Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

LAP INSUFFLATOR TUBE/FILTER

Facility

$300.00

Hospital Charge Code	270335094
Hospital Revenue Code	272
Min. Negotiated Rate	$8.52
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$114.00
Rate for Payer: Aetna Medicare Advantage	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.50
Rate for Payer: Cigna Commercial	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.00
Rate for Payer: Oxford Commercial	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00
Rate for Payer: UnitedHealthcare Commercial	$60.00
Rate for Payer: UnitedHealthcare Community & State	$9.48
Rate for Payer: Wellpoint Medicaid Managed Care	$8.52

LAPIPLASTY 2.7MM 16/18MM

Facility

$3,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270699092
Hospital Revenue Code	278
Min. Negotiated Rate	$98.69
Max. Negotiated Rate	$1,737.50
Rate for Payer: Aetna Commercial	$1,320.50
Rate for Payer: Aetna Medicare Advantage	$1,042.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$886.12
Rate for Payer: Cigna Commercial	$1,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.95
Rate for Payer: Qualcare PPO/HMO/WC	$521.25
Rate for Payer: UnitedHealthcare Community & State	$109.81
Rate for Payer: Wellpoint Medicaid Managed Care	$98.69

LAPIPLASTY 2.7MM 16/18MM

Facility

$3,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270699092
Hospital Revenue Code	278
Min. Negotiated Rate	$521.25
Max. Negotiated Rate	$840.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.95
Rate for Payer: Qualcare PPO/HMO/WC	$521.25

LAPIPLASTY BIPLANAR SYSTEM 1

Facility

$19,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270693836
Hospital Revenue Code	278
Min. Negotiated Rate	$553.09
Max. Negotiated Rate	$9,737.50
Rate for Payer: Aetna Commercial	$7,400.50
Rate for Payer: Aetna Medicare Advantage	$5,842.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,966.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,966.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,966.12
Rate for Payer: Cigna Commercial	$9,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,712.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,921.25
Rate for Payer: UnitedHealthcare Community & State	$615.41
Rate for Payer: Wellpoint Medicaid Managed Care	$553.09

LAPIPLASTY BIPLANAR SYSTEM 1

Facility

$19,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270693836
Hospital Revenue Code	278
Min. Negotiated Rate	$2,921.25
Max. Negotiated Rate	$4,712.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,712.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,921.25

LAPIPLASTY KIT SK341-SD211-SD2

Facility

$19,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270697469
Hospital Revenue Code	278
Min. Negotiated Rate	$2,850.00
Max. Negotiated Rate	$4,598.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,598.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,850.00

LAPIPLASTY KIT SK341-SD211-SD2

Facility

$19,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270697469
Hospital Revenue Code	278
Min. Negotiated Rate	$539.60
Max. Negotiated Rate	$9,500.00
Rate for Payer: Aetna Commercial	$7,220.00
Rate for Payer: Aetna Medicare Advantage	$5,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,845.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,845.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,845.00
Rate for Payer: Cigna Commercial	$9,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,598.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,850.00
Rate for Payer: UnitedHealthcare Community & State	$600.40
Rate for Payer: Wellpoint Medicaid Managed Care	$539.60

LAPIPLASTY MINI SYSTEM SK30

Facility

$27,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270694873
Hospital Revenue Code	278
Min. Negotiated Rate	$780.29
Max. Negotiated Rate	$13,737.50
Rate for Payer: Aetna Commercial	$10,440.50
Rate for Payer: Aetna Medicare Advantage	$8,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,006.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,006.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,006.12
Rate for Payer: Cigna Commercial	$13,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,648.95
Rate for Payer: Qualcare PPO/HMO/WC	$4,121.25
Rate for Payer: UnitedHealthcare Community & State	$868.21
Rate for Payer: Wellpoint Medicaid Managed Care	$780.29

LAPIPLASTY MINI SYSTEM SK30

Facility

$27,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270694873
Hospital Revenue Code	278
Min. Negotiated Rate	$4,121.25
Max. Negotiated Rate	$6,648.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,648.95
Rate for Payer: Qualcare PPO/HMO/WC	$4,121.25

