SCREW 4X40MM

Facility

$1,323.00

Service Code	HCPCS C1713
Hospital Charge Code	270704515
Hospital Revenue Code	278
Min. Negotiated Rate	$198.45
Max. Negotiated Rate	$320.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$264.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.17
Rate for Payer: Qualcare PPO/HMO/WC	$198.45

ANN BLUNT TIP SCREW 4X40MM

Facility

$1,323.00

Service Code	HCPCS C1713
Hospital Charge Code	270704515
Hospital Revenue Code	278
Min. Negotiated Rate	$37.57
Max. Negotiated Rate	$661.50
Rate for Payer: Aetna Commercial	$502.74
Rate for Payer: Aetna Medicare Advantage	$396.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$337.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$337.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$264.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$337.37
Rate for Payer: Cigna Commercial	$661.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.17
Rate for Payer: Qualcare PPO/HMO/WC	$198.45
Rate for Payer: UnitedHealthcare Community & State	$41.81
Rate for Payer: Wellpoint Medicaid Managed Care	$37.57

ANN BLUNT TIP SCREW 4X42MM

Facility

$1,323.00

Service Code	HCPCS C1713
Hospital Charge Code	270704516
Hospital Revenue Code	278
Min. Negotiated Rate	$198.45
Max. Negotiated Rate	$320.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$264.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.17
Rate for Payer: Qualcare PPO/HMO/WC	$198.45

ANN BLUNT TIP SCREW 4X42MM

Facility

$1,323.00

Service Code	HCPCS C1713
Hospital Charge Code	270704516
Hospital Revenue Code	278
Min. Negotiated Rate	$37.57
Max. Negotiated Rate	$661.50
Rate for Payer: Aetna Commercial	$502.74
Rate for Payer: Aetna Medicare Advantage	$396.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$337.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$337.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$264.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$337.37
Rate for Payer: Cigna Commercial	$661.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.17
Rate for Payer: Qualcare PPO/HMO/WC	$198.45
Rate for Payer: UnitedHealthcare Community & State	$41.81
Rate for Payer: Wellpoint Medicaid Managed Care	$37.57

ANN CORT BONE SCREW 4 X 24MM

Facility

$955.00

Service Code	HCPCS C1713
Hospital Charge Code	270688148
Hospital Revenue Code	278
Min. Negotiated Rate	$27.12
Max. Negotiated Rate	$477.50
Rate for Payer: Aetna Commercial	$362.90
Rate for Payer: Aetna Medicare Advantage	$286.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$243.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$243.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$191.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$243.53
Rate for Payer: Cigna Commercial	$477.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.11
Rate for Payer: Qualcare PPO/HMO/WC	$143.25
Rate for Payer: UnitedHealthcare Community & State	$30.18
Rate for Payer: Wellpoint Medicaid Managed Care	$27.12

ANN CORT BONE SCREW 4 X 24MM

Facility

$955.00

Service Code	HCPCS C1713
Hospital Charge Code	270688148
Hospital Revenue Code	278
Min. Negotiated Rate	$143.25
Max. Negotiated Rate	$231.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$191.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.11
Rate for Payer: Qualcare PPO/HMO/WC	$143.25

ANN CORT BONE SCREW 4 X 26MM

Facility

$955.00

Service Code	HCPCS C1713
Hospital Charge Code	270688152
Hospital Revenue Code	278
Min. Negotiated Rate	$27.12
Max. Negotiated Rate	$477.50
Rate for Payer: Aetna Commercial	$362.90
Rate for Payer: Aetna Medicare Advantage	$286.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$243.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$243.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$191.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$243.53
Rate for Payer: Cigna Commercial	$477.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.11
Rate for Payer: Qualcare PPO/HMO/WC	$143.25
Rate for Payer: UnitedHealthcare Community & State	$30.18
Rate for Payer: Wellpoint Medicaid Managed Care	$27.12

ANN CORT BONE SCREW 4 X 26MM

Facility

$955.00

Service Code	HCPCS C1713
Hospital Charge Code	270688152
Hospital Revenue Code	278
Min. Negotiated Rate	$143.25
Max. Negotiated Rate	$231.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$191.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.11
Rate for Payer: Qualcare PPO/HMO/WC	$143.25

