Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SPACER CERES 12X15X8 6DEG

Facility

$7,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270692520
Hospital Revenue Code	278
Min. Negotiated Rate	$220.10
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,945.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50
Rate for Payer: UnitedHealthcare Community & State	$244.90
Rate for Payer: Wellpoint Medicaid Managed Care	$220.10

SPACER CERES 12X15X8 6DEG

Facility

$7,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270692520
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

SPACER CERES-C 12X15X6MM 10D

Facility

$6,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270695317
Hospital Revenue Code	278
Min. Negotiated Rate	$176.08
Max. Negotiated Rate	$3,100.00
Rate for Payer: Aetna Commercial	$2,356.00
Rate for Payer: Aetna Medicare Advantage	$1,860.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,581.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,581.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,581.00
Rate for Payer: Cigna Commercial	$3,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,500.40
Rate for Payer: Qualcare PPO/HMO/WC	$930.00
Rate for Payer: UnitedHealthcare Community & State	$195.92
Rate for Payer: Wellpoint Medicaid Managed Care	$176.08

SPACER CERES-C 12X15X6MM 10D

Facility

$6,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270695317
Hospital Revenue Code	278
Min. Negotiated Rate	$930.00
Max. Negotiated Rate	$1,500.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,500.40
Rate for Payer: Qualcare PPO/HMO/WC	$930.00

SPACER CERES-C 12X15X7MM 10D

Facility

$6,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270695244
Hospital Revenue Code	278
Min. Negotiated Rate	$930.00
Max. Negotiated Rate	$1,500.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,500.40
Rate for Payer: Qualcare PPO/HMO/WC	$930.00

SPACER CERES-C 12X15X7MM 10D

Facility

$6,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270695244
Hospital Revenue Code	278
Min. Negotiated Rate	$176.08
Max. Negotiated Rate	$3,100.00
Rate for Payer: Aetna Commercial	$2,356.00
Rate for Payer: Aetna Medicare Advantage	$1,860.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,581.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,581.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,581.00
Rate for Payer: Cigna Commercial	$3,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,500.40
Rate for Payer: Qualcare PPO/HMO/WC	$930.00
Rate for Payer: UnitedHealthcare Community & State	$195.92
Rate for Payer: Wellpoint Medicaid Managed Care	$176.08

SPACER CERES-C 12X15X8 6DEG

Facility

$7,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270682520
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

SPACER CERES-C 12X15X8 6DEG

Facility

$7,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270682520
Hospital Revenue Code	278
Min. Negotiated Rate	$220.10
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,945.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50
Rate for Payer: UnitedHealthcare Community & State	$244.90
Rate for Payer: Wellpoint Medicaid Managed Care	$220.10

SPACER CERES-C 15X12X10MM 6D

Facility

$6,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270697006
Hospital Revenue Code	278
Min. Negotiated Rate	$176.08
Max. Negotiated Rate	$3,100.00
Rate for Payer: Aetna Commercial	$2,356.00
Rate for Payer: Aetna Medicare Advantage	$1,860.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,581.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,581.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,581.00
Rate for Payer: Cigna Commercial	$3,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,500.40
Rate for Payer: Qualcare PPO/HMO/WC	$930.00
Rate for Payer: UnitedHealthcare Community & State	$195.92
Rate for Payer: Wellpoint Medicaid Managed Care	$176.08

SPACER CERES-C 15X12X10MM 6D

Facility

$6,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270697006
Hospital Revenue Code	278
Min. Negotiated Rate	$930.00
Max. Negotiated Rate	$1,500.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,500.40
Rate for Payer: Qualcare PPO/HMO/WC	$930.00

SPACER CERES-C 6D 12X15X7MM

Facility

$7,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270694122
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

SPACER CERES-C 6D 12X15X7MM

Facility

$7,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270694122
Hospital Revenue Code	278
Min. Negotiated Rate	$220.10
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,945.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50
Rate for Payer: UnitedHealthcare Community & State	$244.90
Rate for Payer: Wellpoint Medicaid Managed Care	$220.10

SPACER CERV HIV-C 18X14X6MM 6D

Facility

$21,097.50

Service Code	HCPCS C1889
Hospital Charge Code	270698669
Hospital Revenue Code	278
Min. Negotiated Rate	$3,164.62
Max. Negotiated Rate	$5,105.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,219.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,105.60
Rate for Payer: Qualcare PPO/HMO/WC	$3,164.62

SPACER CERV HIV-C 18X14X6MM 6D

Facility

$21,097.50

Service Code	HCPCS C1889
Hospital Charge Code	270698669
Hospital Revenue Code	278
Min. Negotiated Rate	$599.17
Max. Negotiated Rate	$10,548.75
Rate for Payer: Aetna Commercial	$8,017.05
Rate for Payer: Aetna Medicare Advantage	$6,329.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,379.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,379.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,219.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,379.86
Rate for Payer: Cigna Commercial	$10,548.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,105.60
Rate for Payer: Qualcare PPO/HMO/WC	$3,164.62
Rate for Payer: UnitedHealthcare Community & State	$666.68
Rate for Payer: Wellpoint Medicaid Managed Care	$599.17

