Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

LP NON LOCK 2.7MM X 10MM

Facility

$595.00

Service Code	HCPCS C1713
Hospital Charge Code	270701900
Hospital Revenue Code	278
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$297.50
Rate for Payer: Aetna Commercial	$226.10
Rate for Payer: Aetna Medicare Advantage	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.72
Rate for Payer: Cigna Commercial	$297.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: Qualcare PPO/HMO/WC	$89.25
Rate for Payer: UnitedHealthcare Community & State	$18.80
Rate for Payer: Wellpoint Medicaid Managed Care	$16.90

LP NON LOCK 2.7MM X 10MM

Facility

$595.00

Service Code	HCPCS C1713
Hospital Charge Code	270701900
Hospital Revenue Code	278
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$143.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: Qualcare PPO/HMO/WC	$89.25

LP NON LOCK 2.7MM X 16MM

Facility

$595.00

Service Code	HCPCS C1713
Hospital Charge Code	270701901
Hospital Revenue Code	278
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$297.50
Rate for Payer: Aetna Commercial	$226.10
Rate for Payer: Aetna Medicare Advantage	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.72
Rate for Payer: Cigna Commercial	$297.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: Qualcare PPO/HMO/WC	$89.25
Rate for Payer: UnitedHealthcare Community & State	$18.80
Rate for Payer: Wellpoint Medicaid Managed Care	$16.90

LP NON LOCK 2.7MM X 16MM

Facility

$595.00

Service Code	HCPCS C1713
Hospital Charge Code	270701901
Hospital Revenue Code	278
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$143.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: Qualcare PPO/HMO/WC	$89.25

LP NON-LOCK 2.7MM X 22MM

Facility

$595.00

Hospital Charge Code	270663846
Hospital Revenue Code	278
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$143.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: Qualcare PPO/HMO/WC	$89.25

LP NON-LOCK 2.7MM X 22MM

Facility

$595.00

Hospital Charge Code	270663846
Hospital Revenue Code	278
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$297.50
Rate for Payer: Aetna Commercial	$226.10
Rate for Payer: Aetna Medicare Advantage	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.72
Rate for Payer: Cigna Commercial	$297.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: Qualcare PPO/HMO/WC	$89.25
Rate for Payer: UnitedHealthcare Community & State	$18.80
Rate for Payer: Wellpoint Medicaid Managed Care	$16.90

LP NON LOCK 2.7MM X 24MM

Facility

$595.00

Service Code	HCPCS C1713
Hospital Charge Code	270701902
Hospital Revenue Code	278
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$297.50
Rate for Payer: Aetna Commercial	$226.10
Rate for Payer: Aetna Medicare Advantage	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.72
Rate for Payer: Cigna Commercial	$297.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: Qualcare PPO/HMO/WC	$89.25
Rate for Payer: UnitedHealthcare Community & State	$18.80
Rate for Payer: Wellpoint Medicaid Managed Care	$16.90

LP NON LOCK 2.7MM X 24MM

Facility

$595.00

Service Code	HCPCS C1713
Hospital Charge Code	270701902
Hospital Revenue Code	278
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$143.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: Qualcare PPO/HMO/WC	$89.25

LP NON LOCK 2.7MM X 26MM

Facility

$595.00

Service Code	HCPCS C1713
Hospital Charge Code	270701899
Hospital Revenue Code	278
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$297.50
Rate for Payer: Aetna Commercial	$226.10
Rate for Payer: Aetna Medicare Advantage	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.72
Rate for Payer: Cigna Commercial	$297.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: Qualcare PPO/HMO/WC	$89.25
Rate for Payer: UnitedHealthcare Community & State	$18.80
Rate for Payer: Wellpoint Medicaid Managed Care	$16.90

LP NON LOCK 2.7MM X 26MM

Facility

$595.00

Service Code	HCPCS C1713
Hospital Charge Code	270701899
Hospital Revenue Code	278
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$143.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: Qualcare PPO/HMO/WC	$89.25

