Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SWIVEL LOCK 5.5 X 22 PEEK

Facility

$1,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270688243
Hospital Revenue Code	278
Min. Negotiated Rate	$296.25
Max. Negotiated Rate	$477.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$477.95
Rate for Payer: Qualcare PPO/HMO/WC	$296.25

SWIVELOCK 4.75MM W/FIBER TAPE

Facility

$3,360.00

Service Code	HCPCS C1713
Hospital Charge Code	270663953
Hospital Revenue Code	278
Min. Negotiated Rate	$504.00
Max. Negotiated Rate	$813.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$672.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$813.12
Rate for Payer: Qualcare PPO/HMO/WC	$504.00

SWIVELOCK 4.75MM W/FIBER TAPE

Facility

$3,360.00

Service Code	HCPCS C1713
Hospital Charge Code	270663953
Hospital Revenue Code	278
Min. Negotiated Rate	$95.42
Max. Negotiated Rate	$1,680.00
Rate for Payer: Aetna Commercial	$1,276.80
Rate for Payer: Aetna Medicare Advantage	$1,008.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$856.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$856.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$672.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$856.80
Rate for Payer: Cigna Commercial	$1,680.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$813.12
Rate for Payer: Qualcare PPO/HMO/WC	$504.00
Rate for Payer: UnitedHealthcare Community & State	$106.18
Rate for Payer: Wellpoint Medicaid Managed Care	$95.42

SWIVELOCK 4.75MM W/TIGER TAPE

Facility

$3,360.00

Hospital Charge Code	270666758
Hospital Revenue Code	278
Min. Negotiated Rate	$504.00
Max. Negotiated Rate	$813.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$672.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$813.12
Rate for Payer: Qualcare PPO/HMO/WC	$504.00

SWIVELOCK 4.75MM W/TIGER TAPE

Facility

$3,360.00

Hospital Charge Code	270666758
Hospital Revenue Code	278
Min. Negotiated Rate	$95.42
Max. Negotiated Rate	$1,680.00
Rate for Payer: Aetna Commercial	$1,276.80
Rate for Payer: Aetna Medicare Advantage	$1,008.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$856.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$856.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$672.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$856.80
Rate for Payer: Cigna Commercial	$1,680.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$813.12
Rate for Payer: Qualcare PPO/HMO/WC	$504.00
Rate for Payer: UnitedHealthcare Community & State	$106.18
Rate for Payer: Wellpoint Medicaid Managed Care	$95.42

SWIVELOCK 9MM TENODESIS SUTURE

Facility

$2,895.00

Service Code	HCPCS C1713
Hospital Charge Code	270664268
Hospital Revenue Code	278
Min. Negotiated Rate	$434.25
Max. Negotiated Rate	$700.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$579.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$700.59
Rate for Payer: Qualcare PPO/HMO/WC	$434.25

SWIVELOCK 9MM TENODESIS SUTURE

Facility

$2,895.00

Service Code	HCPCS C1713
Hospital Charge Code	270664268
Hospital Revenue Code	278
Min. Negotiated Rate	$82.22
Max. Negotiated Rate	$1,447.50
Rate for Payer: Aetna Commercial	$1,100.10
Rate for Payer: Aetna Medicare Advantage	$868.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$738.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$738.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$579.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$738.23
Rate for Payer: Cigna Commercial	$1,447.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$700.59
Rate for Payer: Qualcare PPO/HMO/WC	$434.25
Rate for Payer: UnitedHealthcare Community & State	$91.48
Rate for Payer: Wellpoint Medicaid Managed Care	$82.22

SWIVELOCK BIO-COMP 4.75x24.5MM

Facility

$2,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270676559
Hospital Revenue Code	278
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$1,062.50
Rate for Payer: Aetna Commercial	$807.50
Rate for Payer: Aetna Medicare Advantage	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$541.88
Rate for Payer: Cigna Commercial	$1,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.25
Rate for Payer: Qualcare PPO/HMO/WC	$318.75
Rate for Payer: UnitedHealthcare Community & State	$67.15
Rate for Payer: Wellpoint Medicaid Managed Care	$60.35

