Heights University Hospital

All Charges

Charge

Type

Setting

Price

PEEK OPTIMA LT1 TANTALUM

Facility

$11,665.00

Service Code	HCPCS C1713
Hospital Charge Code	270688032
Hospital Revenue Code	278
Min. Negotiated Rate	$1,749.75
Max. Negotiated Rate	$2,822.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,333.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,822.93
Rate for Payer: Qualcare PPO/HMO/WC	$1,749.75

PEEK OPTIMA LT1 TANTALUM

Facility

$11,665.00

Service Code	HCPCS C1713
Hospital Charge Code	270688032
Hospital Revenue Code	278
Min. Negotiated Rate	$1,749.75
Max. Negotiated Rate	$5,832.50
Rate for Payer: Aetna Commercial	$3,499.50
Rate for Payer: Aetna Medicare Advantage	$3,499.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,974.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,974.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,333.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,974.57
Rate for Payer: Cigna Commercial	$5,832.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,822.93
Rate for Payer: Qualcare PPO/HMO/WC	$1,749.75

PEEK PSACKER 11 X 11 X 9

Facility

$10,675.00

Hospital Charge Code	270657421
Hospital Revenue Code	278
Min. Negotiated Rate	$1,601.25
Max. Negotiated Rate	$2,583.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,583.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,601.25

PEEK PSACKER 11 X 11 X 9

Facility

$10,675.00

Hospital Charge Code	270657421
Hospital Revenue Code	278
Min. Negotiated Rate	$1,601.25
Max. Negotiated Rate	$5,337.50
Rate for Payer: Aetna Commercial	$3,202.50
Rate for Payer: Aetna Medicare Advantage	$3,202.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,722.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,722.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,722.12
Rate for Payer: Cigna Commercial	$5,337.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,583.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,601.25

PEEK PUSHLOCK 2.9x12.5MM

Facility

$1,800.00

Hospital Charge Code	270675325
Hospital Revenue Code	272
Min. Negotiated Rate	$270.00
Max. Negotiated Rate	$270.00
Rate for Payer: Qualcare PPO/HMO/WC	$270.00

PEEK PUSHLOCK 2.9x12.5MM

Facility

$1,800.00

Hospital Charge Code	270675325
Hospital Revenue Code	272
Min. Negotiated Rate	$234.00
Max. Negotiated Rate	$900.00
Rate for Payer: Aetna Commercial	$540.00
Rate for Payer: Aetna Medicare Advantage	$540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$459.00
Rate for Payer: Cigna Commercial	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$234.00
Rate for Payer: Oxford Commercial	$900.00
Rate for Payer: Qualcare PPO/HMO/WC	$270.00
Rate for Payer: UnitedHealthcare Commercial	$900.00

peek spacer 11 x 11 x 8

Facility

$10,675.00

Hospital Charge Code	270657501
Hospital Revenue Code	278
Min. Negotiated Rate	$1,601.25
Max. Negotiated Rate	$2,583.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,583.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,601.25

peek spacer 11 x 11 x 8

Facility

$10,675.00

Hospital Charge Code	270657501
Hospital Revenue Code	278
Min. Negotiated Rate	$1,601.25
Max. Negotiated Rate	$5,337.50
Rate for Payer: Aetna Commercial	$3,202.50
Rate for Payer: Aetna Medicare Advantage	$3,202.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,722.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,722.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,722.12
Rate for Payer: Cigna Commercial	$5,337.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,583.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,601.25

PEEK SUTURE TAK 3 MM X 14.5

Facility

$1,450.00

Service Code	HCPCS C1713
Hospital Charge Code	270693093
Hospital Revenue Code	278
Min. Negotiated Rate	$217.50
Max. Negotiated Rate	$350.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$350.90
Rate for Payer: Qualcare PPO/HMO/WC	$217.50

PEEK SUTURE TAK 3 MM X 14.5

Facility

$1,450.00

Service Code	HCPCS C1713
Hospital Charge Code	270693093
Hospital Revenue Code	278
Min. Negotiated Rate	$217.50
Max. Negotiated Rate	$725.00
Rate for Payer: Aetna Commercial	$435.00
Rate for Payer: Aetna Medicare Advantage	$435.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$290.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$369.75
Rate for Payer: Cigna Commercial	$725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$350.90
Rate for Payer: Qualcare PPO/HMO/WC	$217.50

PEEK SUTURTAK 3x12.2MM

Facility

$1,275.00

Hospital Charge Code	270675326
Hospital Revenue Code	272
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$191.25
Rate for Payer: Qualcare PPO/HMO/WC	$191.25

