Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SPACER PEEK 12x15x7 6DEG

Facility

$9,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270677681
Hospital Revenue Code	278
Min. Negotiated Rate	$255.60
Max. Negotiated Rate	$4,500.00
Rate for Payer: Aetna Commercial	$3,420.00
Rate for Payer: Aetna Medicare Advantage	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,295.00
Rate for Payer: Cigna Commercial	$4,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00
Rate for Payer: UnitedHealthcare Community & State	$284.40
Rate for Payer: Wellpoint Medicaid Managed Care	$255.60

SPACER PEEK 12x15x7 6DEG

Facility

$9,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270677681
Hospital Revenue Code	278
Min. Negotiated Rate	$1,350.00
Max. Negotiated Rate	$2,178.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00

SPACER PEEK 7D 16X14X6MM

Facility

$24,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270694921
Hospital Revenue Code	278
Min. Negotiated Rate	$3,637.50
Max. Negotiated Rate	$5,868.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,868.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,637.50

SPACER PEEK 7D 16X14X6MM

Facility

$24,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270694921
Hospital Revenue Code	278
Min. Negotiated Rate	$688.70
Max. Negotiated Rate	$12,125.00
Rate for Payer: Aetna Commercial	$9,215.00
Rate for Payer: Aetna Medicare Advantage	$7,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,183.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,183.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,183.75
Rate for Payer: Cigna Commercial	$12,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,868.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,637.50
Rate for Payer: UnitedHealthcare Community & State	$766.30
Rate for Payer: Wellpoint Medicaid Managed Care	$688.70

SPACER PEEK INTERB 7X13X16MM7D

Facility

$4,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270695374
Hospital Revenue Code	278
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$1,028.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: Qualcare PPO/HMO/WC	$637.50

SPACER PEEK INTERB 7X13X16MM7D

Facility

$4,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270695374
Hospital Revenue Code	278
Min. Negotiated Rate	$120.70
Max. Negotiated Rate	$2,125.00
Rate for Payer: Aetna Commercial	$1,615.00
Rate for Payer: Aetna Medicare Advantage	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,083.75
Rate for Payer: Cigna Commercial	$2,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: Qualcare PPO/HMO/WC	$637.50
Rate for Payer: UnitedHealthcare Community & State	$134.30
Rate for Payer: Wellpoint Medicaid Managed Care	$120.70

SPACER PEEK OPT TI 14X12X7MM

Facility

$5,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270699546
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

SPACER PEEK OPT TI 14X12X7MM

Facility

$5,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270699546
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

SPACER PLIF 11X22MM

Facility

$20,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694810
Hospital Revenue Code	278
Min. Negotiated Rate	$582.20
Max. Negotiated Rate	$10,250.00
Rate for Payer: Aetna Commercial	$7,790.00
Rate for Payer: Aetna Medicare Advantage	$6,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,227.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,227.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,227.50
Rate for Payer: Cigna Commercial	$10,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,961.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,075.00
Rate for Payer: UnitedHealthcare Community & State	$647.80
Rate for Payer: Wellpoint Medicaid Managed Care	$582.20

SPACER PLIF 11X22MM

Facility

$20,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694810
Hospital Revenue Code	278
Min. Negotiated Rate	$3,075.00
Max. Negotiated Rate	$4,961.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,961.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,075.00

SPACER PLIF 13X22MM

Facility

$20,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694811
Hospital Revenue Code	278
Min. Negotiated Rate	$582.20
Max. Negotiated Rate	$10,250.00
Rate for Payer: Aetna Commercial	$7,790.00
Rate for Payer: Aetna Medicare Advantage	$6,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,227.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,227.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,227.50
Rate for Payer: Cigna Commercial	$10,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,961.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,075.00
Rate for Payer: UnitedHealthcare Community & State	$647.80
Rate for Payer: Wellpoint Medicaid Managed Care	$582.20

SPACER PLIF 13X22MM

Facility

$20,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694811
Hospital Revenue Code	278
Min. Negotiated Rate	$3,075.00
Max. Negotiated Rate	$4,961.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,961.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,075.00

SPACER PLIF ZFUZE 12X22MM

Facility

$20,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270695411
Hospital Revenue Code	278
Min. Negotiated Rate	$3,075.00
Max. Negotiated Rate	$4,961.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,961.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,075.00

SPACER PLIF ZFUZE 12X22MM

Facility

$20,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270695411
Hospital Revenue Code	278
Min. Negotiated Rate	$582.20
Max. Negotiated Rate	$10,250.00
Rate for Payer: Aetna Commercial	$7,790.00
Rate for Payer: Aetna Medicare Advantage	$6,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,227.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,227.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,227.50
Rate for Payer: Cigna Commercial	$10,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,961.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,075.00
Rate for Payer: UnitedHealthcare Community & State	$647.80
Rate for Payer: Wellpoint Medicaid Managed Care	$582.20

