Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

WEDGE COTTON RIPTIDE 15X15X4MM

Facility

$19,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270697162
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

WEDGE COTTON RIPTIDE 15X15X4MM

Facility

$19,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270697162
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

WEDGE EVANS 18X18 6.5MM

Facility

$10,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270687448
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 EVANS 18X18 6.5MM

Facility

$10,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270687448
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 EVANS 20X 20X 6 MM

Facility

$10,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270687073
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 EVANS 20X 20X 6 MM

Facility

$10,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270687073
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 EVANS 6MM

Facility

$6,100.00

Hospital Charge Code	270677906
Hospital Revenue Code	278
Min. Negotiated Rate	$173.24
Max. Negotiated Rate	$3,050.00
Rate for Payer: Aetna Commercial	$2,318.00
Rate for Payer: Aetna Medicare Advantage	$1,830.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,555.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,555.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,220.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,555.50
Rate for Payer: Cigna Commercial	$3,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,476.20
Rate for Payer: Qualcare PPO/HMO/WC	$915.00
Rate for Payer: UnitedHealthcare Community & State	$192.76
Rate for Payer: Wellpoint Medicaid Managed Care	$173.24

WEDGE EVANS 6MM

Facility

$6,100.00

Hospital Charge Code	270677906
Hospital Revenue Code	278
Min. Negotiated Rate	$915.00
Max. Negotiated Rate	$1,476.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,220.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,476.20
Rate for Payer: Qualcare PPO/HMO/WC	$915.00

WEDGE EVANS PURP 18x18MM 8MM

Facility

$8,905.00

Service Code	HCPCS C1713
Hospital Charge Code	270675133
Hospital Revenue Code	278
Min. Negotiated Rate	$252.90
Max. Negotiated Rate	$4,452.50
Rate for Payer: Aetna Commercial	$3,383.90
Rate for Payer: Aetna Medicare Advantage	$2,671.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,270.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,270.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,781.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,270.78
Rate for Payer: Cigna Commercial	$4,452.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,155.01
Rate for Payer: Qualcare PPO/HMO/WC	$1,335.75
Rate for Payer: UnitedHealthcare Community & State	$281.40
Rate for Payer: Wellpoint Medicaid Managed Care	$252.90

WEDGE EVANS PURP 18x18MM 8MM

Facility

$8,905.00

Service Code	HCPCS C1713
Hospital Charge Code	270675133
Hospital Revenue Code	278
Min. Negotiated Rate	$1,335.75
Max. Negotiated Rate	$2,155.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,781.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,155.01
Rate for Payer: Qualcare PPO/HMO/WC	$1,335.75

WEDGE FEMORAL DISTAL 3 X 5MM

Facility

$60.00

Service Code	HCPCS C1713
Hospital Charge Code	270687753
Hospital Revenue Code	278
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$14.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.52
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

WEDGE FEMORAL DISTAL 3 X 5MM

Facility

$60.00

Service Code	HCPCS C1713
Hospital Charge Code	270687753
Hospital Revenue Code	278
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna Commercial	$22.80
Rate for Payer: Aetna Medicare Advantage	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.30
Rate for Payer: Cigna Commercial	$30.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.52
Rate for Payer: Qualcare PPO/HMO/WC	$9.00
Rate for Payer: UnitedHealthcare Community & State	$1.90
Rate for Payer: Wellpoint Medicaid Managed Care	$1.70

WEDGE GRAFT LAPIDUS 8X8X10MM

Facility

$10,312.50

Service Code	HCPCS C1713
Hospital Charge Code	270700161
Hospital Revenue Code	278
Min. Negotiated Rate	$292.88
Max. Negotiated Rate	$5,156.25
Rate for Payer: Aetna Commercial	$3,918.75
Rate for Payer: Aetna Medicare Advantage	$3,093.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,629.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,629.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,062.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,629.69
Rate for Payer: Cigna Commercial	$5,156.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,495.62
Rate for Payer: Qualcare PPO/HMO/WC	$1,546.88
Rate for Payer: UnitedHealthcare Community & State	$325.88
Rate for Payer: Wellpoint Medicaid Managed Care	$292.88

WEDGE GRAFT LAPIDUS 8X8X10MM

Facility

$10,312.50

Service Code	HCPCS C1713
Hospital Charge Code	270700161
Hospital Revenue Code	278
Min. Negotiated Rate	$1,546.88
Max. Negotiated Rate	$2,495.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,495.62
Rate for Payer: Qualcare PPO/HMO/WC	$1,546.88

WEDGE ILIAC CREST 12X6

Facility

$3,532.50

Service Code	HCPCS C1776
Hospital Charge Code	270686434
Hospital Revenue Code	278
Min. Negotiated Rate	$529.88
Max. Negotiated Rate	$854.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$706.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$854.87
Rate for Payer: Qualcare PPO/HMO/WC	$529.88

