Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

WEDGE PLATE 3MM LEFT

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270687965
Hospital Revenue Code	278
Min. Negotiated Rate	$112.89
Max. Negotiated Rate	$1,987.50
Rate for Payer: Aetna Commercial	$1,510.50
Rate for Payer: Aetna Medicare Advantage	$1,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,013.62
Rate for Payer: Cigna Commercial	$1,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25
Rate for Payer: UnitedHealthcare Community & State	$125.61
Rate for Payer: Wellpoint Medicaid Managed Care	$112.89

WEDGE PLATE 5MM SPACER STER

Facility

$4,005.00

Hospital Charge Code	270676153
Hospital Revenue Code	278
Min. Negotiated Rate	$600.75
Max. Negotiated Rate	$969.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$801.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$969.21
Rate for Payer: Qualcare PPO/HMO/WC	$600.75

WEDGE PLATE 5MM SPACER STER

Facility

$4,005.00

Hospital Charge Code	270676153
Hospital Revenue Code	278
Min. Negotiated Rate	$113.74
Max. Negotiated Rate	$2,002.50
Rate for Payer: Aetna Commercial	$1,521.90
Rate for Payer: Aetna Medicare Advantage	$1,201.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,021.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,021.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$801.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,021.27
Rate for Payer: Cigna Commercial	$2,002.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$969.21
Rate for Payer: Qualcare PPO/HMO/WC	$600.75
Rate for Payer: UnitedHealthcare Community & State	$126.56
Rate for Payer: Wellpoint Medicaid Managed Care	$113.74

WEDGE RESECT OF LUNG INITIAL

Facility

$35,520.38

Service Code	HCPCS 32505
Hospital Charge Code	160000366
Hospital Revenue Code	360
Min. Negotiated Rate	$1,008.78
Max. Negotiated Rate	$17,760.19
Rate for Payer: Aetna Commercial	$13,497.74
Rate for Payer: Aetna Medicare Advantage	$10,656.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,057.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,057.70
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	$9,057.70
Rate for Payer: Cigna Commercial	$17,760.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,235.30
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,328.06
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$1,122.44
Rate for Payer: Wellpoint Medicaid Managed Care	$1,008.78

WEDGE RESECT OF LUNG INITIAL

Facility

$35,520.38

Service Code	HCPCS 32505
Hospital Charge Code	160000366
Hospital Revenue Code	360
Min. Negotiated Rate	$5,328.06
Max. Negotiated Rate	$5,328.06
Rate for Payer: Qualcare PPO/HMO/WC	$5,328.06

WEDGE SCREW UNIVERSAL 9x20MM

Facility

$955.00

Service Code	HCPCS C1713
Hospital Charge Code	270675670
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

WEDGE SCREW UNIVERSAL 9x20MM

Facility

$955.00

Service Code	HCPCS C1713
Hospital Charge Code	270675670
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

WEDGE SCREW UNIVERSAL 9x25MM

Facility

$955.00

Service Code	HCPCS C1713
Hospital Charge Code	270675671
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

WEDGE SCREW UNIVERSAL 9x25MM

Facility

$955.00

Service Code	HCPCS C1713
Hospital Charge Code	270675671
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

WEDGET EVANS TI /PEEK 18X8MM

Facility

$13,350.00

Service Code	HCPCS C1713
Hospital Charge Code	270686481
Hospital Revenue Code	278
Min. Negotiated Rate	$2,002.50
Max. Negotiated Rate	$3,230.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,670.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,230.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,002.50

WEDGET EVANS TI /PEEK 18X8MM

Facility

$13,350.00

Service Code	HCPCS C1713
Hospital Charge Code	270686481
Hospital Revenue Code	278
Min. Negotiated Rate	$379.14
Max. Negotiated Rate	$6,675.00
Rate for Payer: Aetna Commercial	$5,073.00
Rate for Payer: Aetna Medicare Advantage	$4,005.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,404.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,404.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,670.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,404.25
Rate for Payer: Cigna Commercial	$6,675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,230.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,002.50
Rate for Payer: UnitedHealthcare Community & State	$421.86
Rate for Payer: Wellpoint Medicaid Managed Care	$379.14

WEDGE TRIAL SUBTULAR 10MM

Facility

$18,625.00

Service Code	HCPCS C1776
Hospital Charge Code	270698254
Hospital Revenue Code	278
Min. Negotiated Rate	$2,793.75
Max. Negotiated Rate	$4,507.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,507.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,793.75

WEDGE TRIAL SUBTULAR 10MM

Facility

$18,625.00

Service Code	HCPCS C1776
Hospital Charge Code	270698254
Hospital Revenue Code	278
Min. Negotiated Rate	$528.95
Max. Negotiated Rate	$9,312.50
Rate for Payer: Aetna Commercial	$7,077.50
Rate for Payer: Aetna Medicare Advantage	$5,587.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,749.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,749.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,749.38
Rate for Payer: Cigna Commercial	$9,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,507.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,793.75
Rate for Payer: UnitedHealthcare Community & State	$588.55
Rate for Payer: Wellpoint Medicaid Managed Care	$528.95