SWIVELOCK BIO-COMP 4.75x24.5MM

Facility

$2,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270676559
Hospital Revenue Code	278
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$514.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.25
Rate for Payer: Qualcare PPO/HMO/WC	$318.75

SWIVELOCK BIO-COMP DBL 4.75x19

Facility

$2,100.00

Service Code	HCPCS C1713
Hospital Charge Code	270675920
Hospital Revenue Code	278
Min. Negotiated Rate	$59.64
Max. Negotiated Rate	$1,050.00
Rate for Payer: Aetna Commercial	$798.00
Rate for Payer: Aetna Medicare Advantage	$630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$535.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$535.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$535.50
Rate for Payer: Cigna Commercial	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$508.20
Rate for Payer: Qualcare PPO/HMO/WC	$315.00
Rate for Payer: UnitedHealthcare Community & State	$66.36
Rate for Payer: Wellpoint Medicaid Managed Care	$59.64

SWIVELOCK BIO-COMP DBL 4.75x19

Facility

$2,100.00

Service Code	HCPCS C1713
Hospital Charge Code	270675920
Hospital Revenue Code	278
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$508.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$420.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$508.20
Rate for Payer: Qualcare PPO/HMO/WC	$315.00

SWIVELOCK BIO-COMP-TENCO 6.25x

Facility

$2,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270684943
Hospital Revenue Code	278
Min. Negotiated Rate	$57.51
Max. Negotiated Rate	$1,012.50
Rate for Payer: Aetna Commercial	$769.50
Rate for Payer: Aetna Medicare Advantage	$607.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$516.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$516.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$405.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$516.38
Rate for Payer: Cigna Commercial	$1,012.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$490.05
Rate for Payer: Qualcare PPO/HMO/WC	$303.75
Rate for Payer: UnitedHealthcare Community & State	$63.99
Rate for Payer: Wellpoint Medicaid Managed Care	$57.51

SWIVELOCK BIO-COMP-TENCO 6.25x

Facility

$2,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270684943
Hospital Revenue Code	278
Min. Negotiated Rate	$303.75
Max. Negotiated Rate	$490.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$405.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$490.05
Rate for Payer: Qualcare PPO/HMO/WC	$303.75

SWIVELOCK DISP KIT 2.5x3.8MM

Facility

$1,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270677961
Hospital Revenue Code	278
Min. Negotiated Rate	$39.05
Max. Negotiated Rate	$687.50
Rate for Payer: Aetna Commercial	$522.50
Rate for Payer: Aetna Medicare Advantage	$412.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$350.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$350.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$350.62
Rate for Payer: Cigna Commercial	$687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$332.75
Rate for Payer: Qualcare PPO/HMO/WC	$206.25
Rate for Payer: UnitedHealthcare Community & State	$43.45
Rate for Payer: Wellpoint Medicaid Managed Care	$39.05

SWIVELOCK DISP KIT 2.5x3.8MM

Facility

$1,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270677961
Hospital Revenue Code	278
Min. Negotiated Rate	$206.25
Max. Negotiated Rate	$332.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$332.75
Rate for Payer: Qualcare PPO/HMO/WC	$206.25

SWIVELOCK DOUBLE 5.5

Facility

$2,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270680961
Hospital Revenue Code	278
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$1,062.50
Rate for Payer: Aetna Commercial	$807.50
Rate for Payer: Aetna Medicare Advantage	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$541.88
Rate for Payer: Cigna Commercial	$1,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.25
Rate for Payer: Qualcare PPO/HMO/WC	$318.75
Rate for Payer: UnitedHealthcare Community & State	$67.15
Rate for Payer: Wellpoint Medicaid Managed Care	$60.35