ANN CORT BONE SCREW 4 X 36MM

Facility

$955.00

Service Code	HCPCS C1713
Hospital Charge Code	270688144
Hospital Revenue Code	278
Min. Negotiated Rate	$27.12
Max. Negotiated Rate	$477.50
Rate for Payer: Aetna Commercial	$362.90
Rate for Payer: Aetna Medicare Advantage	$286.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$243.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$243.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$191.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$243.53
Rate for Payer: Cigna Commercial	$477.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.11
Rate for Payer: Qualcare PPO/HMO/WC	$143.25
Rate for Payer: UnitedHealthcare Community & State	$30.18
Rate for Payer: Wellpoint Medicaid Managed Care	$27.12

ANN CORT BONE SCREW 4 X 36MM

Facility

$955.00

Service Code	HCPCS C1713
Hospital Charge Code	270688144
Hospital Revenue Code	278
Min. Negotiated Rate	$143.25
Max. Negotiated Rate	$231.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$191.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.11
Rate for Payer: Qualcare PPO/HMO/WC	$143.25

ANN CORT BONE SCREW 4 X 38MM

Facility

$955.00

Service Code	HCPCS C1713
Hospital Charge Code	270688145
Hospital Revenue Code	278
Min. Negotiated Rate	$143.25
Max. Negotiated Rate	$231.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$191.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.11
Rate for Payer: Qualcare PPO/HMO/WC	$143.25

ANN CORT BONE SCREW 4 X 38MM

Facility

$955.00

Service Code	HCPCS C1713
Hospital Charge Code	270688145
Hospital Revenue Code	278
Min. Negotiated Rate	$27.12
Max. Negotiated Rate	$477.50
Rate for Payer: Aetna Commercial	$362.90
Rate for Payer: Aetna Medicare Advantage	$286.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$243.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$243.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$191.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$243.53
Rate for Payer: Cigna Commercial	$477.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.11
Rate for Payer: Qualcare PPO/HMO/WC	$143.25
Rate for Payer: UnitedHealthcare Community & State	$30.18
Rate for Payer: Wellpoint Medicaid Managed Care	$27.12

ANNUAL WELLNESS VISIT - FIRST

Facility

$543.00

Service Code	HCPCS G0438
Hospital Charge Code	87502680
Hospital Revenue Code	770
Min. Negotiated Rate	$81.45
Max. Negotiated Rate	$81.45
Rate for Payer: Qualcare PPO/HMO/WC	$81.45

ANNUAL WELLNESS VISIT - FIRST

Facility

$543.00

Service Code	HCPCS G0438
Hospital Charge Code	87502680
Hospital Revenue Code	770
Min. Negotiated Rate	$15.42
Max. Negotiated Rate	$271.50
Rate for Payer: Aetna Commercial	$206.34
Rate for Payer: Aetna Medicare Advantage	$162.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$138.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$138.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$138.47
Rate for Payer: Cigna Commercial	$271.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$141.18
Rate for Payer: Oxford Commercial	$108.60
Rate for Payer: Qualcare PPO/HMO/WC	$81.45
Rate for Payer: UnitedHealthcare Commercial	$108.60
Rate for Payer: UnitedHealthcare Community & State	$17.16
Rate for Payer: Wellpoint Medicaid Managed Care	$15.42

ANNUAL WELLNESS VISIT-FIRST

Facility

$543.00

Service Code	HCPCS G0438
Hospital Charge Code	83652533
Hospital Revenue Code	770
Min. Negotiated Rate	$15.42
Max. Negotiated Rate	$271.50
Rate for Payer: Aetna Commercial	$206.34
Rate for Payer: Aetna Medicare Advantage	$162.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$138.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$138.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$138.47
Rate for Payer: Cigna Commercial	$271.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$141.18
Rate for Payer: Oxford Commercial	$108.60
Rate for Payer: Qualcare PPO/HMO/WC	$81.45
Rate for Payer: UnitedHealthcare Commercial	$108.60
Rate for Payer: UnitedHealthcare Community & State	$17.16
Rate for Payer: Wellpoint Medicaid Managed Care	$15.42

ANNUAL WELLNESS VISIT-FIRST

Facility

$543.00

Service Code	HCPCS G0438
Hospital Charge Code	83652533
Hospital Revenue Code	770
Min. Negotiated Rate	$81.45
Max. Negotiated Rate	$81.45
Rate for Payer: Qualcare PPO/HMO/WC	$81.45

Know your out-of-pocket cost for care.

All Charges