SPACER CERVICAL 6D 16X14X7MM

Facility

$20,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270697544
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

SPACER CERVICAL 6D 16X14X7MM

Facility

$20,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270697544
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

SPACER CERV LORD 6D 16X14X7

Facility

$23,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270693595
Hospital Revenue Code	278
Min. Negotiated Rate	$674.50
Max. Negotiated Rate	$11,875.00
Rate for Payer: Aetna Commercial	$9,025.00
Rate for Payer: Aetna Medicare Advantage	$7,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,056.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,056.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,056.25
Rate for Payer: Cigna Commercial	$11,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,747.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,562.50
Rate for Payer: UnitedHealthcare Community & State	$750.50
Rate for Payer: Wellpoint Medicaid Managed Care	$674.50

SPACER CERV LORD 6D 16X14X7

Facility

$23,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270693595
Hospital Revenue Code	278
Min. Negotiated Rate	$3,562.50
Max. Negotiated Rate	$5,747.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,747.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,562.50

SPACER CEV BLACKHWK CONV 14X12

Facility

$23,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270693379
Hospital Revenue Code	278
Min. Negotiated Rate	$674.50
Max. Negotiated Rate	$11,875.00
Rate for Payer: Aetna Commercial	$9,025.00
Rate for Payer: Aetna Medicare Advantage	$7,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,056.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,056.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,056.25
Rate for Payer: Cigna Commercial	$11,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,747.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,562.50
Rate for Payer: UnitedHealthcare Community & State	$750.50
Rate for Payer: Wellpoint Medicaid Managed Care	$674.50

SPACER CEV BLACKHWK CONV 14X12

Facility

$23,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270693379
Hospital Revenue Code	278
Min. Negotiated Rate	$3,562.50
Max. Negotiated Rate	$5,747.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,747.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,562.50

SPACER COALIT 12X14 O D 5MM

Facility

$31,880.00

Service Code	HCPCS C1889
Hospital Charge Code	270694203
Hospital Revenue Code	278
Min. Negotiated Rate	$4,782.00
Max. Negotiated Rate	$7,714.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,376.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,714.96
Rate for Payer: Qualcare PPO/HMO/WC	$4,782.00

SPACER COALIT 12X14 O D 5MM

Facility

$31,880.00

Service Code	HCPCS C1889
Hospital Charge Code	270694203
Hospital Revenue Code	278
Min. Negotiated Rate	$905.39
Max. Negotiated Rate	$15,940.00
Rate for Payer: Aetna Commercial	$12,114.40
Rate for Payer: Aetna Medicare Advantage	$9,564.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,129.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,129.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,376.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,129.40
Rate for Payer: Cigna Commercial	$15,940.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,714.96
Rate for Payer: Qualcare PPO/HMO/WC	$4,782.00
Rate for Payer: UnitedHealthcare Community & State	$1,007.41
Rate for Payer: Wellpoint Medicaid Managed Care	$905.39

SPACER COALIT 12X14 O D 6MM

Facility

$31,880.00

Service Code	HCPCS C1889
Hospital Charge Code	270694202
Hospital Revenue Code	278
Min. Negotiated Rate	$4,782.00
Max. Negotiated Rate	$7,714.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,376.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,714.96
Rate for Payer: Qualcare PPO/HMO/WC	$4,782.00

SPACER COALIT 12X14 O D 6MM

Facility

$31,880.00

Service Code	HCPCS C1889
Hospital Charge Code	270694202
Hospital Revenue Code	278
Min. Negotiated Rate	$905.39
Max. Negotiated Rate	$15,940.00
Rate for Payer: Aetna Commercial	$12,114.40
Rate for Payer: Aetna Medicare Advantage	$9,564.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,129.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,129.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,376.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,129.40
Rate for Payer: Cigna Commercial	$15,940.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,714.96
Rate for Payer: Qualcare PPO/HMO/WC	$4,782.00
Rate for Payer: UnitedHealthcare Community & State	$1,007.41
Rate for Payer: Wellpoint Medicaid Managed Care	$905.39

SPACERCOALITIONMIS12X14X7MM0D

Facility

$31,880.00

Service Code	HCPCS C1889
Hospital Charge Code	270694453
Hospital Revenue Code	278
Min. Negotiated Rate	$4,782.00
Max. Negotiated Rate	$7,714.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,376.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,714.96
Rate for Payer: Qualcare PPO/HMO/WC	$4,782.00

Know your out-of-pocket cost for care.

All Charges