WEDGE ILIAC CREST 12X6

Facility

$3,532.50

Service Code	HCPCS C1776
Hospital Charge Code	270686434
Hospital Revenue Code	278
Min. Negotiated Rate	$100.32
Max. Negotiated Rate	$1,766.25
Rate for Payer: Aetna Commercial	$1,342.35
Rate for Payer: Aetna Medicare Advantage	$1,059.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$900.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$900.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$706.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$900.79
Rate for Payer: Cigna Commercial	$1,766.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$854.87
Rate for Payer: Qualcare PPO/HMO/WC	$529.88
Rate for Payer: UnitedHealthcare Community & State	$111.63
Rate for Payer: Wellpoint Medicaid Managed Care	$100.32

WEDGE OSFERION 7MMX30 MMX12 MM

Facility

$2,425.00

Service Code	HCPCS C1713
Hospital Charge Code	270691442
Hospital Revenue Code	278
Min. Negotiated Rate	$68.87
Max. Negotiated Rate	$1,212.50
Rate for Payer: Aetna Commercial	$921.50
Rate for Payer: Aetna Medicare Advantage	$727.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$618.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$618.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$485.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$618.38
Rate for Payer: Cigna Commercial	$1,212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$586.85
Rate for Payer: Qualcare PPO/HMO/WC	$363.75
Rate for Payer: UnitedHealthcare Community & State	$76.63
Rate for Payer: Wellpoint Medicaid Managed Care	$68.87

WEDGE OSFERION 7MMX30 MMX12 MM

Facility

$2,425.00

Service Code	HCPCS C1713
Hospital Charge Code	270691442
Hospital Revenue Code	278
Min. Negotiated Rate	$363.75
Max. Negotiated Rate	$586.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$485.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$586.85
Rate for Payer: Qualcare PPO/HMO/WC	$363.75

WEDGE OSFERION OSTEOTOMY 10MM

Facility

$2,475.00

Service Code	HCPCS C1776
Hospital Charge Code	270675921
Hospital Revenue Code	278
Min. Negotiated Rate	$70.29
Max. Negotiated Rate	$1,237.50
Rate for Payer: Aetna Commercial	$940.50
Rate for Payer: Aetna Medicare Advantage	$742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$631.12
Rate for Payer: Cigna Commercial	$1,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.95
Rate for Payer: Qualcare PPO/HMO/WC	$371.25
Rate for Payer: UnitedHealthcare Community & State	$78.21
Rate for Payer: Wellpoint Medicaid Managed Care	$70.29

WEDGE OSFERION OSTEOTOMY 10MM

Facility

$2,475.00

Service Code	HCPCS C1776
Hospital Charge Code	270675921
Hospital Revenue Code	278
Min. Negotiated Rate	$371.25
Max. Negotiated Rate	$598.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.95
Rate for Payer: Qualcare PPO/HMO/WC	$371.25

WEDGE OSTEHON OSTEOTOMY

Facility

$2,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270683945
Hospital Revenue Code	278
Min. Negotiated Rate	$70.29
Max. Negotiated Rate	$1,237.50
Rate for Payer: Aetna Commercial	$940.50
Rate for Payer: Aetna Medicare Advantage	$742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$631.12
Rate for Payer: Cigna Commercial	$1,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.95
Rate for Payer: Qualcare PPO/HMO/WC	$371.25
Rate for Payer: UnitedHealthcare Community & State	$78.21
Rate for Payer: Wellpoint Medicaid Managed Care	$70.29

WEDGE OSTEHON OSTEOTOMY

Facility

$2,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270683945
Hospital Revenue Code	278
Min. Negotiated Rate	$371.25
Max. Negotiated Rate	$598.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.95
Rate for Payer: Qualcare PPO/HMO/WC	$371.25

WEDGE PILLOW LRG DISPOSABLE

Facility

$160.00

Hospital Charge Code	270666211
Hospital Revenue Code	270
Min. Negotiated Rate	$4.54
Max. Negotiated Rate	$80.00
Rate for Payer: Aetna Commercial	$60.80
Rate for Payer: Aetna Medicare Advantage	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.80
Rate for Payer: Cigna Commercial	$80.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.60
Rate for Payer: Oxford Commercial	$32.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00
Rate for Payer: UnitedHealthcare Commercial	$32.00
Rate for Payer: UnitedHealthcare Community & State	$5.06
Rate for Payer: Wellpoint Medicaid Managed Care	$4.54

WEDGE PILLOW LRG DISPOSABLE

Facility

$160.00

Hospital Charge Code	270666211
Hospital Revenue Code	270
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00

WEDGE PLATE 3MM LEFT

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270687965
Hospital Revenue Code	278
Min. Negotiated Rate	$596.25
Max. Negotiated Rate	$961.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

Know your out-of-pocket cost for care.

All Charges