WELLBUTRIN XL TAB 150MG

Facility

$207.77

Service Code	NDC 187073030
Hospital Charge Code	60629368
Hospital Revenue Code	250
Min. Negotiated Rate	$5.90
Max. Negotiated Rate	$103.89
Rate for Payer: Aetna Commercial	$78.95
Rate for Payer: Aetna Medicare Advantage	$62.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.98
Rate for Payer: Cigna Commercial	$103.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.02
Rate for Payer: Oxford Commercial	$41.55
Rate for Payer: Qualcare PPO/HMO/WC	$31.17
Rate for Payer: UnitedHealthcare Commercial	$41.55
Rate for Payer: UnitedHealthcare Community & State	$6.57
Rate for Payer: Wellpoint Medicaid Managed Care	$5.90

WELLBUTRIN XL TAB 150MG

Facility

$207.77

Service Code	NDC 187073030
Hospital Charge Code	60629368
Hospital Revenue Code	250
Min. Negotiated Rate	$31.17
Max. Negotiated Rate	$31.17
Rate for Payer: Qualcare PPO/HMO/WC	$31.17

WEST NILE AB(IGG,IGM),CSF I

Facility

$115.75

Service Code	HCPCS 86788
Hospital Charge Code	39990109A
Hospital Revenue Code	302
Min. Negotiated Rate	$17.36
Max. Negotiated Rate	$17.36
Rate for Payer: Qualcare PPO/HMO/WC	$17.36

WEST NILE AB(IGG,IGM),CSF I

Facility

$115.75

Service Code	HCPCS 86788
Hospital Charge Code	39990109A
Hospital Revenue Code	302
Min. Negotiated Rate	$3.29
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$45.83
Rate for Payer: Aetna Medicare Advantage	$54.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.12
Rate for Payer: Cigna Commercial	$57.88
Rate for Payer: Cigna Medicare Advantage	$16.85
Rate for Payer: Clover Medicare Advantage	$16.01
Rate for Payer: EmblemHealth Commercial	$50.55
Rate for Payer: Humana Medicare Advantage	$17.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.09
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.36
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.85
Rate for Payer: Wellcare Medicare Advantage	$16.85
Rate for Payer: Wellpoint Medicaid Managed Care	$3.29

WEST NILE AB(IGG,IGM),CSF II

Facility

$98.95

Service Code	HCPCS 86789
Hospital Charge Code	39990109B
Hospital Revenue Code	302
Min. Negotiated Rate	$14.84
Max. Negotiated Rate	$14.84
Rate for Payer: Qualcare PPO/HMO/WC	$14.84

WEST NILE AB(IGG,IGM),CSF II

Facility

$98.95

Service Code	HCPCS 86789
Hospital Charge Code	39990109B
Hospital Revenue Code	302
Min. Negotiated Rate	$2.81
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$46.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.20
Rate for Payer: Cigna Commercial	$49.48
Rate for Payer: Cigna Medicare Advantage	$14.39
Rate for Payer: Clover Medicare Advantage	$13.67
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Humana Medicare Advantage	$14.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.73
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.84
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$11.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.39
Rate for Payer: Wellcare Medicare Advantage	$14.39
Rate for Payer: Wellpoint Medicaid Managed Care	$2.81

WEST NILE CSF I

Facility

$390.00

Service Code	HCPCS 86788
Hospital Charge Code	39990108A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

WEST NILE CSF I

Facility

$390.00

Service Code	HCPCS 86788
Hospital Charge Code	39990108A
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$45.83
Rate for Payer: Aetna Medicare Advantage	$54.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.12
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$16.85
Rate for Payer: Clover Medicare Advantage	$16.01
Rate for Payer: EmblemHealth Commercial	$50.55
Rate for Payer: Humana Medicare Advantage	$17.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.85
Rate for Payer: Wellcare Medicare Advantage	$16.85
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

WEST NILE CSF II

Facility

$390.00

Service Code	HCPCS 86789
Hospital Charge Code	39990108B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

WEST NILE CSF II

Facility

$390.00

Service Code	HCPCS 86789
Hospital Charge Code	39990108B
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$46.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.20
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$14.39
Rate for Payer: Clover Medicare Advantage	$13.67
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Humana Medicare Advantage	$14.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$11.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.39
Rate for Payer: Wellcare Medicare Advantage	$14.39
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

WEST NILE IGG/IGM II

Facility

$390.00

Service Code	HCPCS 86788
Hospital Charge Code	39990107A
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$45.83
Rate for Payer: Aetna Medicare Advantage	$54.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.12
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$16.85
Rate for Payer: Clover Medicare Advantage	$16.01
Rate for Payer: EmblemHealth Commercial	$50.55
Rate for Payer: Humana Medicare Advantage	$17.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.85
Rate for Payer: Wellcare Medicare Advantage	$16.85
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

WEST NILE IGG/IGM II

Facility

$390.00

Service Code	HCPCS 86788
Hospital Charge Code	39990107A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

All Charges