Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

WEDGE BIOCORTICAL COTTON 6MM

Facility

$7,155.00

Service Code	HCPCS C1713
Hospital Charge Code	270684863
Hospital Revenue Code	278
Min. Negotiated Rate	$1,073.25
Max. Negotiated Rate	$1,731.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,431.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,731.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,073.25

WEDGE BIOCORTICAL EVANS 8MM

Facility

$8,745.00

Service Code	HCPCS C1713
Hospital Charge Code	270684862
Hospital Revenue Code	278
Min. Negotiated Rate	$248.36
Max. Negotiated Rate	$4,372.50
Rate for Payer: Aetna Commercial	$3,323.10
Rate for Payer: Aetna Medicare Advantage	$2,623.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,229.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,229.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,749.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,229.97
Rate for Payer: Cigna Commercial	$4,372.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,116.29
Rate for Payer: Qualcare PPO/HMO/WC	$1,311.75
Rate for Payer: UnitedHealthcare Community & State	$276.34
Rate for Payer: Wellpoint Medicaid Managed Care	$248.36

WEDGE BIOCORTICAL EVANS 8MM

Facility

$8,745.00

Service Code	HCPCS C1713
Hospital Charge Code	270684862
Hospital Revenue Code	278
Min. Negotiated Rate	$1,311.75
Max. Negotiated Rate	$2,116.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,749.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,116.29
Rate for Payer: Qualcare PPO/HMO/WC	$1,311.75

WEDGE BIOFOAM 16X4.5MM

Facility

$11,795.00

Service Code	HCPCS C1713
Hospital Charge Code	270700553
Hospital Revenue Code	278
Min. Negotiated Rate	$1,769.25
Max. Negotiated Rate	$2,854.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,359.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,854.39
Rate for Payer: Qualcare PPO/HMO/WC	$1,769.25

WEDGE BIOFOAM 16X4.5MM

Facility

$11,795.00

Service Code	HCPCS C1713
Hospital Charge Code	270700553
Hospital Revenue Code	278
Min. Negotiated Rate	$334.98
Max. Negotiated Rate	$5,897.50
Rate for Payer: Aetna Commercial	$4,482.10
Rate for Payer: Aetna Medicare Advantage	$3,538.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,007.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,007.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,359.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,007.72
Rate for Payer: Cigna Commercial	$5,897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,854.39
Rate for Payer: Qualcare PPO/HMO/WC	$1,769.25
Rate for Payer: UnitedHealthcare Community & State	$372.72
Rate for Payer: Wellpoint Medicaid Managed Care	$334.98

WEDGE BIOSYNC 18X18X8MM

Facility

$10,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270693396
Hospital Revenue Code	278
Min. Negotiated Rate	$1,646.25
Max. Negotiated Rate	$2,655.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,655.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,646.25

WEDGE BIOSYNC 18X18X8MM

Facility

$10,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270693396
Hospital Revenue Code	278
Min. Negotiated Rate	$311.69
Max. Negotiated Rate	$5,487.50
Rate for Payer: Aetna Commercial	$4,170.50
Rate for Payer: Aetna Medicare Advantage	$3,292.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,798.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,798.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,798.62
Rate for Payer: Cigna Commercial	$5,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,655.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,646.25
Rate for Payer: UnitedHealthcare Community & State	$346.81
Rate for Payer: Wellpoint Medicaid Managed Care	$311.69

WEDGE BIOSYNC 20X 5.5MM

Facility

$9,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270690273
Hospital Revenue Code	278
Min. Negotiated Rate	$1,496.25
Max. Negotiated Rate	$2,413.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25

WEDGE BIOSYNC 20X 5.5MM

Facility

$9,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270690273
Hospital Revenue Code	278
Min. Negotiated Rate	$283.29
Max. Negotiated Rate	$4,987.50
Rate for Payer: Aetna Commercial	$3,790.50
Rate for Payer: Aetna Medicare Advantage	$2,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,543.62
Rate for Payer: Cigna Commercial	$4,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25
Rate for Payer: UnitedHealthcare Community & State	$315.21
Rate for Payer: Wellpoint Medicaid Managed Care	$283.29

WEDGE BIOSYNC SET

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270687871
Hospital Revenue Code	278
Min. Negotiated Rate	$85.20
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$94.80
Rate for Payer: Wellpoint Medicaid Managed Care	$85.20

WEDGE BIOSYNC SET

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270687871
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

WEDGE COTTN CONSTRUCT T AND I

Facility

$16,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270701839
Hospital Revenue Code	278
Min. Negotiated Rate	$2,475.00
Max. Negotiated Rate	$3,993.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,993.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00