LAPIPLASTY SAW BLADE 40MM X 11

Facility

$725.00

Hospital Charge Code	270690887
Hospital Revenue Code	272
Min. Negotiated Rate	$108.75
Max. Negotiated Rate	$108.75
Rate for Payer: Qualcare PPO/HMO/WC	$108.75

LAPIPLASTY SAW BLADE 40MM X 11

Facility

$725.00

Hospital Charge Code	270690887
Hospital Revenue Code	272
Min. Negotiated Rate	$20.59
Max. Negotiated Rate	$362.50
Rate for Payer: Aetna Commercial	$275.50
Rate for Payer: Aetna Medicare Advantage	$217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.88
Rate for Payer: Cigna Commercial	$362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.50
Rate for Payer: Oxford Commercial	$145.00
Rate for Payer: Qualcare PPO/HMO/WC	$108.75
Rate for Payer: UnitedHealthcare Commercial	$145.00
Rate for Payer: UnitedHealthcare Community & State	$22.91
Rate for Payer: Wellpoint Medicaid Managed Care	$20.59

LAPIPLASTY SELECT ANATOMIC

Facility

$13,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270701275
Hospital Revenue Code	278
Min. Negotiated Rate	$390.50
Max. Negotiated Rate	$6,875.00
Rate for Payer: Aetna Commercial	$5,225.00
Rate for Payer: Aetna Medicare Advantage	$4,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,506.25
Rate for Payer: Cigna Commercial	$6,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50
Rate for Payer: UnitedHealthcare Community & State	$434.50
Rate for Payer: Wellpoint Medicaid Managed Care	$390.50

LAPIPLASTY SELECT ANATOMIC

Facility

$13,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270701275
Hospital Revenue Code	278
Min. Negotiated Rate	$2,062.50
Max. Negotiated Rate	$3,327.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50

LAPIPLASTY SPEEDPLATE

Facility

$16,870.00

Service Code	HCPCS C1713
Hospital Charge Code	270700315
Hospital Revenue Code	278
Min. Negotiated Rate	$2,530.50
Max. Negotiated Rate	$4,082.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,374.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,082.54
Rate for Payer: Qualcare PPO/HMO/WC	$2,530.50

LAPIPLASTY SPEEDPLATE

Facility

$16,870.00

Service Code	HCPCS C1713
Hospital Charge Code	270700315
Hospital Revenue Code	278
Min. Negotiated Rate	$479.11
Max. Negotiated Rate	$8,435.00
Rate for Payer: Aetna Commercial	$6,410.60
Rate for Payer: Aetna Medicare Advantage	$5,061.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,301.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,301.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,374.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,301.85
Rate for Payer: Cigna Commercial	$8,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,082.54
Rate for Payer: Qualcare PPO/HMO/WC	$2,530.50
Rate for Payer: UnitedHealthcare Community & State	$533.09
Rate for Payer: Wellpoint Medicaid Managed Care	$479.11

LAPIPLASTY SPEEDPLATE KIT 18X1

Facility

$16,870.00

Service Code	HCPCS C1713
Hospital Charge Code	270699935
Hospital Revenue Code	278
Min. Negotiated Rate	$2,530.50
Max. Negotiated Rate	$4,082.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,374.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,082.54
Rate for Payer: Qualcare PPO/HMO/WC	$2,530.50

LAPIPLASTY SPEEDPLATE KIT 18X1

Facility

$16,870.00

Service Code	HCPCS C1713
Hospital Charge Code	270699935
Hospital Revenue Code	278
Min. Negotiated Rate	$479.11
Max. Negotiated Rate	$8,435.00
Rate for Payer: Aetna Commercial	$6,410.60
Rate for Payer: Aetna Medicare Advantage	$5,061.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,301.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,301.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,374.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,301.85
Rate for Payer: Cigna Commercial	$8,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,082.54
Rate for Payer: Qualcare PPO/HMO/WC	$2,530.50
Rate for Payer: UnitedHealthcare Community & State	$533.09
Rate for Payer: Wellpoint Medicaid Managed Care	$479.11

