Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BONE CEMENT 10CC STABILIT

Facility

$803.23

Hospital Charge Code	270670676
Hospital Revenue Code	272
Min. Negotiated Rate	$22.81
Max. Negotiated Rate	$401.62
Rate for Payer: Aetna Commercial	$305.23
Rate for Payer: Aetna Medicare Advantage	$240.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.82
Rate for Payer: Cigna Commercial	$401.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.84
Rate for Payer: Oxford Commercial	$160.65
Rate for Payer: Qualcare PPO/HMO/WC	$120.48
Rate for Payer: UnitedHealthcare Commercial	$160.65
Rate for Payer: UnitedHealthcare Community & State	$25.38
Rate for Payer: Wellpoint Medicaid Managed Care	$22.81

BONE CEMENT 10CC STABILIT

Facility

$803.23

Hospital Charge Code	270670676
Hospital Revenue Code	272
Min. Negotiated Rate	$120.48
Max. Negotiated Rate	$120.48
Rate for Payer: Qualcare PPO/HMO/WC	$120.48

BONE CEMENT 40G SIMPLEX SPDSET

Facility

$355.00

Service Code	HCPCS C1713
Hospital Charge Code	270673761
Hospital Revenue Code	278
Min. Negotiated Rate	$53.25
Max. Negotiated Rate	$85.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.91
Rate for Payer: Qualcare PPO/HMO/WC	$53.25

BONE CEMENT 40G SIMPLEX SPDSET

Facility

$355.00

Service Code	HCPCS C1713
Hospital Charge Code	270673761
Hospital Revenue Code	278
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$177.50
Rate for Payer: Aetna Commercial	$134.90
Rate for Payer: Aetna Medicare Advantage	$106.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$90.53
Rate for Payer: Cigna Commercial	$177.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.91
Rate for Payer: Qualcare PPO/HMO/WC	$53.25
Rate for Payer: UnitedHealthcare Community & State	$11.22
Rate for Payer: Wellpoint Medicaid Managed Care	$10.08

BONE CEMENT 40G SIMPLEX SPDSET

Facility

$390.00

Service Code	HCPCS C1713
Hospital Charge Code	270673760
Hospital Revenue Code	278
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.38
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Community & State	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

BONE CEMENT 40G SIMPLEX SPDSET

Facility

$390.00

Service Code	HCPCS C1713
Hospital Charge Code	270673760
Hospital Revenue Code	278
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$94.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.38
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BONE CEMENT HIGH VIS

Facility

$650.00

Hospital Charge Code	270651645
Hospital Revenue Code	272
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

BONE CEMENT HIGH VIS

Facility

$650.00

Hospital Charge Code	270651645
Hospital Revenue Code	272
Min. Negotiated Rate	$18.46
Max. Negotiated Rate	$325.00
Rate for Payer: Aetna Commercial	$247.00
Rate for Payer: Aetna Medicare Advantage	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.75
Rate for Payer: Cigna Commercial	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.00
Rate for Payer: Oxford Commercial	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.50
Rate for Payer: UnitedHealthcare Commercial	$130.00
Rate for Payer: UnitedHealthcare Community & State	$20.54
Rate for Payer: Wellpoint Medicaid Managed Care	$18.46

BONE CEMENT MIXER MIXEVAC 3

Facility

$332.20

Hospital Charge Code	270668624
Hospital Revenue Code	272
Min. Negotiated Rate	$49.83
Max. Negotiated Rate	$49.83
Rate for Payer: Qualcare PPO/HMO/WC	$49.83

BONE CEMENT MIXER MIXEVAC 3

Facility

$332.20

Hospital Charge Code	270668624
Hospital Revenue Code	272
Min. Negotiated Rate	$9.43
Max. Negotiated Rate	$166.10
Rate for Payer: Aetna Commercial	$126.24
Rate for Payer: Aetna Medicare Advantage	$99.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.71
Rate for Payer: Cigna Commercial	$166.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.37
Rate for Payer: Oxford Commercial	$66.44
Rate for Payer: Qualcare PPO/HMO/WC	$49.83
Rate for Payer: UnitedHealthcare Commercial	$66.44
Rate for Payer: UnitedHealthcare Community & State	$10.50
Rate for Payer: Wellpoint Medicaid Managed Care	$9.43

BONE CEMENT SAT MIXING SYS

Facility

$3,318.00

Hospital Charge Code	270670685
Hospital Revenue Code	272
Min. Negotiated Rate	$497.70
Max. Negotiated Rate	$497.70
Rate for Payer: Qualcare PPO/HMO/WC	$497.70

BONE CEMENT SAT MIXING SYS

Facility

$3,318.00

Hospital Charge Code	270670685
Hospital Revenue Code	272
Min. Negotiated Rate	$94.23
Max. Negotiated Rate	$1,659.00
Rate for Payer: Aetna Commercial	$1,260.84
Rate for Payer: Aetna Medicare Advantage	$995.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$846.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$846.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$846.09
Rate for Payer: Cigna Commercial	$1,659.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$862.68
Rate for Payer: Oxford Commercial	$663.60
Rate for Payer: Qualcare PPO/HMO/WC	$497.70
Rate for Payer: UnitedHealthcare Commercial	$663.60
Rate for Payer: UnitedHealthcare Community & State	$104.85
Rate for Payer: Wellpoint Medicaid Managed Care	$94.23

