Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PEEK 12x12x7

Facility

$11,140.00

Service Code	HCPCS C1713
Hospital Charge Code	270669949
Hospital Revenue Code	278
Min. Negotiated Rate	$316.38
Max. Negotiated Rate	$5,570.00
Rate for Payer: Aetna Commercial	$4,233.20
Rate for Payer: Aetna Medicare Advantage	$3,342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,840.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,840.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,840.70
Rate for Payer: Cigna Commercial	$5,570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,695.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,671.00
Rate for Payer: UnitedHealthcare Community & State	$352.02
Rate for Payer: Wellpoint Medicaid Managed Care	$316.38

PEEK 12x12x7

Facility

$11,140.00

Service Code	HCPCS C1713
Hospital Charge Code	270669949
Hospital Revenue Code	278
Min. Negotiated Rate	$1,671.00
Max. Negotiated Rate	$2,695.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,695.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,671.00

PEEK CAGE ROIC LORDOTIC COATED

Facility

$20,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270691790
Hospital Revenue Code	278
Min. Negotiated Rate	$568.00
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$7,600.00
Rate for Payer: Aetna Medicare Advantage	$6,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,100.00
Rate for Payer: Cigna Commercial	$10,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00
Rate for Payer: UnitedHealthcare Community & State	$632.00
Rate for Payer: Wellpoint Medicaid Managed Care	$568.00

PEEK CAGE ROIC LORDOTIC COATED

Facility

$20,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270691790
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

PEEK IMPLANT CSI XLG WIFS

Facility

$87,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270697104
Hospital Revenue Code	278
Min. Negotiated Rate	$13,125.00
Max. Negotiated Rate	$21,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21,175.00
Rate for Payer: Qualcare PPO/HMO/WC	$13,125.00

PEEK IMPLANT CSI XLG WIFS

Facility

$87,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270697104
Hospital Revenue Code	278
Min. Negotiated Rate	$2,485.00
Max. Negotiated Rate	$43,750.00
Rate for Payer: Aetna Commercial	$33,250.00
Rate for Payer: Aetna Medicare Advantage	$26,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22,312.50
Rate for Payer: Cigna Commercial	$43,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21,175.00
Rate for Payer: Qualcare PPO/HMO/WC	$13,125.00
Rate for Payer: UnitedHealthcare Community & State	$2,765.00
Rate for Payer: Wellpoint Medicaid Managed Care	$2,485.00

PEEK INTERBODY 12MMX12MMX7M

Facility

$13,500.00

Hospital Charge Code	270661262
Hospital Revenue Code	278
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$3,267.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

PEEK INTERBODY 12MMX12MMX7M

Facility

$13,500.00

Hospital Charge Code	270661262
Hospital Revenue Code	278
Min. Negotiated Rate	$383.40
Max. Negotiated Rate	$6,750.00
Rate for Payer: Aetna Commercial	$5,130.00
Rate for Payer: Aetna Medicare Advantage	$4,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$6,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
Rate for Payer: UnitedHealthcare Community & State	$426.60
Rate for Payer: Wellpoint Medicaid Managed Care	$383.40

PEEK LORDOTIC 12x12x7MM

Facility

$11,140.00

Hospital Charge Code	270659694
Hospital Revenue Code	278
Min. Negotiated Rate	$1,671.00
Max. Negotiated Rate	$2,695.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,695.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,671.00

PEEK LORDOTIC 12x12x7MM

Facility

$11,140.00

Hospital Charge Code	270659694
Hospital Revenue Code	278
Min. Negotiated Rate	$316.38
Max. Negotiated Rate	$5,570.00
Rate for Payer: Aetna Commercial	$4,233.20
Rate for Payer: Aetna Medicare Advantage	$3,342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,840.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,840.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,840.70
Rate for Payer: Cigna Commercial	$5,570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,695.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,671.00
Rate for Payer: UnitedHealthcare Community & State	$352.02
Rate for Payer: Wellpoint Medicaid Managed Care	$316.38

PEEK LORDOTIC 12 X 12 X 8

Facility

$13,500.00

Hospital Charge Code	270659693
Hospital Revenue Code	278
Min. Negotiated Rate	$383.40
Max. Negotiated Rate	$6,750.00
Rate for Payer: Aetna Commercial	$5,130.00
Rate for Payer: Aetna Medicare Advantage	$4,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$6,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
Rate for Payer: UnitedHealthcare Community & State	$426.60
Rate for Payer: Wellpoint Medicaid Managed Care	$383.40