LP-PLA2

Facility

$239.00

Service Code	HCPCS 83698
Hospital Charge Code	38477189
Hospital Revenue Code	301
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$167.99
Rate for Payer: Aetna Commercial	$125.96
Rate for Payer: Aetna Medicare Advantage	$150.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$167.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$167.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$46.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$167.99
Rate for Payer: Cigna Commercial	$119.50
Rate for Payer: Cigna Medicare Advantage	$46.31
Rate for Payer: Clover Medicare Advantage	$43.99
Rate for Payer: EmblemHealth Commercial	$138.93
Rate for Payer: Humana Medicare Advantage	$47.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$46.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.14
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.85
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$37.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.31
Rate for Payer: Wellcare Medicare Advantage	$46.31
Rate for Payer: Wellpoint Medicaid Managed Care	$6.79

LP-PLA2

Facility

$239.00

Service Code	HCPCS 83698
Hospital Charge Code	38477189
Hospital Revenue Code	301
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$35.85
Rate for Payer: Qualcare PPO/HMO/WC	$35.85

LP-PLA2

Facility

$286.00

Service Code	HCPCS 83698
Hospital Charge Code	38474062
Hospital Revenue Code	301
Min. Negotiated Rate	$8.12
Max. Negotiated Rate	$167.99
Rate for Payer: Aetna Commercial	$125.96
Rate for Payer: Aetna Medicare Advantage	$150.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$167.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$167.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$46.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$167.99
Rate for Payer: Cigna Commercial	$143.00
Rate for Payer: Cigna Medicare Advantage	$46.31
Rate for Payer: Clover Medicare Advantage	$43.99
Rate for Payer: EmblemHealth Commercial	$138.93
Rate for Payer: Humana Medicare Advantage	$47.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$46.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.36
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.90
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$37.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.31
Rate for Payer: Wellcare Medicare Advantage	$46.31
Rate for Payer: Wellpoint Medicaid Managed Care	$8.12

LP-PLA2

Facility

$286.00

Service Code	HCPCS 83698
Hospital Charge Code	38474062
Hospital Revenue Code	301
Min. Negotiated Rate	$42.90
Max. Negotiated Rate	$42.90
Rate for Payer: Qualcare PPO/HMO/WC	$42.90

LPR-VAG HYST INCL T/O =<250 GM

Facility

$43,337.60

Service Code	HCPCS 58552
Hospital Charge Code	16001007
Hospital Revenue Code	360
Min. Negotiated Rate	$6,500.64
Max. Negotiated Rate	$6,500.64
Rate for Payer: Qualcare PPO/HMO/WC	$6,500.64

LPR-VAG HYST INCL T/O =<250 GM

Facility

$43,337.60

Service Code	HCPCS 58552
Hospital Charge Code	16001007
Hospital Revenue Code	360
Min. Negotiated Rate	$1,230.79
Max. Negotiated Rate	$45,809.96
Rate for Payer: Aetna Commercial	$34,349.57
Rate for Payer: Aetna Medicare Advantage	$40,916.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45,809.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45,809.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,628.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45,809.96
Rate for Payer: Cigna Commercial	$25,313.84
Rate for Payer: Cigna Medicare Advantage	$12,628.52
Rate for Payer: Clover Medicare Advantage	$11,997.09
Rate for Payer: EmblemHealth Commercial	$37,885.56
Rate for Payer: Humana Medicare Advantage	$13,007.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12,628.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,267.78
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,500.64
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$1,369.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,628.52
Rate for Payer: Wellcare Medicare Advantage	$12,628.52
Rate for Payer: Wellpoint Medicaid Managed Care	$1,230.79

LPS FLEX FIXED SUR CD 1-2 12MM

Facility

$5,862.10

Hospital Charge Code	270669608
Hospital Revenue Code	278
Min. Negotiated Rate	$166.48
Max. Negotiated Rate	$2,931.05
Rate for Payer: Aetna Commercial	$2,227.60
Rate for Payer: Aetna Medicare Advantage	$1,758.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,494.84
Rate for Payer: Cigna Commercial	$2,931.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: Qualcare PPO/HMO/WC	$879.32
Rate for Payer: UnitedHealthcare Community & State	$185.24
Rate for Payer: Wellpoint Medicaid Managed Care	$166.48