LAPIPLASTY SPEEDPLATE QUAD

Facility

$18,120.00

Hospital Charge Code	270701879
Hospital Revenue Code	278
Min. Negotiated Rate	$514.61
Max. Negotiated Rate	$9,060.00
Rate for Payer: Aetna Commercial	$6,885.60
Rate for Payer: Aetna Medicare Advantage	$5,436.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,620.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,620.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,624.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,620.60
Rate for Payer: Cigna Commercial	$9,060.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,385.04
Rate for Payer: Qualcare PPO/HMO/WC	$2,718.00
Rate for Payer: UnitedHealthcare Community & State	$572.59
Rate for Payer: Wellpoint Medicaid Managed Care	$514.61

LAPIPLASTY SPEEDPLATE QUAD

Facility

$18,120.00

Hospital Charge Code	270701879
Hospital Revenue Code	278
Min. Negotiated Rate	$2,718.00
Max. Negotiated Rate	$4,385.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,624.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,385.04
Rate for Payer: Qualcare PPO/HMO/WC	$2,718.00

LAPIPLASTY SPEED PLATE SQUAD

Facility

$16,870.00

Service Code	HCPCS C1713
Hospital Charge Code	270699211
Hospital Revenue Code	278
Min. Negotiated Rate	$2,530.50
Max. Negotiated Rate	$4,082.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,374.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,082.54
Rate for Payer: Qualcare PPO/HMO/WC	$2,530.50

LAPIPLASTY SPEED PLATE SQUAD

Facility

$16,870.00

Service Code	HCPCS C1713
Hospital Charge Code	270699211
Hospital Revenue Code	278
Min. Negotiated Rate	$479.11
Max. Negotiated Rate	$8,435.00
Rate for Payer: Aetna Commercial	$6,410.60
Rate for Payer: Aetna Medicare Advantage	$5,061.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,301.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,301.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,374.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,301.85
Rate for Payer: Cigna Commercial	$8,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,082.54
Rate for Payer: Qualcare PPO/HMO/WC	$2,530.50
Rate for Payer: UnitedHealthcare Community & State	$533.09
Rate for Payer: Wellpoint Medicaid Managed Care	$479.11

LAPIPLASTY SPEED PLT QUAD SK50

Facility

$18,120.00

Service Code	HCPCS C1713
Hospital Charge Code	270700151
Hospital Revenue Code	278
Min. Negotiated Rate	$2,718.00
Max. Negotiated Rate	$4,385.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,624.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,385.04
Rate for Payer: Qualcare PPO/HMO/WC	$2,718.00

LAPIPLASTY SPEED PLT QUAD SK50

Facility

$18,120.00

Service Code	HCPCS C1713
Hospital Charge Code	270700151
Hospital Revenue Code	278
Min. Negotiated Rate	$514.61
Max. Negotiated Rate	$9,060.00
Rate for Payer: Aetna Commercial	$6,885.60
Rate for Payer: Aetna Medicare Advantage	$5,436.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,620.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,620.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,624.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,620.60
Rate for Payer: Cigna Commercial	$9,060.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,385.04
Rate for Payer: Qualcare PPO/HMO/WC	$2,718.00
Rate for Payer: UnitedHealthcare Community & State	$572.59
Rate for Payer: Wellpoint Medicaid Managed Care	$514.61

LAPIPLASTY SYSTEM2 PLT 3.9MM

Facility

$27,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270690865
Hospital Revenue Code	278
Min. Negotiated Rate	$4,121.25
Max. Negotiated Rate	$6,648.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,648.95
Rate for Payer: Qualcare PPO/HMO/WC	$4,121.25

LAPIPLASTY SYSTEM2 PLT 3.9MM

Facility

$27,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270690865
Hospital Revenue Code	278
Min. Negotiated Rate	$780.29
Max. Negotiated Rate	$13,737.50
Rate for Payer: Aetna Commercial	$10,440.50
Rate for Payer: Aetna Medicare Advantage	$8,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,006.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,006.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,006.12
Rate for Payer: Cigna Commercial	$13,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,648.95
Rate for Payer: Qualcare PPO/HMO/WC	$4,121.25
Rate for Payer: UnitedHealthcare Community & State	$868.21
Rate for Payer: Wellpoint Medicaid Managed Care	$780.29

Know your out-of-pocket cost for care.

All Charges