Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SPEEDBRIDGE W/BIOCOMP SWLCK SP

Facility

$8,900.00

Service Code	HCPCS C1713
Hospital Charge Code	270677723
Hospital Revenue Code	278
Min. Negotiated Rate	$1,335.00
Max. Negotiated Rate	$2,153.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,780.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,153.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,335.00

SPEEDBRIDGE W/BIOCOMP SWLCK SP

Facility

$8,900.00

Service Code	HCPCS C1713
Hospital Charge Code	270677723
Hospital Revenue Code	278
Min. Negotiated Rate	$252.76
Max. Negotiated Rate	$4,450.00
Rate for Payer: Aetna Commercial	$3,382.00
Rate for Payer: Aetna Medicare Advantage	$2,670.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,269.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,269.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,780.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,269.50
Rate for Payer: Cigna Commercial	$4,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,153.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,335.00
Rate for Payer: UnitedHealthcare Community & State	$281.24
Rate for Payer: Wellpoint Medicaid Managed Care	$252.76

SPEEDBRIDGE W/BIOCOMP SWLOCL

Facility

$8,700.00

Service Code	HCPCS C1713
Hospital Charge Code	270688426
Hospital Revenue Code	278
Min. Negotiated Rate	$247.08
Max. Negotiated Rate	$4,350.00
Rate for Payer: Aetna Commercial	$3,306.00
Rate for Payer: Aetna Medicare Advantage	$2,610.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,218.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,218.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,740.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,218.50
Rate for Payer: Cigna Commercial	$4,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,105.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,305.00
Rate for Payer: UnitedHealthcare Community & State	$274.92
Rate for Payer: Wellpoint Medicaid Managed Care	$247.08

SPEEDBRIDGE W/BIOCOMP SWLOCL

Facility

$8,700.00

Service Code	HCPCS C1713
Hospital Charge Code	270688426
Hospital Revenue Code	278
Min. Negotiated Rate	$1,305.00
Max. Negotiated Rate	$2,105.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,740.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,105.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,305.00

SPEEDBRIDGE W/BIO SWIVELOCK

Facility

$11,430.00

Service Code	HCPCS C1776
Hospital Charge Code	270681385
Hospital Revenue Code	278
Min. Negotiated Rate	$324.61
Max. Negotiated Rate	$5,715.00
Rate for Payer: Aetna Commercial	$4,343.40
Rate for Payer: Aetna Medicare Advantage	$3,429.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,914.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,914.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,286.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,914.65
Rate for Payer: Cigna Commercial	$5,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,766.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,714.50
Rate for Payer: UnitedHealthcare Community & State	$361.19
Rate for Payer: Wellpoint Medicaid Managed Care	$324.61

SPEEDBRIDGE W/BIO SWIVELOCK

Facility

$11,430.00

Service Code	HCPCS C1776
Hospital Charge Code	270681385
Hospital Revenue Code	278
Min. Negotiated Rate	$1,714.50
Max. Negotiated Rate	$2,766.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,286.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,766.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,714.50

SPEED COMPRESS IMPLANT SIZING

Facility

$180.00

Service Code	HCPCS C1713
Hospital Charge Code	270659685
Hospital Revenue Code	278
Min. Negotiated Rate	$5.11
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna Commercial	$68.40
Rate for Payer: Aetna Medicare Advantage	$54.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.90
Rate for Payer: Cigna Commercial	$90.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.56
Rate for Payer: Qualcare PPO/HMO/WC	$27.00
Rate for Payer: UnitedHealthcare Community & State	$5.69
Rate for Payer: Wellpoint Medicaid Managed Care	$5.11

SPEED COMPRESS IMPLANT SIZING

Facility

$180.00

Service Code	HCPCS C1713
Hospital Charge Code	270659685
Hospital Revenue Code	278
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$43.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.56
Rate for Payer: Qualcare PPO/HMO/WC	$27.00

SPEEDGRAFT

Facility

$11,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270673596
Hospital Revenue Code	278
Min. Negotiated Rate	$330.15
Max. Negotiated Rate	$5,812.50
Rate for Payer: Aetna Commercial	$4,417.50
Rate for Payer: Aetna Medicare Advantage	$3,487.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,964.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,964.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,964.38
Rate for Payer: Cigna Commercial	$5,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,813.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,743.75
Rate for Payer: UnitedHealthcare Community & State	$367.35
Rate for Payer: Wellpoint Medicaid Managed Care	$330.15

