Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PLATE CERES 3 LEVEL 42MM

Facility

$4,800.00

Service Code	HCPCS C1713
Hospital Charge Code	270695468
Hospital Revenue Code	278
Min. Negotiated Rate	$720.00
Max. Negotiated Rate	$1,161.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$960.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.60
Rate for Payer: Qualcare PPO/HMO/WC	$720.00

PLATE CERES 3 LEVEL 42MM

Facility

$4,800.00

Service Code	HCPCS C1713
Hospital Charge Code	270695468
Hospital Revenue Code	278
Min. Negotiated Rate	$136.32
Max. Negotiated Rate	$2,400.00
Rate for Payer: Aetna Commercial	$1,824.00
Rate for Payer: Aetna Medicare Advantage	$1,440.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,224.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,224.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$960.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,224.00
Rate for Payer: Cigna Commercial	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.60
Rate for Payer: Qualcare PPO/HMO/WC	$720.00
Rate for Payer: UnitedHealthcare Community & State	$151.68
Rate for Payer: Wellpoint Medicaid Managed Care	$136.32

PLATE CERES ACP 2 LEVEL 28 MM

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270693004
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

PLATE CERES ACP 2 LEVEL 28 MM

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270693004
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

PLATE CERES-C 8MM

Facility

$10,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270692529
Hospital Revenue Code	278
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$316.00
Rate for Payer: Wellpoint Medicaid Managed Care	$284.00

PLATE CERES-C 8MM

Facility

$10,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270692529
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

PLATE CERES-C INTERBODY 7MM

Facility

$10,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270694123
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

PLATE CERES-C INTERBODY 7MM

Facility

$10,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270694123
Hospital Revenue Code	278
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$316.00
Rate for Payer: Wellpoint Medicaid Managed Care	$284.00

PLATE CERV 1LEV SAPPHIREX 13MM

Facility

$6,600.00

Service Code	HCPCS C1713
Hospital Charge Code	270694724
Hospital Revenue Code	278
Min. Negotiated Rate	$187.44
Max. Negotiated Rate	$3,300.00
Rate for Payer: Aetna Commercial	$2,508.00
Rate for Payer: Aetna Medicare Advantage	$1,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.00
Rate for Payer: Cigna Commercial	$3,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: Qualcare PPO/HMO/WC	$990.00
Rate for Payer: UnitedHealthcare Community & State	$208.56
Rate for Payer: Wellpoint Medicaid Managed Care	$187.44

PLATE CERV 1LEV SAPPHIREX 13MM

Facility

$6,600.00

Service Code	HCPCS C1713
Hospital Charge Code	270694724
Hospital Revenue Code	278
Min. Negotiated Rate	$990.00
Max. Negotiated Rate	$1,597.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: Qualcare PPO/HMO/WC	$990.00

PLATE CERV 3LEVEL 14MM

Facility

$19,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270693406
Hospital Revenue Code	278
Min. Negotiated Rate	$2,887.50
Max. Negotiated Rate	$4,658.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,658.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,887.50

PLATE CERV 3LEVEL 14MM

Facility

$19,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270693406
Hospital Revenue Code	278
Min. Negotiated Rate	$546.70
Max. Negotiated Rate	$9,625.00
Rate for Payer: Aetna Commercial	$7,315.00
Rate for Payer: Aetna Medicare Advantage	$5,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,908.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,908.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,908.75
Rate for Payer: Cigna Commercial	$9,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,658.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,887.50
Rate for Payer: UnitedHealthcare Community & State	$608.30
Rate for Payer: Wellpoint Medicaid Managed Care	$546.70

PLATE CERV ANT 1.6V 20MM 1LEV

Facility

$11,203.50

Service Code	HCPCS C1713
Hospital Charge Code	270696332
Hospital Revenue Code	278
Min. Negotiated Rate	$318.18
Max. Negotiated Rate	$5,601.75
Rate for Payer: Aetna Commercial	$4,257.33
Rate for Payer: Aetna Medicare Advantage	$3,361.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,856.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,856.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,240.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,856.89
Rate for Payer: Cigna Commercial	$5,601.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,711.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,680.53
Rate for Payer: UnitedHealthcare Community & State	$354.03
Rate for Payer: Wellpoint Medicaid Managed Care	$318.18