SWIVELOCK DOUBLE 5.5

Facility

$2,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270680961
Hospital Revenue Code	278
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$514.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.25
Rate for Payer: Qualcare PPO/HMO/WC	$318.75

SWIVELOCK DOUBLE 5.5

Facility

$2,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270680965
Hospital Revenue Code	278
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$514.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.25
Rate for Payer: Qualcare PPO/HMO/WC	$318.75

SWIVELOCK DOUBLE 5.5

Facility

$2,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270680965
Hospital Revenue Code	278
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$1,062.50
Rate for Payer: Aetna Commercial	$807.50
Rate for Payer: Aetna Medicare Advantage	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$541.88
Rate for Payer: Cigna Commercial	$1,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.25
Rate for Payer: Qualcare PPO/HMO/WC	$318.75
Rate for Payer: UnitedHealthcare Community & State	$67.15
Rate for Payer: Wellpoint Medicaid Managed Care	$60.35

SWIVELOCK DX 3.5 X13.5

Facility

$2,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270691416
Hospital Revenue Code	278
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$514.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.25
Rate for Payer: Qualcare PPO/HMO/WC	$318.75

SWIVELOCK DX 3.5 X13.5

Facility

$2,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270691416
Hospital Revenue Code	278
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$1,062.50
Rate for Payer: Aetna Commercial	$807.50
Rate for Payer: Aetna Medicare Advantage	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$541.88
Rate for Payer: Cigna Commercial	$1,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.25
Rate for Payer: Qualcare PPO/HMO/WC	$318.75
Rate for Payer: UnitedHealthcare Community & State	$67.15
Rate for Payer: Wellpoint Medicaid Managed Care	$60.35

SWIVELOCK IMPLANT SYSTEM

Facility

$3,200.00

Service Code	HCPCS C1713
Hospital Charge Code	270676064
Hospital Revenue Code	278
Min. Negotiated Rate	$90.88
Max. Negotiated Rate	$1,600.00
Rate for Payer: Aetna Commercial	$1,216.00
Rate for Payer: Aetna Medicare Advantage	$960.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$816.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$816.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$640.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$816.00
Rate for Payer: Cigna Commercial	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$774.40
Rate for Payer: Qualcare PPO/HMO/WC	$480.00
Rate for Payer: UnitedHealthcare Community & State	$101.12
Rate for Payer: Wellpoint Medicaid Managed Care	$90.88

SWIVELOCK IMPLANT SYSTEM

Facility

$3,200.00

Service Code	HCPCS C1713
Hospital Charge Code	270676064
Hospital Revenue Code	278
Min. Negotiated Rate	$480.00
Max. Negotiated Rate	$774.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$640.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$774.40
Rate for Payer: Qualcare PPO/HMO/WC	$480.00

SWIVELOCK KNOTLESS ANCHOR 5.5M

Facility

$2,549.25

Service Code	HCPCS C1713
Hospital Charge Code	270702941
Hospital Revenue Code	278
Min. Negotiated Rate	$382.39
Max. Negotiated Rate	$616.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$509.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$616.92
Rate for Payer: Qualcare PPO/HMO/WC	$382.39

SWIVELOCK KNOTLESS ANCHOR 5.5M

Facility

$2,549.25

Service Code	HCPCS C1713
Hospital Charge Code	270702941
Hospital Revenue Code	278
Min. Negotiated Rate	$72.40
Max. Negotiated Rate	$1,274.62
Rate for Payer: Aetna Commercial	$968.72
Rate for Payer: Aetna Medicare Advantage	$764.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$650.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$650.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$509.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$650.06
Rate for Payer: Cigna Commercial	$1,274.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$616.92
Rate for Payer: Qualcare PPO/HMO/WC	$382.39
Rate for Payer: UnitedHealthcare Community & State	$80.56
Rate for Payer: Wellpoint Medicaid Managed Care	$72.40

Know your out-of-pocket cost for care.

All Charges