LPS FLEX FIXED SUR CD 1-2 12MM

Facility

$5,862.10

Hospital Charge Code	270669608
Hospital Revenue Code	278
Min. Negotiated Rate	$879.32
Max. Negotiated Rate	$1,418.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: Qualcare PPO/HMO/WC	$879.32

LPS FLEX FIXED SUR CD 1-2 14MM

Facility

$5,862.10

Hospital Charge Code	270657092
Hospital Revenue Code	278
Min. Negotiated Rate	$879.32
Max. Negotiated Rate	$1,418.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: Qualcare PPO/HMO/WC	$879.32

LPS FLEX FIXED SUR CD 1-2 14MM

Facility

$5,862.10

Hospital Charge Code	270657092
Hospital Revenue Code	278
Min. Negotiated Rate	$166.48
Max. Negotiated Rate	$2,931.05
Rate for Payer: Aetna Commercial	$2,227.60
Rate for Payer: Aetna Medicare Advantage	$1,758.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,494.84
Rate for Payer: Cigna Commercial	$2,931.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: Qualcare PPO/HMO/WC	$879.32
Rate for Payer: UnitedHealthcare Community & State	$185.24
Rate for Payer: Wellpoint Medicaid Managed Care	$166.48

LPS-FLEX GSF OPTION FEMORAL, S

Facility

$15,359.40

Hospital Charge Code	270657035
Hospital Revenue Code	278
Min. Negotiated Rate	$436.21
Max. Negotiated Rate	$7,679.70
Rate for Payer: Aetna Commercial	$5,836.57
Rate for Payer: Aetna Medicare Advantage	$4,607.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,916.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,916.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,071.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,916.65
Rate for Payer: Cigna Commercial	$7,679.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,716.97
Rate for Payer: Qualcare PPO/HMO/WC	$2,303.91
Rate for Payer: UnitedHealthcare Community & State	$485.36
Rate for Payer: Wellpoint Medicaid Managed Care	$436.21

LPS-FLEX GSF OPTION FEMORAL, S

Facility

$15,359.40

Hospital Charge Code	270657035
Hospital Revenue Code	278
Min. Negotiated Rate	$2,303.91
Max. Negotiated Rate	$3,716.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,071.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,716.97
Rate for Payer: Qualcare PPO/HMO/WC	$2,303.91

LPS-FLEX GSF OPTION FEMORAL, S

Facility

$12,166.15

Hospital Charge Code	270662344
Hospital Revenue Code	272
Min. Negotiated Rate	$1,824.92
Max. Negotiated Rate	$1,824.92
Rate for Payer: Qualcare PPO/HMO/WC	$1,824.92

LPS-FLEX GSF OPTION FEMORAL, S

Facility

$12,166.15

Hospital Charge Code	270662344
Hospital Revenue Code	272
Min. Negotiated Rate	$345.52
Max. Negotiated Rate	$6,083.07
Rate for Payer: Aetna Commercial	$4,623.14
Rate for Payer: Aetna Medicare Advantage	$3,649.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,102.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,102.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,102.37
Rate for Payer: Cigna Commercial	$6,083.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,163.20
Rate for Payer: Oxford Commercial	$2,433.23
Rate for Payer: Qualcare PPO/HMO/WC	$1,824.92
Rate for Payer: UnitedHealthcare Commercial	$2,433.23
Rate for Payer: UnitedHealthcare Community & State	$384.45
Rate for Payer: Wellpoint Medicaid Managed Care	$345.52

LRG BNE OSCLLTNG BLD 63.0X42MM

Facility

$35.00

Hospital Charge Code	270662588
Hospital Revenue Code	272
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$17.50
Rate for Payer: Aetna Commercial	$13.30
Rate for Payer: Aetna Medicare Advantage	$10.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.93
Rate for Payer: Cigna Commercial	$17.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.10
Rate for Payer: Oxford Commercial	$7.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.25
Rate for Payer: UnitedHealthcare Commercial	$7.00
Rate for Payer: UnitedHealthcare Community & State	$1.11
Rate for Payer: Wellpoint Medicaid Managed Care	$0.99

Know your out-of-pocket cost for care.

All Charges