SPEEDGRAFT

Facility

$11,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270673596
Hospital Revenue Code	278
Min. Negotiated Rate	$1,743.75
Max. Negotiated Rate	$2,813.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,813.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,743.75

SPEEDGUIDE VARIAX T8 2.4 2.7MM

Facility

$2,999.70

Service Code	HCPCS C1713
Hospital Charge Code	270700522
Hospital Revenue Code	272
Min. Negotiated Rate	$85.19
Max. Negotiated Rate	$1,499.85
Rate for Payer: Aetna Commercial	$1,139.89
Rate for Payer: Aetna Medicare Advantage	$899.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$764.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$764.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$764.92
Rate for Payer: Cigna Commercial	$1,499.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$779.92
Rate for Payer: Oxford Commercial	$599.94
Rate for Payer: Qualcare PPO/HMO/WC	$449.95
Rate for Payer: UnitedHealthcare Commercial	$599.94
Rate for Payer: UnitedHealthcare Community & State	$94.79
Rate for Payer: Wellpoint Medicaid Managed Care	$85.19

SPEEDGUIDE VARIAX T8 2.4 2.7MM

Facility

$2,999.70

Service Code	HCPCS C1713
Hospital Charge Code	270700522
Hospital Revenue Code	272
Min. Negotiated Rate	$449.95
Max. Negotiated Rate	$449.95
Rate for Payer: Qualcare PPO/HMO/WC	$449.95

SPEED IMPLANT 11x08x08mm

Facility

$3,900.00

Service Code	HCPCS C1713
Hospital Charge Code	270684799
Hospital Revenue Code	278
Min. Negotiated Rate	$585.00
Max. Negotiated Rate	$943.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$780.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$943.80
Rate for Payer: Qualcare PPO/HMO/WC	$585.00

SPEED IMPLANT 11x08x08mm

Facility

$3,900.00

Service Code	HCPCS C1713
Hospital Charge Code	270684799
Hospital Revenue Code	278
Min. Negotiated Rate	$110.76
Max. Negotiated Rate	$1,950.00
Rate for Payer: Aetna Commercial	$1,482.00
Rate for Payer: Aetna Medicare Advantage	$1,170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$994.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$994.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$780.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$994.50
Rate for Payer: Cigna Commercial	$1,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$943.80
Rate for Payer: Qualcare PPO/HMO/WC	$585.00
Rate for Payer: UnitedHealthcare Community & State	$123.24
Rate for Payer: Wellpoint Medicaid Managed Care	$110.76

SPEED IMPLANT 11X10X10MM

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270669876
Hospital Revenue Code	278
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$158.00
Rate for Payer: Wellpoint Medicaid Managed Care	$142.00

SPEED IMPLANT 11X10X10MM

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270669876
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

SPEED IMPLANT 11x12x10mm

Facility

$7,000.00

Hospital Charge Code	270672298
Hospital Revenue Code	278
Min. Negotiated Rate	$198.80
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,660.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00
Rate for Payer: UnitedHealthcare Community & State	$221.20
Rate for Payer: Wellpoint Medicaid Managed Care	$198.80

SPEED IMPLANT 11x12x10mm

Facility

$7,000.00

Hospital Charge Code	270672298
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

SPEED IMPLANT 13x10x10MM

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270677251
Hospital Revenue Code	278
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$158.00
Rate for Payer: Wellpoint Medicaid Managed Care	$142.00

SPEED IMPLANT 13x10x10MM

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270677251
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

SPEED IMPLANT 20x20x20MM

Facility

$10,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270659687
Hospital Revenue Code	278
Min. Negotiated Rate	$305.30
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$4,085.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50
Rate for Payer: UnitedHealthcare Community & State	$339.70
Rate for Payer: Wellpoint Medicaid Managed Care	$305.30

SPEED IMPLANT 20x20x20MM

Facility

$10,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270659687
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

SPEED IMPLANT 25x20x20MM

Facility

$10,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270673177
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

SPEED IMPLANT 25x20x20MM

Facility

$10,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270673177
Hospital Revenue Code	278
Min. Negotiated Rate	$305.30
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$4,085.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50
Rate for Payer: UnitedHealthcare Community & State	$339.70
Rate for Payer: Wellpoint Medicaid Managed Care	$305.30

SPEED IMPLANT 9x10x10MM

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270674296
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

Know your out-of-pocket cost for care.

All Charges