Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CEMENT BONE RADIOPQUE HVR C01A

Facility

$650.00

Service Code	HCPCS C1713
Hospital Charge Code	270633797
Hospital Revenue Code	278
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) NJ Health	$130.00
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	$157.30
Rate for Payer: Qualcare PPO/HMO/WC	$97.50
Rate for Payer: UnitedHealthcare Community & State	$20.54
Rate for Payer: Wellpoint Medicaid Managed Care	$18.46

CEMENT BONE RADIOPQUE HVR C01A

Facility

$650.00

Service Code	HCPCS C1713
Hospital Charge Code	270633797
Hospital Revenue Code	278
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$157.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.30
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

CEMENT BONESYNC 5CC PHOSPHATE

Facility

$8,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270692085
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

CEMENT BONESYNC 5CC PHOSPHATE

Facility

$8,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270692085
Hospital Revenue Code	278
Min. Negotiated Rate	$234.30
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Community & State	$260.70
Rate for Payer: Wellpoint Medicaid Managed Care	$234.30

CEMENT FEMORAL RESTRICTOR SZ2

Facility

$397.50

Service Code	HCPCS C1713
Hospital Charge Code	270655655
Hospital Revenue Code	278
Min. Negotiated Rate	$59.62
Max. Negotiated Rate	$96.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.19
Rate for Payer: Qualcare PPO/HMO/WC	$59.62

CEMENT FEMORAL RESTRICTOR SZ2

Facility

$397.50

Service Code	HCPCS C1713
Hospital Charge Code	270655655
Hospital Revenue Code	278
Min. Negotiated Rate	$11.29
Max. Negotiated Rate	$198.75
Rate for Payer: Aetna Commercial	$151.05
Rate for Payer: Aetna Medicare Advantage	$119.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$101.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$101.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$101.36
Rate for Payer: Cigna Commercial	$198.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.19
Rate for Payer: Qualcare PPO/HMO/WC	$59.62
Rate for Payer: UnitedHealthcare Community & State	$12.56
Rate for Payer: Wellpoint Medicaid Managed Care	$11.29

CEMENTLESS ACETAB SHELL 56MM.

Facility

$9,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270703600
Hospital Revenue Code	278
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$2,299.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,299.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CEMENTLESS ACETAB SHELL 56MM.

Facility

$9,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270703600
Hospital Revenue Code	278
Min. Negotiated Rate	$269.80
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$3,610.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,299.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Community & State	$300.20
Rate for Payer: Wellpoint Medicaid Managed Care	$269.80

CEMENTLESS EXTENSION STEM 15M

Facility

$8,990.00

Service Code	HCPCS C1776
Hospital Charge Code	270687677
Hospital Revenue Code	278
Min. Negotiated Rate	$1,348.50
Max. Negotiated Rate	$2,175.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,798.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,175.58
Rate for Payer: Qualcare PPO/HMO/WC	$1,348.50

CEMENTLESS EXTENSION STEM 15M

Facility

$8,990.00

Service Code	HCPCS C1776
Hospital Charge Code	270687677
Hospital Revenue Code	278
Min. Negotiated Rate	$255.32
Max. Negotiated Rate	$4,495.00
Rate for Payer: Aetna Commercial	$3,416.20
Rate for Payer: Aetna Medicare Advantage	$2,697.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,292.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,292.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,798.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,292.45
Rate for Payer: Cigna Commercial	$4,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,175.58
Rate for Payer: Qualcare PPO/HMO/WC	$1,348.50
Rate for Payer: UnitedHealthcare Community & State	$284.08
Rate for Payer: Wellpoint Medicaid Managed Care	$255.32

CEMENT MIXING BOWL COMPACT VAC

Facility

$1,425.00

Hospital Charge Code	270678378
Hospital Revenue Code	272
Min. Negotiated Rate	$213.75
Max. Negotiated Rate	$213.75
Rate for Payer: Qualcare PPO/HMO/WC	$213.75

CEMENT MIXING BOWL COMPACT VAC

Facility

$1,425.00

Hospital Charge Code	270678378
Hospital Revenue Code	272
Min. Negotiated Rate	$40.47
Max. Negotiated Rate	$712.50
Rate for Payer: Aetna Commercial	$541.50
Rate for Payer: Aetna Medicare Advantage	$427.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$363.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$363.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$363.38
Rate for Payer: Cigna Commercial	$712.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$370.50
Rate for Payer: Oxford Commercial	$285.00
Rate for Payer: Qualcare PPO/HMO/WC	$213.75
Rate for Payer: UnitedHealthcare Commercial	$285.00
Rate for Payer: UnitedHealthcare Community & State	$45.03
Rate for Payer: Wellpoint Medicaid Managed Care	$40.47

CEMENT MIXING/DELIVERY SYSTEM

Facility

$568.75

Service Code	HCPCS C1713
Hospital Charge Code	270677293
Hospital Revenue Code	278
Min. Negotiated Rate	$16.15
Max. Negotiated Rate	$284.38
Rate for Payer: Aetna Commercial	$216.12
Rate for Payer: Aetna Medicare Advantage	$170.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$145.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$145.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$113.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$145.03
Rate for Payer: Cigna Commercial	$284.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.64
Rate for Payer: Qualcare PPO/HMO/WC	$85.31
Rate for Payer: UnitedHealthcare Community & State	$17.97
Rate for Payer: Wellpoint Medicaid Managed Care	$16.15

