Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

OSTEOSURGE 300 PUTTY 5CC

Facility

$5,670.00

Service Code	HCPCS C1713
Hospital Charge Code	270694151
Hospital Revenue Code	278
Min. Negotiated Rate	$161.03
Max. Negotiated Rate	$2,835.00
Rate for Payer: Aetna Commercial	$2,154.60
Rate for Payer: Aetna Medicare Advantage	$1,701.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,445.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,445.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,134.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,445.85
Rate for Payer: Cigna Commercial	$2,835.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,372.14
Rate for Payer: Qualcare PPO/HMO/WC	$850.50
Rate for Payer: UnitedHealthcare Community & State	$179.17
Rate for Payer: Wellpoint Medicaid Managed Care	$161.03

OSTEOSURGE 300 PUTTY 5CC

Facility

$5,670.00

Service Code	HCPCS C1713
Hospital Charge Code	270694151
Hospital Revenue Code	278
Min. Negotiated Rate	$850.50
Max. Negotiated Rate	$1,372.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,134.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,372.14
Rate for Payer: Qualcare PPO/HMO/WC	$850.50

OSTEOSURGE BN MATRIX SYR10CC

Facility

$18,650.00

Service Code	HCPCS C1713
Hospital Charge Code	270672817
Hospital Revenue Code	278
Min. Negotiated Rate	$529.66
Max. Negotiated Rate	$9,325.00
Rate for Payer: Aetna Commercial	$7,087.00
Rate for Payer: Aetna Medicare Advantage	$5,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,755.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,755.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,730.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,755.75
Rate for Payer: Cigna Commercial	$9,325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,513.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,797.50
Rate for Payer: UnitedHealthcare Community & State	$589.34
Rate for Payer: Wellpoint Medicaid Managed Care	$529.66

OSTEOSURGE BN MATRIX SYR10CC

Facility

$18,650.00

Service Code	HCPCS C1713
Hospital Charge Code	270672817
Hospital Revenue Code	278
Min. Negotiated Rate	$2,797.50
Max. Negotiated Rate	$4,513.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,730.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,513.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,797.50

OSTEOSURGE BONE MATRIX 300CC

Facility

$4,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270694774
Hospital Revenue Code	278
Min. Negotiated Rate	$618.75
Max. Negotiated Rate	$998.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$998.25
Rate for Payer: Qualcare PPO/HMO/WC	$618.75

OSTEOSURGE BONE MATRIX 300CC

Facility

$4,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270694774
Hospital Revenue Code	278
Min. Negotiated Rate	$117.15
Max. Negotiated Rate	$2,062.50
Rate for Payer: Aetna Commercial	$1,567.50
Rate for Payer: Aetna Medicare Advantage	$1,237.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,051.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,051.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,051.88
Rate for Payer: Cigna Commercial	$2,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$998.25
Rate for Payer: Qualcare PPO/HMO/WC	$618.75
Rate for Payer: UnitedHealthcare Community & State	$130.35
Rate for Payer: Wellpoint Medicaid Managed Care	$117.15

OSTEOT COTTON WEDGE 15X15X4MM

Facility

$19,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270697160
Hospital Revenue Code	278
Min. Negotiated Rate	$553.80
Max. Negotiated Rate	$9,750.00
Rate for Payer: Aetna Commercial	$7,410.00
Rate for Payer: Aetna Medicare Advantage	$5,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,972.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,972.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,972.50
Rate for Payer: Cigna Commercial	$9,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,719.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,925.00
Rate for Payer: UnitedHealthcare Community & State	$616.20
Rate for Payer: Wellpoint Medicaid Managed Care	$553.80

OSTEOT COTTON WEDGE 15X15X4MM

Facility

$19,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270697160
Hospital Revenue Code	278
Min. Negotiated Rate	$2,925.00
Max. Negotiated Rate	$4,719.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,719.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,925.00

OSTEOT COTTON WEDGE 20X15X4MM

Facility

$19,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270697161
Hospital Revenue Code	278
Min. Negotiated Rate	$2,925.00
Max. Negotiated Rate	$4,719.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,719.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,925.00

OSTEOT COTTON WEDGE 20X15X4MM

Facility

$19,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270697161
Hospital Revenue Code	278
Min. Negotiated Rate	$553.80
Max. Negotiated Rate	$9,750.00
Rate for Payer: Aetna Commercial	$7,410.00
Rate for Payer: Aetna Medicare Advantage	$5,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,972.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,972.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,972.50
Rate for Payer: Cigna Commercial	$9,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,719.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,925.00
Rate for Payer: UnitedHealthcare Community & State	$616.20
Rate for Payer: Wellpoint Medicaid Managed Care	$553.80

OSTEOTOME 7MM

Facility

$2,500.00

Hospital Charge Code	270700493
Hospital Revenue Code	272
Min. Negotiated Rate	$71.00
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$950.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$650.00
Rate for Payer: Oxford Commercial	$500.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Commercial	$500.00
Rate for Payer: UnitedHealthcare Community & State	$79.00
Rate for Payer: Wellpoint Medicaid Managed Care	$71.00

OSTEOTOME 7MM

Facility

$2,500.00

Hospital Charge Code	270700493
Hospital Revenue Code	272
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$375.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

OSTEOTOME CEM 3.0-11.5 STR LN

Facility

$930.05

Hospital Charge Code	270670669
Hospital Revenue Code	272
Min. Negotiated Rate	$139.51
Max. Negotiated Rate	$139.51
Rate for Payer: Qualcare PPO/HMO/WC	$139.51