SPACER POLY TIBIAL 20MM

Facility

$8,565.00

Service Code	HCPCS C1776
Hospital Charge Code	270682844
Hospital Revenue Code	278
Min. Negotiated Rate	$1,284.75
Max. Negotiated Rate	$2,072.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,713.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,072.73
Rate for Payer: Qualcare PPO/HMO/WC	$1,284.75

SPACER POLY TIBIAL 20MM

Facility

$8,565.00

Service Code	HCPCS C1776
Hospital Charge Code	270682844
Hospital Revenue Code	278
Min. Negotiated Rate	$243.25
Max. Negotiated Rate	$4,282.50
Rate for Payer: Aetna Commercial	$3,254.70
Rate for Payer: Aetna Medicare Advantage	$2,569.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,184.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,184.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,713.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,184.07
Rate for Payer: Cigna Commercial	$4,282.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,072.73
Rate for Payer: Qualcare PPO/HMO/WC	$1,284.75
Rate for Payer: UnitedHealthcare Community & State	$270.65
Rate for Payer: Wellpoint Medicaid Managed Care	$243.25

SPACER SABLE 10X22X6MM 8D

Facility

$37,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270693833
Hospital Revenue Code	278
Min. Negotiated Rate	$1,065.00
Max. Negotiated Rate	$18,750.00
Rate for Payer: Aetna Commercial	$14,250.00
Rate for Payer: Aetna Medicare Advantage	$11,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,562.50
Rate for Payer: Cigna Commercial	$18,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,075.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00
Rate for Payer: UnitedHealthcare Community & State	$1,185.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1,065.00

SPACER SABLE 10X22X6MM 8D

Facility

$37,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270693833
Hospital Revenue Code	278
Min. Negotiated Rate	$5,625.00
Max. Negotiated Rate	$9,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,075.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00

SPACER SABLE 10X26 7-14MM 15D

Facility

$57,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270693237
Hospital Revenue Code	278
Min. Negotiated Rate	$1,633.00
Max. Negotiated Rate	$28,750.00
Rate for Payer: Aetna Commercial	$21,850.00
Rate for Payer: Aetna Medicare Advantage	$17,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,662.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,662.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,662.50
Rate for Payer: Cigna Commercial	$28,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,915.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,625.00
Rate for Payer: UnitedHealthcare Community & State	$1,817.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1,633.00

SPACER SABLE 10X26 7-14MM 15D

Facility

$57,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270693237
Hospital Revenue Code	278
Min. Negotiated Rate	$8,625.00
Max. Negotiated Rate	$13,915.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,915.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,625.00

SPACER SABLE 10X26 8D

Facility

$37,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270693489
Hospital Revenue Code	278
Min. Negotiated Rate	$5,625.00
Max. Negotiated Rate	$9,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,075.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00

SPACER SABLE 10X26 8D

Facility

$37,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270693489
Hospital Revenue Code	278
Min. Negotiated Rate	$1,065.00
Max. Negotiated Rate	$18,750.00
Rate for Payer: Aetna Commercial	$14,250.00
Rate for Payer: Aetna Medicare Advantage	$11,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,562.50
Rate for Payer: Cigna Commercial	$18,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,075.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00
Rate for Payer: UnitedHealthcare Community & State	$1,185.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1,065.00

SPACERS (FOR RADIUM SEED)

Facility

$126.00

Hospital Charge Code	270335234
Hospital Revenue Code	278
Min. Negotiated Rate	$3.58
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna Commercial	$47.88
Rate for Payer: Aetna Medicare Advantage	$37.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.13
Rate for Payer: Cigna Commercial	$63.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.49
Rate for Payer: Qualcare PPO/HMO/WC	$18.90
Rate for Payer: UnitedHealthcare Community & State	$3.98
Rate for Payer: Wellpoint Medicaid Managed Care	$3.58

SPACERS (FOR RADIUM SEED)

Facility

$126.00

Hospital Charge Code	270335234
Hospital Revenue Code	278
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$30.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.49
Rate for Payer: Qualcare PPO/HMO/WC	$18.90

SPACER SIDE RAIL

Facility

$77.00

Hospital Charge Code	270679661
Hospital Revenue Code	272
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$38.50
Rate for Payer: Aetna Commercial	$29.26
Rate for Payer: Aetna Medicare Advantage	$23.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.64
Rate for Payer: Cigna Commercial	$38.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.02
Rate for Payer: Oxford Commercial	$15.40
Rate for Payer: Qualcare PPO/HMO/WC	$11.55
Rate for Payer: UnitedHealthcare Commercial	$15.40
Rate for Payer: UnitedHealthcare Community & State	$2.43
Rate for Payer: Wellpoint Medicaid Managed Care	$2.19

Know your out-of-pocket cost for care.

All Charges