PEEK SUTURTAK 3x12.2MM

Facility

$1,275.00

Hospital Charge Code	270675326
Hospital Revenue Code	272
Min. Negotiated Rate	$165.75
Max. Negotiated Rate	$637.50
Rate for Payer: Aetna Commercial	$382.50
Rate for Payer: Aetna Medicare Advantage	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$325.12
Rate for Payer: Cigna Commercial	$637.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.75
Rate for Payer: Oxford Commercial	$637.50
Rate for Payer: Qualcare PPO/HMO/WC	$191.25
Rate for Payer: UnitedHealthcare Commercial	$637.50

PEEK SWIVELOCK 3.9 X 17.9 MM

Facility

$1,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270687857
Hospital Revenue Code	278
Min. Negotiated Rate	$281.25
Max. Negotiated Rate	$937.50
Rate for Payer: Aetna Commercial	$562.50
Rate for Payer: Aetna Medicare Advantage	$562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$478.12
Rate for Payer: Cigna Commercial	$937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.75
Rate for Payer: Qualcare PPO/HMO/WC	$281.25

PEEK SWIVELOCK 3.9 X 17.9 MM

Facility

$1,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270687857
Hospital Revenue Code	278
Min. Negotiated Rate	$281.25
Max. Negotiated Rate	$453.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.75
Rate for Payer: Qualcare PPO/HMO/WC	$281.25

PEEK SWIVELOCK 4.75 X 191

Facility

$2,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270690218
Hospital Revenue Code	278
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$1,062.50
Rate for Payer: Aetna Commercial	$637.50
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

PEEK SWIVELOCK 4.75 X 191

Facility

$2,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270690218
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

PEEL-AWAY INTRODUCER 10FR 30c

Facility

$495.00

Hospital Charge Code	270CH0107
Hospital Revenue Code	272
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$74.25
Rate for Payer: Qualcare PPO/HMO/WC	$74.25

PEEL-AWAY INTRODUCER 10FR 30c

Facility

$495.00

Hospital Charge Code	270CH0107
Hospital Revenue Code	272
Min. Negotiated Rate	$64.35
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna Commercial	$148.50
Rate for Payer: Aetna Medicare Advantage	$148.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.22
Rate for Payer: Cigna Commercial	$247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.35
Rate for Payer: Oxford Commercial	$247.50
Rate for Payer: Qualcare PPO/HMO/WC	$74.25
Rate for Payer: UnitedHealthcare Commercial	$247.50

PEEL-AWAY INTRODUCER 12FR 15.

Facility

$250.00

Hospital Charge Code	270CH0106
Hospital Revenue Code	272
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

PEEL-AWAY INTRODUCER 12FR 15.

Facility

$250.00

Hospital Charge Code	270CH0106
Hospital Revenue Code	272
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$125.00

PEEL-AWAY INTRODUCER 13FR 30c

Facility

$495.00

Hospital Charge Code	270CH0108
Hospital Revenue Code	272
Min. Negotiated Rate	$64.35
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna Commercial	$148.50
Rate for Payer: Aetna Medicare Advantage	$148.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.22
Rate for Payer: Cigna Commercial	$247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.35
Rate for Payer: Oxford Commercial	$247.50
Rate for Payer: Qualcare PPO/HMO/WC	$74.25
Rate for Payer: UnitedHealthcare Commercial	$247.50

PEEL-AWAY INTRODUCER 13FR 30c

Facility

$495.00

Hospital Charge Code	270CH0108
Hospital Revenue Code	272
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$74.25
Rate for Payer: Qualcare PPO/HMO/WC	$74.25

PEEL-AWAY INTRODUCER 18FR 30c

Facility

$495.00

Hospital Charge Code	270CH0109
Hospital Revenue Code	272
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$74.25
Rate for Payer: Qualcare PPO/HMO/WC	$74.25

PEEL-AWAY INTRODUCER 18FR 30c

Facility

$495.00

Hospital Charge Code	270CH0109
Hospital Revenue Code	272
Min. Negotiated Rate	$64.35
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna Commercial	$148.50
Rate for Payer: Aetna Medicare Advantage	$148.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.22
Rate for Payer: Cigna Commercial	$247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.35
Rate for Payer: Oxford Commercial	$247.50
Rate for Payer: Qualcare PPO/HMO/WC	$74.25
Rate for Payer: UnitedHealthcare Commercial	$247.50

PEEL-AWAY INTRODUCER 5FR 15.5

Facility

$250.00

Hospital Charge Code	270CH0102
Hospital Revenue Code	272
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$125.00

Know your out-of-pocket cost for care.

All Charges