PLATE CERV ANT 1.6V 20MM 1LEV

Facility

$11,203.50

Service Code	HCPCS C1713
Hospital Charge Code	270696332
Hospital Revenue Code	278
Min. Negotiated Rate	$1,680.53
Max. Negotiated Rate	$2,711.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,240.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,711.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,680.53

PLATE CERV ANT 1LEVEL 10MM

Facility

$16,747.50

Service Code	HCPCS C1713
Hospital Charge Code	270698384
Hospital Revenue Code	278
Min. Negotiated Rate	$2,512.12
Max. Negotiated Rate	$4,052.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,349.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,052.89
Rate for Payer: Qualcare PPO/HMO/WC	$2,512.12

PLATE CERV ANT 1LEVEL 10MM

Facility

$16,747.50

Service Code	HCPCS C1713
Hospital Charge Code	270698384
Hospital Revenue Code	278
Min. Negotiated Rate	$475.63
Max. Negotiated Rate	$8,373.75
Rate for Payer: Aetna Commercial	$6,364.05
Rate for Payer: Aetna Medicare Advantage	$5,024.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,270.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,270.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,349.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,270.61
Rate for Payer: Cigna Commercial	$8,373.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,052.89
Rate for Payer: Qualcare PPO/HMO/WC	$2,512.12
Rate for Payer: UnitedHealthcare Community & State	$529.22
Rate for Payer: Wellpoint Medicaid Managed Care	$475.63

PLATE CERV ANT 2LEVEL 28MM

Facility

$16,747.50

Service Code	HCPCS C1713
Hospital Charge Code	270698386
Hospital Revenue Code	278
Min. Negotiated Rate	$2,512.12
Max. Negotiated Rate	$4,052.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,349.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,052.89
Rate for Payer: Qualcare PPO/HMO/WC	$2,512.12

PLATE CERV ANT 2LEVEL 28MM

Facility

$16,747.50

Service Code	HCPCS C1713
Hospital Charge Code	270698386
Hospital Revenue Code	278
Min. Negotiated Rate	$475.63
Max. Negotiated Rate	$8,373.75
Rate for Payer: Aetna Commercial	$6,364.05
Rate for Payer: Aetna Medicare Advantage	$5,024.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,270.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,270.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,349.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,270.61
Rate for Payer: Cigna Commercial	$8,373.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,052.89
Rate for Payer: Qualcare PPO/HMO/WC	$2,512.12
Rate for Payer: UnitedHealthcare Community & State	$529.22
Rate for Payer: Wellpoint Medicaid Managed Care	$475.63

PLATE CERV ANT CYGNUS 2LVL26MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270698899
Hospital Revenue Code	278
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

PLATE CERV ANT CYGNUS 2LVL26MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270698899
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

PLATE CERV ANT CYGNUS 8MM 1LEV

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270699281
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

PLATE CERV ANT CYGNUS 8MM 1LEV

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270699281
Hospital Revenue Code	278
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

PLATE CERV APTITUDE 1LEV 14MM

Facility

$19,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270695376
Hospital Revenue Code	278
Min. Negotiated Rate	$2,887.50
Max. Negotiated Rate	$4,658.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,658.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,887.50

PLATE CERV APTITUDE 1LEV 14MM

Facility

$19,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270695376
Hospital Revenue Code	278
Min. Negotiated Rate	$546.70
Max. Negotiated Rate	$9,625.00
Rate for Payer: Aetna Commercial	$7,315.00
Rate for Payer: Aetna Medicare Advantage	$5,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,908.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,908.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,908.75
Rate for Payer: Cigna Commercial	$9,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,658.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,887.50
Rate for Payer: UnitedHealthcare Community & State	$608.30
Rate for Payer: Wellpoint Medicaid Managed Care	$546.70

PLATE CERV CERES 3LEVEL 45MM

Facility

$4,800.00

Service Code	HCPCS C1713
Hospital Charge Code	270696503
Hospital Revenue Code	278
Min. Negotiated Rate	$720.00
Max. Negotiated Rate	$1,161.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$960.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.60
Rate for Payer: Qualcare PPO/HMO/WC	$720.00

Know your out-of-pocket cost for care.

All Charges