Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CEMENT PALACOS LOW VISCOSITY W

Facility

$1,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270660975
Hospital Revenue Code	278
Min. Negotiated Rate	$41.89
Max. Negotiated Rate	$737.50
Rate for Payer: Aetna Commercial	$560.50
Rate for Payer: Aetna Medicare Advantage	$442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$376.12
Rate for Payer: Cigna Commercial	$737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.95
Rate for Payer: Qualcare PPO/HMO/WC	$221.25
Rate for Payer: UnitedHealthcare Community & State	$46.61
Rate for Payer: Wellpoint Medicaid Managed Care	$41.89

CEMENT PALACOS R+G SINGLE

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270679667
Hospital Revenue Code	278
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

CEMENT PALACOS R+G SINGLE

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270679667
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

CEMENT PREP KIT FEMORAL BONE

Facility

$1,032.00

Hospital Charge Code	270635406
Hospital Revenue Code	272
Min. Negotiated Rate	$29.31
Max. Negotiated Rate	$516.00
Rate for Payer: Aetna Commercial	$392.16
Rate for Payer: Aetna Medicare Advantage	$309.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$263.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$263.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$263.16
Rate for Payer: Cigna Commercial	$516.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$268.32
Rate for Payer: Oxford Commercial	$206.40
Rate for Payer: Qualcare PPO/HMO/WC	$154.80
Rate for Payer: UnitedHealthcare Commercial	$206.40
Rate for Payer: UnitedHealthcare Community & State	$32.61
Rate for Payer: Wellpoint Medicaid Managed Care	$29.31

CEMENT PREP KIT FEMORAL BONE

Facility

$1,032.00

Hospital Charge Code	270635406
Hospital Revenue Code	272
Min. Negotiated Rate	$154.80
Max. Negotiated Rate	$154.80
Rate for Payer: Qualcare PPO/HMO/WC	$154.80

CEMENT REFOBACIN BC R 40 GM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270682312
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 REFOBACIN BC R 40 GM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270682312
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 RESTRICTOR

Facility

$395.00

Service Code	HCPCS C1776
Hospital Charge Code	270691681
Hospital Revenue Code	278
Min. Negotiated Rate	$11.22
Max. Negotiated Rate	$197.50
Rate for Payer: Aetna Commercial	$150.10
Rate for Payer: Aetna Medicare Advantage	$118.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.72
Rate for Payer: Cigna Commercial	$197.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.59
Rate for Payer: Qualcare PPO/HMO/WC	$59.25
Rate for Payer: UnitedHealthcare Community & State	$12.48
Rate for Payer: Wellpoint Medicaid Managed Care	$11.22

CEMENT RESTRICTOR

Facility

$395.00

Service Code	HCPCS C1776
Hospital Charge Code	270691681
Hospital Revenue Code	278
Min. Negotiated Rate	$59.25
Max. Negotiated Rate	$95.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.59
Rate for Payer: Qualcare PPO/HMO/WC	$59.25

CEMENT RESTRICTOR FEMORAL SZ 3

Facility

$597.00

Hospital Charge Code	270330690
Hospital Revenue Code	278
Min. Negotiated Rate	$16.95
Max. Negotiated Rate	$298.50
Rate for Payer: Aetna Commercial	$226.86
Rate for Payer: Aetna Medicare Advantage	$179.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.24
Rate for Payer: Cigna Commercial	$298.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.47
Rate for Payer: Qualcare PPO/HMO/WC	$89.55
Rate for Payer: UnitedHealthcare Community & State	$18.87
Rate for Payer: Wellpoint Medicaid Managed Care	$16.95

CEMENT RESTRICTOR FEMORAL SZ 3

Facility

$597.00

Hospital Charge Code	270330690
Hospital Revenue Code	278
Min. Negotiated Rate	$89.55
Max. Negotiated Rate	$144.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.47
Rate for Payer: Qualcare PPO/HMO/WC	$89.55

CEMENT RESTRICTOR FEMORAL SZ 4

Facility

$630.00

Hospital Charge Code	270330695
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$152.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$126.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.46
Rate for Payer: Qualcare PPO/HMO/WC	$94.50

CEMENT RESTRICTOR FEMORAL SZ 4

Facility

$630.00

Hospital Charge Code	270330695
Hospital Revenue Code	278
Min. Negotiated Rate	$17.89
Max. Negotiated Rate	$315.00
Rate for Payer: Aetna Commercial	$239.40
Rate for Payer: Aetna Medicare Advantage	$189.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$126.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.65
Rate for Payer: Cigna Commercial	$315.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.46
Rate for Payer: Qualcare PPO/HMO/WC	$94.50
Rate for Payer: UnitedHealthcare Community & State	$19.91
Rate for Payer: Wellpoint Medicaid Managed Care	$17.89