BONE CEMENT SAT MIXING SYS 7CC

Facility

$3,505.00

Hospital Charge Code	270670688
Hospital Revenue Code	272
Min. Negotiated Rate	$99.54
Max. Negotiated Rate	$1,752.50
Rate for Payer: Aetna Commercial	$1,331.90
Rate for Payer: Aetna Medicare Advantage	$1,051.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$893.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$893.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$893.77
Rate for Payer: Cigna Commercial	$1,752.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$911.30
Rate for Payer: Oxford Commercial	$701.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.75
Rate for Payer: UnitedHealthcare Commercial	$701.00
Rate for Payer: UnitedHealthcare Community & State	$110.76
Rate for Payer: Wellpoint Medicaid Managed Care	$99.54

BONE CEMENT SAT MIXING SYS 7CC

Facility

$3,505.00

Hospital Charge Code	270670688
Hospital Revenue Code	272
Min. Negotiated Rate	$525.75
Max. Negotiated Rate	$525.75
Rate for Payer: Qualcare PPO/HMO/WC	$525.75

BONE CEMENT SIMPLEX FULL DOSE

Facility

$390.00

Service Code	HCPCS C1713
Hospital Charge Code	270672934
Hospital Revenue Code	278
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$94.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.38
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BONE CEMENT SIMPLEX FULL DOSE

Facility

$390.00

Service Code	HCPCS C1713
Hospital Charge Code	270672934
Hospital Revenue Code	278
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.38
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Community & State	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

BONE CEMENT SIMPLEX FULL DOSE

Facility

$355.00

Service Code	HCPCS C1713
Hospital Charge Code	270651646
Hospital Revenue Code	278
Min. Negotiated Rate	$53.25
Max. Negotiated Rate	$85.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.91
Rate for Payer: Qualcare PPO/HMO/WC	$53.25

BONE CEMENT SIMPLEX FULL DOSE

Facility

$355.00

Service Code	HCPCS C1713
Hospital Charge Code	270651646
Hospital Revenue Code	278
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$177.50
Rate for Payer: Aetna Commercial	$134.90
Rate for Payer: Aetna Medicare Advantage	$106.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$90.53
Rate for Payer: Cigna Commercial	$177.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.91
Rate for Payer: Qualcare PPO/HMO/WC	$53.25
Rate for Payer: UnitedHealthcare Community & State	$11.22
Rate for Payer: Wellpoint Medicaid Managed Care	$10.08

BONE CEMENT SIMPLEX HALF DOSE

Facility

$249.50

Hospital Charge Code	270673759
Hospital Revenue Code	278
Min. Negotiated Rate	$7.09
Max. Negotiated Rate	$124.75
Rate for Payer: Aetna Commercial	$94.81
Rate for Payer: Aetna Medicare Advantage	$74.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.62
Rate for Payer: Cigna Commercial	$124.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.38
Rate for Payer: Qualcare PPO/HMO/WC	$37.42
Rate for Payer: UnitedHealthcare Community & State	$7.88
Rate for Payer: Wellpoint Medicaid Managed Care	$7.09

BONE CEMENT SIMPLEX HALF DOSE

Facility

$250.00

Hospital Charge Code	270673756
Hospital Revenue Code	278
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$95.00
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) NJ Health	$50.00
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	$60.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Community & State	$7.90
Rate for Payer: Wellpoint Medicaid Managed Care	$7.10

BONE CEMENT SIMPLEX HALF DOSE

Facility

$249.50

Hospital Charge Code	270673759
Hospital Revenue Code	278
Min. Negotiated Rate	$37.42
Max. Negotiated Rate	$60.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.38
Rate for Payer: Qualcare PPO/HMO/WC	$37.42

BONE CEMENT SIMPLEX HALF DOSE

Facility

$250.00

Hospital Charge Code	270673756
Hospital Revenue Code	278
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$60.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

BONE CEMENT SIMPLEX HV

Facility

$355.00

Service Code	HCPCS C1713
Hospital Charge Code	270669204
Hospital Revenue Code	278
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$177.50
Rate for Payer: Aetna Commercial	$134.90
Rate for Payer: Aetna Medicare Advantage	$106.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$90.53
Rate for Payer: Cigna Commercial	$177.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.91
Rate for Payer: Qualcare PPO/HMO/WC	$53.25
Rate for Payer: UnitedHealthcare Community & State	$11.22
Rate for Payer: Wellpoint Medicaid Managed Care	$10.08

BONE CEMENT SIMPLEX HV

Facility

$355.00

Service Code	HCPCS C1713
Hospital Charge Code	270669204
Hospital Revenue Code	278
Min. Negotiated Rate	$53.25
Max. Negotiated Rate	$85.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.91
Rate for Payer: Qualcare PPO/HMO/WC	$53.25

BONE CEMENT SIMPLEX HV

Facility

$355.00

Hospital Charge Code	270673762
Hospital Revenue Code	278
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$177.50
Rate for Payer: Aetna Commercial	$134.90
Rate for Payer: Aetna Medicare Advantage	$106.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$90.53
Rate for Payer: Cigna Commercial	$177.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.91
Rate for Payer: Qualcare PPO/HMO/WC	$53.25
Rate for Payer: UnitedHealthcare Community & State	$11.22
Rate for Payer: Wellpoint Medicaid Managed Care	$10.08

Know your out-of-pocket cost for care.

All Charges