PEEK LORDOTIC 12 X 12 X 8

Facility

$13,500.00

Hospital Charge Code	270659693
Hospital Revenue Code	278
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$3,267.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

PEEK OPTIMA CAGE 9MM OR 10MM

Facility

$2,882.00

Hospital Charge Code	270335968
Hospital Revenue Code	278
Min. Negotiated Rate	$432.30
Max. Negotiated Rate	$697.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$576.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$697.44
Rate for Payer: Qualcare PPO/HMO/WC	$432.30

PEEK OPTIMA CAGE 9MM OR 10MM

Facility

$2,882.00

Hospital Charge Code	270335968
Hospital Revenue Code	278
Min. Negotiated Rate	$81.85
Max. Negotiated Rate	$1,441.00
Rate for Payer: Aetna Commercial	$1,095.16
Rate for Payer: Aetna Medicare Advantage	$864.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$734.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$734.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$576.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$734.91
Rate for Payer: Cigna Commercial	$1,441.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$697.44
Rate for Payer: Qualcare PPO/HMO/WC	$432.30
Rate for Payer: UnitedHealthcare Community & State	$91.07
Rate for Payer: Wellpoint Medicaid Managed Care	$81.85

PEEK OPTIMA LT+1 TANTALUM

Facility

$28,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270686591
Hospital Revenue Code	278
Min. Negotiated Rate	$4,200.00
Max. Negotiated Rate	$6,776.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,776.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,200.00

PEEK OPTIMA LT+1 TANTALUM

Facility

$28,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270686591
Hospital Revenue Code	278
Min. Negotiated Rate	$795.20
Max. Negotiated Rate	$14,000.00
Rate for Payer: Aetna Commercial	$10,640.00
Rate for Payer: Aetna Medicare Advantage	$8,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,140.00
Rate for Payer: Cigna Commercial	$14,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,776.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,200.00
Rate for Payer: UnitedHealthcare Community & State	$884.80
Rate for Payer: Wellpoint Medicaid Managed Care	$795.20

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	$331.29
Max. Negotiated Rate	$5,832.50
Rate for Payer: Aetna Commercial	$4,432.70
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
Rate for Payer: UnitedHealthcare Community & State	$368.61
Rate for Payer: Wellpoint Medicaid Managed Care	$331.29

PEEK PUSHLOCK 2.9x12.5MM

Facility

$1,800.00

Hospital Charge Code	270675325
Hospital Revenue Code	272
Min. Negotiated Rate	$51.12
Max. Negotiated Rate	$900.00
Rate for Payer: Aetna Commercial	$684.00
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	$468.00
Rate for Payer: Oxford Commercial	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$270.00
Rate for Payer: UnitedHealthcare Commercial	$360.00
Rate for Payer: UnitedHealthcare Community & State	$56.88
Rate for Payer: Wellpoint Medicaid Managed Care	$51.12

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 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	$41.18
Max. Negotiated Rate	$725.00
Rate for Payer: Aetna Commercial	$551.00
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
Rate for Payer: UnitedHealthcare Community & State	$45.82
Rate for Payer: Wellpoint Medicaid Managed Care	$41.18

PEEK SUTURTAK 3x12.2MM

Facility

$1,275.00

Hospital Charge Code	270675326
Hospital Revenue Code	272
Min. Negotiated Rate	$36.21
Max. Negotiated Rate	$637.50
Rate for Payer: Aetna Commercial	$484.50
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	$331.50
Rate for Payer: Oxford Commercial	$255.00
Rate for Payer: Qualcare PPO/HMO/WC	$191.25
Rate for Payer: UnitedHealthcare Commercial	$255.00
Rate for Payer: UnitedHealthcare Community & State	$40.29
Rate for Payer: Wellpoint Medicaid Managed Care	$36.21

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 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	$53.25
Max. Negotiated Rate	$937.50
Rate for Payer: Aetna Commercial	$712.50
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
Rate for Payer: UnitedHealthcare Community & State	$59.25
Rate for Payer: Wellpoint Medicaid Managed Care	$53.25

Know your out-of-pocket cost for care.

All Charges