CEMENT RESTRICTOR SIZE 1

Facility

$547.00

Hospital Charge Code	270332160
Hospital Revenue Code	278
Min. Negotiated Rate	$82.05
Max. Negotiated Rate	$132.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$109.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.37
Rate for Payer: Qualcare PPO/HMO/WC	$82.05

CEMENT RESTRICTOR SIZE 1

Facility

$547.00

Hospital Charge Code	270332160
Hospital Revenue Code	278
Min. Negotiated Rate	$15.53
Max. Negotiated Rate	$273.50
Rate for Payer: Aetna Commercial	$207.86
Rate for Payer: Aetna Medicare Advantage	$164.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$139.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$139.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$109.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$139.49
Rate for Payer: Cigna Commercial	$273.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.37
Rate for Payer: Qualcare PPO/HMO/WC	$82.05
Rate for Payer: UnitedHealthcare Community & State	$17.29
Rate for Payer: Wellpoint Medicaid Managed Care	$15.53

CEMENT RESTRICTOR SZ3 13.25MM

Facility

$1,405.00

Service Code	HCPCS C1776
Hospital Charge Code	270699295
Hospital Revenue Code	278
Min. Negotiated Rate	$210.75
Max. Negotiated Rate	$340.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$281.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$340.01
Rate for Payer: Qualcare PPO/HMO/WC	$210.75

CEMENT RESTRICTOR SZ3 13.25MM

Facility

$1,405.00

Service Code	HCPCS C1776
Hospital Charge Code	270699295
Hospital Revenue Code	278
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$702.50
Rate for Payer: Aetna Commercial	$533.90
Rate for Payer: Aetna Medicare Advantage	$421.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$358.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$358.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$281.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$358.27
Rate for Payer: Cigna Commercial	$702.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$340.01
Rate for Payer: Qualcare PPO/HMO/WC	$210.75
Rate for Payer: UnitedHealthcare Community & State	$44.40
Rate for Payer: Wellpoint Medicaid Managed Care	$39.90

CEMENT RESTRICTOR SZ.5

Facility

$460.00

Hospital Charge Code	270331120
Hospital Revenue Code	278
Min. Negotiated Rate	$69.00
Max. Negotiated Rate	$111.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$92.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.32
Rate for Payer: Qualcare PPO/HMO/WC	$69.00

CEMENT RESTRICTOR SZ.5

Facility

$460.00

Hospital Charge Code	270331120
Hospital Revenue Code	278
Min. Negotiated Rate	$13.06
Max. Negotiated Rate	$230.00
Rate for Payer: Aetna Commercial	$174.80
Rate for Payer: Aetna Medicare Advantage	$138.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$117.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$117.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$92.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$117.30
Rate for Payer: Cigna Commercial	$230.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.32
Rate for Payer: Qualcare PPO/HMO/WC	$69.00
Rate for Payer: UnitedHealthcare Community & State	$14.54
Rate for Payer: Wellpoint Medicaid Managed Care	$13.06

CEMENT VACUUM 3 DOSE COMPACT

Facility

$650.00

Hospital Charge Code	270687013
Hospital Revenue Code	272
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

CEMENT VACUUM 3 DOSE COMPACT

Facility

$650.00

Hospital Charge Code	270687013
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

CEMENT VERTEPLEX

Facility

$4,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270692069
Hospital Revenue Code	278
Min. Negotiated Rate	$618.75
Max. Negotiated Rate	$998.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$998.25
Rate for Payer: Qualcare PPO/HMO/WC	$618.75

CEMENT VERTEPLEX

Facility

$4,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270692069
Hospital Revenue Code	278
Min. Negotiated Rate	$117.15
Max. Negotiated Rate	$2,062.50
Rate for Payer: Aetna Commercial	$1,567.50
Rate for Payer: Aetna Medicare Advantage	$1,237.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,051.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,051.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,051.88
Rate for Payer: Cigna Commercial	$2,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$998.25
Rate for Payer: Qualcare PPO/HMO/WC	$618.75
Rate for Payer: UnitedHealthcare Community & State	$130.35
Rate for Payer: Wellpoint Medicaid Managed Care	$117.15

CEMENT W/GENTAMICIN HI VISCOS

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	270676722
Hospital Revenue Code	278
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$23.70
Rate for Payer: Wellpoint Medicaid Managed Care	$21.30

CEMENT W/GENTAMICIN HI VISCOS

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	270676722
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

Know your out-of-pocket cost for care.

All Charges