OSTEOTOME CEM 3.0-11.5 STR LN

Facility

$930.05

Hospital Charge Code	270670669
Hospital Revenue Code	272
Min. Negotiated Rate	$26.41
Max. Negotiated Rate	$465.02
Rate for Payer: Aetna Commercial	$353.42
Rate for Payer: Aetna Medicare Advantage	$279.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$237.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$237.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$237.16
Rate for Payer: Cigna Commercial	$465.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$241.81
Rate for Payer: Oxford Commercial	$186.01
Rate for Payer: Qualcare PPO/HMO/WC	$139.51
Rate for Payer: UnitedHealthcare Commercial	$186.01
Rate for Payer: UnitedHealthcare Community & State	$29.39
Rate for Payer: Wellpoint Medicaid Managed Care	$26.41

OSTEOTOME CEM STAG 3 STR LINE

Facility

$930.05

Hospital Charge Code	270670673
Hospital Revenue Code	272
Min. Negotiated Rate	$139.51
Max. Negotiated Rate	$139.51
Rate for Payer: Qualcare PPO/HMO/WC	$139.51

OSTEOTOME CEM STAG 3 STR LINE

Facility

$930.05

Hospital Charge Code	270670673
Hospital Revenue Code	272
Min. Negotiated Rate	$26.41
Max. Negotiated Rate	$465.02
Rate for Payer: Aetna Commercial	$353.42
Rate for Payer: Aetna Medicare Advantage	$279.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$237.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$237.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$237.16
Rate for Payer: Cigna Commercial	$465.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$241.81
Rate for Payer: Oxford Commercial	$186.01
Rate for Payer: Qualcare PPO/HMO/WC	$139.51
Rate for Payer: UnitedHealthcare Commercial	$186.01
Rate for Payer: UnitedHealthcare Community & State	$29.39
Rate for Payer: Wellpoint Medicaid Managed Care	$26.41

OSTEOTOME DRIVER S9 MINI

Facility

$1,300.00

Hospital Charge Code	270696819
Hospital Revenue Code	272
Min. Negotiated Rate	$36.92
Max. Negotiated Rate	$650.00
Rate for Payer: Aetna Commercial	$494.00
Rate for Payer: Aetna Medicare Advantage	$390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$331.50
Rate for Payer: Cigna Commercial	$650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$338.00
Rate for Payer: Oxford Commercial	$260.00
Rate for Payer: Qualcare PPO/HMO/WC	$195.00
Rate for Payer: UnitedHealthcare Commercial	$260.00
Rate for Payer: UnitedHealthcare Community & State	$41.08
Rate for Payer: Wellpoint Medicaid Managed Care	$36.92

OSTEOTOME DRIVER S9 MINI

Facility

$1,300.00

Hospital Charge Code	270696819
Hospital Revenue Code	272
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$195.00

OSTEOTOME FLAT FLEX NARROW

Facility

$3,500.00

Hospital Charge Code	270668745
Hospital Revenue Code	272
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$910.00
Rate for Payer: Oxford Commercial	$700.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Commercial	$700.00
Rate for Payer: UnitedHealthcare Community & State	$110.60
Rate for Payer: Wellpoint Medicaid Managed Care	$99.40

OSTEOTOME FLAT FLEX NARROW

Facility

$3,500.00

Hospital Charge Code	270668745
Hospital Revenue Code	272
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

OSTEOTOME FLAT FLEX NARRW LONG

Facility

$3,500.00

Hospital Charge Code	270677340
Hospital Revenue Code	272
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

OSTEOTOME FLAT FLEX NARRW LONG

Facility

$3,500.00

Hospital Charge Code	270677340
Hospital Revenue Code	272
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$910.00
Rate for Payer: Oxford Commercial	$700.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Commercial	$700.00
Rate for Payer: UnitedHealthcare Community & State	$110.60
Rate for Payer: Wellpoint Medicaid Managed Care	$99.40

OSTEOTOME FLAT FLEX RND NARROW

Facility

$4,600.00

Hospital Charge Code	270678729
Hospital Revenue Code	272
Min. Negotiated Rate	$130.64
Max. Negotiated Rate	$2,300.00
Rate for Payer: Aetna Commercial	$1,748.00
Rate for Payer: Aetna Medicare Advantage	$1,380.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,173.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,173.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,173.00
Rate for Payer: Cigna Commercial	$2,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,196.00
Rate for Payer: Oxford Commercial	$920.00
Rate for Payer: Qualcare PPO/HMO/WC	$690.00
Rate for Payer: UnitedHealthcare Commercial	$920.00
Rate for Payer: UnitedHealthcare Community & State	$145.36
Rate for Payer: Wellpoint Medicaid Managed Care	$130.64

OSTEOTOME FLAT FLEX RND NARROW

Facility

$4,600.00

Hospital Charge Code	270678729
Hospital Revenue Code	272
Min. Negotiated Rate	$690.00
Max. Negotiated Rate	$690.00
Rate for Payer: Qualcare PPO/HMO/WC	$690.00

OSTEOTOME HOOKED 7MM

Facility

$2,500.00

Service Code	HCPCS A4649
Hospital Charge Code	270699907
Hospital Revenue Code	272
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$375.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

Know your out-of-pocket cost for care.

All Charges