WEDGE COTTN CONSTRUCT T AND I

Facility

$16,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270701839
Hospital Revenue Code	278
Min. Negotiated Rate	$468.60
Max. Negotiated Rate	$8,250.00
Rate for Payer: Aetna Commercial	$6,270.00
Rate for Payer: Aetna Medicare Advantage	$4,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,207.50
Rate for Payer: Cigna Commercial	$8,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,993.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00
Rate for Payer: UnitedHealthcare Community & State	$521.40
Rate for Payer: Wellpoint Medicaid Managed Care	$468.60

WEDGE COTTON

Facility

$9,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270687703
Hospital Revenue Code	278
Min. Negotiated Rate	$283.29
Max. Negotiated Rate	$4,987.50
Rate for Payer: Aetna Commercial	$3,790.50
Rate for Payer: Aetna Medicare Advantage	$2,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,543.62
Rate for Payer: Cigna Commercial	$4,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25
Rate for Payer: UnitedHealthcare Community & State	$315.21
Rate for Payer: Wellpoint Medicaid Managed Care	$283.29

WEDGE COTTON

Facility

$9,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270687703
Hospital Revenue Code	278
Min. Negotiated Rate	$1,496.25
Max. Negotiated Rate	$2,413.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25

WEDGE COTTON 16 5.5 MM

Facility

$9,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270686656
Hospital Revenue Code	278
Min. Negotiated Rate	$283.29
Max. Negotiated Rate	$4,987.50
Rate for Payer: Aetna Commercial	$3,790.50
Rate for Payer: Aetna Medicare Advantage	$2,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,543.62
Rate for Payer: Cigna Commercial	$4,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25
Rate for Payer: UnitedHealthcare Community & State	$315.21
Rate for Payer: Wellpoint Medicaid Managed Care	$283.29

WEDGE COTTON 16 5.5 MM

Facility

$9,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270686656
Hospital Revenue Code	278
Min. Negotiated Rate	$1,496.25
Max. Negotiated Rate	$2,413.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25

WEDGE COTTON 16 X5 MM

Facility

$9,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270687074
Hospital Revenue Code	278
Min. Negotiated Rate	$283.29
Max. Negotiated Rate	$4,987.50
Rate for Payer: Aetna Commercial	$3,790.50
Rate for Payer: Aetna Medicare Advantage	$2,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,543.62
Rate for Payer: Cigna Commercial	$4,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25
Rate for Payer: UnitedHealthcare Community & State	$315.21
Rate for Payer: Wellpoint Medicaid Managed Care	$283.29

WEDGE COTTON 16 X5 MM

Facility

$9,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270687074
Hospital Revenue Code	278
Min. Negotiated Rate	$1,496.25
Max. Negotiated Rate	$2,413.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25

WEDGE COTTON 5MM 403205

Facility

$5,040.00

Service Code	HCPCS C1713
Hospital Charge Code	270677907
Hospital Revenue Code	278
Min. Negotiated Rate	$756.00
Max. Negotiated Rate	$1,219.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,008.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,219.68
Rate for Payer: Qualcare PPO/HMO/WC	$756.00

WEDGE COTTON 5MM 403205

Facility

$5,040.00

Service Code	HCPCS C1713
Hospital Charge Code	270677907
Hospital Revenue Code	278
Min. Negotiated Rate	$143.14
Max. Negotiated Rate	$2,520.00
Rate for Payer: Aetna Commercial	$1,915.20
Rate for Payer: Aetna Medicare Advantage	$1,512.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,285.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,285.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,008.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,285.20
Rate for Payer: Cigna Commercial	$2,520.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,219.68
Rate for Payer: Qualcare PPO/HMO/WC	$756.00
Rate for Payer: UnitedHealthcare Community & State	$159.26
Rate for Payer: Wellpoint Medicaid Managed Care	$143.14

WEDGE COTTON ALLOGRAFT 7MM

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270697528
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

WEDGE COTTON ALLOGRAFT 7MM

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270697528
Hospital Revenue Code	278
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

WEDGE COTTON BIOSYNE 16X 6.5MM

Facility

$9,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270688028
Hospital Revenue Code	278
Min. Negotiated Rate	$1,496.25
Max. Negotiated Rate	$2,413.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25

WEDGE COTTON BIOSYNE 16X 6.5MM

Facility

$9,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270688028
Hospital Revenue Code	278
Min. Negotiated Rate	$283.29
Max. Negotiated Rate	$4,987.50
Rate for Payer: Aetna Commercial	$3,790.50
Rate for Payer: Aetna Medicare Advantage	$2,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,543.62
Rate for Payer: Cigna Commercial	$4,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25
Rate for Payer: UnitedHealthcare Community & State	$315.21
Rate for Payer: Wellpoint Medicaid Managed Care	$283.29

Know your out-of-pocket cost for care.

All Charges