CEMENT MIXING/DELIVERY SYSTEM

Facility

$568.75

Service Code	HCPCS C1713
Hospital Charge Code	270677293
Hospital Revenue Code	278
Min. Negotiated Rate	$85.31
Max. Negotiated Rate	$137.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$113.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.64
Rate for Payer: Qualcare PPO/HMO/WC	$85.31

CEMENT MIXING SYSTEM

Facility

$352.00

Hospital Charge Code	270335504
Hospital Revenue Code	272
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$176.00
Rate for Payer: Aetna Commercial	$133.76
Rate for Payer: Aetna Medicare Advantage	$105.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.76
Rate for Payer: Cigna Commercial	$176.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.52
Rate for Payer: Oxford Commercial	$70.40
Rate for Payer: Qualcare PPO/HMO/WC	$52.80
Rate for Payer: UnitedHealthcare Commercial	$70.40
Rate for Payer: UnitedHealthcare Community & State	$11.12
Rate for Payer: Wellpoint Medicaid Managed Care	$10.00

CEMENT MIXING SYSTEM

Facility

$352.00

Hospital Charge Code	270335504
Hospital Revenue Code	272
Min. Negotiated Rate	$52.80
Max. Negotiated Rate	$52.80
Rate for Payer: Qualcare PPO/HMO/WC	$52.80

CEMENT MVX PLUS 10CC

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270699969
Hospital Revenue Code	278
Min. Negotiated Rate	$28.40
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$31.60
Rate for Payer: Wellpoint Medicaid Managed Care	$28.40

CEMENT MVX PLUS 10CC

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270699969
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CEMENT OSSILIX FIL 10CC

Facility

$11,985.00

Service Code	HCPCS C1713
Hospital Charge Code	270682056
Hospital Revenue Code	278
Min. Negotiated Rate	$1,797.75
Max. Negotiated Rate	$2,900.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,397.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,900.37
Rate for Payer: Qualcare PPO/HMO/WC	$1,797.75

CEMENT OSSILIX FIL 10CC

Facility

$11,985.00

Service Code	HCPCS C1713
Hospital Charge Code	270682056
Hospital Revenue Code	278
Min. Negotiated Rate	$340.37
Max. Negotiated Rate	$5,992.50
Rate for Payer: Aetna Commercial	$4,554.30
Rate for Payer: Aetna Medicare Advantage	$3,595.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,056.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,056.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,397.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,056.18
Rate for Payer: Cigna Commercial	$5,992.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,900.37
Rate for Payer: Qualcare PPO/HMO/WC	$1,797.75
Rate for Payer: UnitedHealthcare Community & State	$378.73
Rate for Payer: Wellpoint Medicaid Managed Care	$340.37

CEMENT PALACOS BONE 424800

Facility

$545.00

Service Code	HCPCS C1713
Hospital Charge Code	270618650
Hospital Revenue Code	278
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$272.50
Rate for Payer: Aetna Commercial	$207.10
Rate for Payer: Aetna Medicare Advantage	$163.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$138.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$138.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$109.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$138.97
Rate for Payer: Cigna Commercial	$272.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.89
Rate for Payer: Qualcare PPO/HMO/WC	$81.75
Rate for Payer: UnitedHealthcare Community & State	$17.22
Rate for Payer: Wellpoint Medicaid Managed Care	$15.48

CEMENT PALACOS BONE 424800

Facility

$545.00

Service Code	HCPCS C1713
Hospital Charge Code	270618650
Hospital Revenue Code	278
Min. Negotiated Rate	$81.75
Max. Negotiated Rate	$131.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$109.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.89
Rate for Payer: Qualcare PPO/HMO/WC	$81.75

CEMENT PALACOS LOW VISCOSIT

Facility

$502.50

Hospital Charge Code	270660974
Hospital Revenue Code	278
Min. Negotiated Rate	$14.27
Max. Negotiated Rate	$251.25
Rate for Payer: Aetna Commercial	$190.95
Rate for Payer: Aetna Medicare Advantage	$150.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.14
Rate for Payer: Cigna Commercial	$251.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.61
Rate for Payer: Qualcare PPO/HMO/WC	$75.38
Rate for Payer: UnitedHealthcare Community & State	$15.88
Rate for Payer: Wellpoint Medicaid Managed Care	$14.27

CEMENT PALACOS LOW VISCOSIT

Facility

$502.50

Hospital Charge Code	270660974
Hospital Revenue Code	278
Min. Negotiated Rate	$75.38
Max. Negotiated Rate	$121.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.61
Rate for Payer: Qualcare PPO/HMO/WC	$75.38

CEMENT PALACOS LOW VISCOSITY W

Facility

$1,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270660975
Hospital Revenue Code	278
Min. Negotiated Rate	$221.25
Max. Negotiated Rate	$356.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.95
Rate for Payer: Qualcare PPO/HMO/WC	$221.25

Know your out-of-pocket cost for care.

All Charges