Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TALAR DOME FLAT CUT SZ 3

Facility

$69,143.90

Service Code	HCPCS C1713
Hospital Charge Code	270704972
Hospital Revenue Code	278
Min. Negotiated Rate	$10,371.58
Max. Negotiated Rate	$16,732.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,828.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,732.82
Rate for Payer: Qualcare PPO/HMO/WC	$10,371.58

TALAR DOME SZ 1 SULCUS

Facility

$18,895.00

Service Code	HCPCS C1776
Hospital Charge Code	270670888
Hospital Revenue Code	278
Min. Negotiated Rate	$2,834.25
Max. Negotiated Rate	$4,572.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,779.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,572.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,834.25

TALAR DOME SZ 1 SULCUS

Facility

$18,895.00

Service Code	HCPCS C1776
Hospital Charge Code	270670888
Hospital Revenue Code	278
Min. Negotiated Rate	$536.62
Max. Negotiated Rate	$9,447.50
Rate for Payer: Aetna Commercial	$7,180.10
Rate for Payer: Aetna Medicare Advantage	$5,668.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,818.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,818.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,779.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,818.23
Rate for Payer: Cigna Commercial	$9,447.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,572.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,834.25
Rate for Payer: UnitedHealthcare Community & State	$597.08
Rate for Payer: Wellpoint Medicaid Managed Care	$536.62

TALC 5 GM STERILE POWDER

Facility

$666.65

Service Code	NDC 63256020005
Hospital Charge Code	60628553
Hospital Revenue Code	250
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.00

TALC 5 GM STERILE POWDER

Facility

$666.65

Service Code	NDC 63256020005
Hospital Charge Code	60628553
Hospital Revenue Code	250
Min. Negotiated Rate	$18.93
Max. Negotiated Rate	$333.32
Rate for Payer: Aetna Commercial	$253.33
Rate for Payer: Aetna Medicare Advantage	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.00
Rate for Payer: Cigna Commercial	$333.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.33
Rate for Payer: Oxford Commercial	$133.33
Rate for Payer: Qualcare PPO/HMO/WC	$100.00
Rate for Payer: UnitedHealthcare Commercial	$133.33
Rate for Payer: UnitedHealthcare Community & State	$21.07
Rate for Payer: Wellpoint Medicaid Managed Care	$18.93

TA LONG 90-3.5 STAPLER BLUE

Facility

$653.00

Hospital Charge Code	270334730
Hospital Revenue Code	272
Min. Negotiated Rate	$97.95
Max. Negotiated Rate	$97.95
Rate for Payer: Qualcare PPO/HMO/WC	$97.95

TA LONG 90-3.5 STAPLER BLUE

Facility

$653.00

Hospital Charge Code	270334730
Hospital Revenue Code	272
Min. Negotiated Rate	$18.55
Max. Negotiated Rate	$326.50
Rate for Payer: Aetna Commercial	$248.14
Rate for Payer: Aetna Medicare Advantage	$195.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.51
Rate for Payer: Cigna Commercial	$326.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.78
Rate for Payer: Oxford Commercial	$130.60
Rate for Payer: Qualcare PPO/HMO/WC	$97.95
Rate for Payer: UnitedHealthcare Commercial	$130.60
Rate for Payer: UnitedHealthcare Community & State	$20.63
Rate for Payer: Wellpoint Medicaid Managed Care	$18.55

TA LONG 90-4.8 STAPLER GREEN

Facility

$597.00

Hospital Charge Code	270334731
Hospital Revenue Code	272
Min. Negotiated Rate	$89.55
Max. Negotiated Rate	$89.55
Rate for Payer: Qualcare PPO/HMO/WC	$89.55

TA LONG 90-4.8 STAPLER GREEN

Facility

$597.00

Hospital Charge Code	270334731
Hospital Revenue Code	272
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) PPO	$152.24
Rate for Payer: Cigna Commercial	$298.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.22
Rate for Payer: Oxford Commercial	$119.40
Rate for Payer: Qualcare PPO/HMO/WC	$89.55
Rate for Payer: UnitedHealthcare Commercial	$119.40
Rate for Payer: UnitedHealthcare Community & State	$18.87
Rate for Payer: Wellpoint Medicaid Managed Care	$16.95

TALUS SZ 5 ANKLE TOTAL

Facility

$29,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270697284
Hospital Revenue Code	278
Min. Negotiated Rate	$4,350.00
Max. Negotiated Rate	$7,018.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,350.00

TALUS SZ 5 ANKLE TOTAL

Facility

$29,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270697284
Hospital Revenue Code	278
Min. Negotiated Rate	$823.60
Max. Negotiated Rate	$14,500.00
Rate for Payer: Aetna Commercial	$11,020.00
Rate for Payer: Aetna Medicare Advantage	$8,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,395.00
Rate for Payer: Cigna Commercial	$14,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,350.00
Rate for Payer: UnitedHealthcare Community & State	$916.40
Rate for Payer: Wellpoint Medicaid Managed Care	$823.60

TALUS TOTAL ANKLE SZ2 RT

Facility

$25,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677295
Hospital Revenue Code	278
Min. Negotiated Rate	$710.00
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$9,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00
Rate for Payer: UnitedHealthcare Community & State	$790.00
Rate for Payer: Wellpoint Medicaid Managed Care	$710.00

TALUS TOTAL ANKLE SZ2 RT

Facility

$25,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677295
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

TALUS TOTAL ANKLE SZ4 RT

Facility

$25,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678162
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

TALUS TOTAL ANKLE SZ4 RT

Facility

$25,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678162
Hospital Revenue Code	278
Min. Negotiated Rate	$710.00
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$9,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00
Rate for Payer: UnitedHealthcare Community & State	$790.00
Rate for Payer: Wellpoint Medicaid Managed Care	$710.00

TAMIFLU ORAL SUSP

Facility

$16.15

Service Code	NDC 4082205
Hospital Charge Code	60635754
Hospital Revenue Code	250
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$2.42
Rate for Payer: Qualcare PPO/HMO/WC	$2.42

TAMIFLU ORAL SUSP

Facility

$16.15

Service Code	NDC 4082205
Hospital Charge Code	60635754
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$8.07
Rate for Payer: Aetna Commercial	$6.14
Rate for Payer: Aetna Medicare Advantage	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.12
Rate for Payer: Cigna Commercial	$8.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.20
Rate for Payer: Oxford Commercial	$3.23
Rate for Payer: Qualcare PPO/HMO/WC	$2.42
Rate for Payer: UnitedHealthcare Commercial	$3.23
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.46

TAMOXIFEN 10 MG TAB

Facility

$15.88

Service Code	NDC 63739026910
Hospital Charge Code	6010086
Hospital Revenue Code	250
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$2.38
Rate for Payer: Qualcare PPO/HMO/WC	$2.38

TAMOXIFEN 10 MG TAB

Facility

$15.88

Service Code	NDC 63739026910
Hospital Charge Code	6010086
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$7.94
Rate for Payer: Aetna Commercial	$6.03
Rate for Payer: Aetna Medicare Advantage	$4.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.05
Rate for Payer: Cigna Commercial	$7.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.13
Rate for Payer: Oxford Commercial	$3.18
Rate for Payer: Qualcare PPO/HMO/WC	$2.38
Rate for Payer: UnitedHealthcare Commercial	$3.18
Rate for Payer: UnitedHealthcare Community & State	$0.50
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

TAMP BONE INFLATABLE 10/2 K15A

Facility

$5,975.00

Hospital Charge Code	270637758
Hospital Revenue Code	272
Min. Negotiated Rate	$169.69
Max. Negotiated Rate	$2,987.50
Rate for Payer: Aetna Commercial	$2,270.50
Rate for Payer: Aetna Medicare Advantage	$1,792.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,523.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,523.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,523.62
Rate for Payer: Cigna Commercial	$2,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,553.50
Rate for Payer: Oxford Commercial	$1,195.00
Rate for Payer: Qualcare PPO/HMO/WC	$896.25
Rate for Payer: UnitedHealthcare Commercial	$1,195.00
Rate for Payer: UnitedHealthcare Community & State	$188.81
Rate for Payer: Wellpoint Medicaid Managed Care	$169.69

TAMP BONE INFLATABLE 10/2 K15A

Facility

$5,975.00

Hospital Charge Code	270637758
Hospital Revenue Code	272
Min. Negotiated Rate	$896.25
Max. Negotiated Rate	$896.25
Rate for Payer: Qualcare PPO/HMO/WC	$896.25

TAMP OAT SZ 10

Facility

$970.00

Hospital Charge Code	270677743
Hospital Revenue Code	272
Min. Negotiated Rate	$145.50
Max. Negotiated Rate	$145.50
Rate for Payer: Qualcare PPO/HMO/WC	$145.50

TAMP OAT SZ 10

Facility

$970.00

Hospital Charge Code	270677743
Hospital Revenue Code	272
Min. Negotiated Rate	$27.55
Max. Negotiated Rate	$485.00
Rate for Payer: Aetna Commercial	$368.60
Rate for Payer: Aetna Medicare Advantage	$291.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$247.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$247.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$247.35
Rate for Payer: Cigna Commercial	$485.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$252.20
Rate for Payer: Oxford Commercial	$194.00
Rate for Payer: Qualcare PPO/HMO/WC	$145.50
Rate for Payer: UnitedHealthcare Commercial	$194.00
Rate for Payer: UnitedHealthcare Community & State	$30.65
Rate for Payer: Wellpoint Medicaid Managed Care	$27.55

TAMP OAT SZ 5

Facility

$970.00

Hospital Charge Code	270677738
Hospital Revenue Code	272
Min. Negotiated Rate	$145.50
Max. Negotiated Rate	$145.50
Rate for Payer: Qualcare PPO/HMO/WC	$145.50

TAMP OAT SZ 5

Facility

$970.00

Hospital Charge Code	270677738
Hospital Revenue Code	272
Min. Negotiated Rate	$27.55
Max. Negotiated Rate	$485.00
Rate for Payer: Aetna Commercial	$368.60
Rate for Payer: Aetna Medicare Advantage	$291.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$247.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$247.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$247.35
Rate for Payer: Cigna Commercial	$485.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$252.20
Rate for Payer: Oxford Commercial	$194.00
Rate for Payer: Qualcare PPO/HMO/WC	$145.50
Rate for Payer: UnitedHealthcare Commercial	$194.00
Rate for Payer: UnitedHealthcare Community & State	$30.65
Rate for Payer: Wellpoint Medicaid Managed Care	$27.55

Know your out-of-pocket cost for care.

All Charges