Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TBI TRIATHLON X3 SZ 4 CS 12MM

Facility

$5,082.40

Service Code	HCPCS C1776
Hospital Charge Code	270697368
Hospital Revenue Code	278
Min. Negotiated Rate	$144.34
Max. Negotiated Rate	$2,541.20
Rate for Payer: Aetna Commercial	$1,931.31
Rate for Payer: Aetna Medicare Advantage	$1,524.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,296.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,296.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,296.01
Rate for Payer: Cigna Commercial	$2,541.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.94
Rate for Payer: Qualcare PPO/HMO/WC	$762.36
Rate for Payer: UnitedHealthcare Community & State	$160.60
Rate for Payer: Wellpoint Medicaid Managed Care	$144.34

TBI TRIATHLON X3 SZ 4 CS 12MM

Facility

$5,082.40

Service Code	HCPCS C1776
Hospital Charge Code	270697368
Hospital Revenue Code	278
Min. Negotiated Rate	$762.36
Max. Negotiated Rate	$1,229.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.94
Rate for Payer: Qualcare PPO/HMO/WC	$762.36

TBI TRIATH TS SZ6 11MM

Facility

$4,447.75

Service Code	HCPCS C1776
Hospital Charge Code	270694178
Hospital Revenue Code	278
Min. Negotiated Rate	$126.32
Max. Negotiated Rate	$2,223.88
Rate for Payer: Aetna Commercial	$1,690.14
Rate for Payer: Aetna Medicare Advantage	$1,334.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,134.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,134.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$889.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,134.18
Rate for Payer: Cigna Commercial	$2,223.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,076.36
Rate for Payer: Qualcare PPO/HMO/WC	$667.16
Rate for Payer: UnitedHealthcare Community & State	$140.55
Rate for Payer: Wellpoint Medicaid Managed Care	$126.32

TBI TRIATH TS SZ6 11MM

Facility

$4,447.75

Service Code	HCPCS C1776
Hospital Charge Code	270694178
Hospital Revenue Code	278
Min. Negotiated Rate	$667.16
Max. Negotiated Rate	$1,076.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$889.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,076.36
Rate for Payer: Qualcare PPO/HMO/WC	$667.16

TBI X3 PS TRIATHLON SZ4 11MM

Facility

$4,985.30

Service Code	HCPCS C1776
Hospital Charge Code	270694175
Hospital Revenue Code	278
Min. Negotiated Rate	$141.58
Max. Negotiated Rate	$2,492.65
Rate for Payer: Aetna Commercial	$1,894.41
Rate for Payer: Aetna Medicare Advantage	$1,495.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,271.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,271.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,271.25
Rate for Payer: Cigna Commercial	$2,492.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.44
Rate for Payer: Qualcare PPO/HMO/WC	$747.79
Rate for Payer: UnitedHealthcare Community & State	$157.54
Rate for Payer: Wellpoint Medicaid Managed Care	$141.58

TBI X3 PS TRIATHLON SZ4 11MM

Facility

$4,985.30

Service Code	HCPCS C1776
Hospital Charge Code	270694175
Hospital Revenue Code	278
Min. Negotiated Rate	$747.79
Max. Negotiated Rate	$1,206.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.44
Rate for Payer: Qualcare PPO/HMO/WC	$747.79

TBI X3 TRIATHLON CS SZ7 11MM

Facility

$5,082.55

Service Code	HCPCS C1776
Hospital Charge Code	270694174
Hospital Revenue Code	278
Min. Negotiated Rate	$144.34
Max. Negotiated Rate	$2,541.28
Rate for Payer: Aetna Commercial	$1,931.37
Rate for Payer: Aetna Medicare Advantage	$1,524.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,296.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,296.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,296.05
Rate for Payer: Cigna Commercial	$2,541.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.98
Rate for Payer: Qualcare PPO/HMO/WC	$762.38
Rate for Payer: UnitedHealthcare Community & State	$160.61
Rate for Payer: Wellpoint Medicaid Managed Care	$144.34

TBI X3 TRIATHLON CS SZ7 11MM

Facility

$5,082.55

Service Code	HCPCS C1776
Hospital Charge Code	270694174
Hospital Revenue Code	278
Min. Negotiated Rate	$762.38
Max. Negotiated Rate	$1,229.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.98
Rate for Payer: Qualcare PPO/HMO/WC	$762.38

T&B LYMPHOCYTE DIFFERENTIAL PR

Facility

$393.00

Service Code	HCPCS 88182
Hospital Charge Code	38473048
Hospital Revenue Code	311
Min. Negotiated Rate	$11.16
Max. Negotiated Rate	$224.58
Rate for Payer: Aetna Commercial	$168.40
Rate for Payer: Aetna Medicare Advantage	$200.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$224.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$224.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$61.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$224.58
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$61.91
Rate for Payer: Clover Medicare Advantage	$58.81
Rate for Payer: EmblemHealth Commercial	$185.73
Rate for Payer: Humana Medicare Advantage	$63.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$61.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.18
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.95
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$136.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.91
Rate for Payer: Wellcare Medicare Advantage	$61.91
Rate for Payer: Wellpoint Medicaid Managed Care	$11.16

T&B LYMPHOCYTE DIFFERENTIAL PR

Facility

$393.00

Service Code	HCPCS 88182
Hospital Charge Code	38473048
Hospital Revenue Code	311
Min. Negotiated Rate	$58.95
Max. Negotiated Rate	$58.95
Rate for Payer: Qualcare PPO/HMO/WC	$58.95

TBO-FILGRASTIM 300 MCG/0.5 ML

Facility

$2,008.93

Service Code	HCPCS J1447
Hospital Charge Code	606380015
Hospital Revenue Code	636
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$486.16
Rate for Payer: Aetna Commercial	$0.68
Rate for Payer: Aetna Medicare Advantage	$0.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$0.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.91
Rate for Payer: Cigna Medicare Advantage	$0.25
Rate for Payer: Clover Medicare Advantage	$0.24
Rate for Payer: EmblemHealth Commercial	$0.75
Rate for Payer: Humana Medicare Advantage	$0.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$0.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$486.16
Rate for Payer: Qualcare PPO/HMO/WC	$301.34
Rate for Payer: UnitedHealthcare Community & State	$63.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$0.25
Rate for Payer: Wellcare Medicare Advantage	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$57.05

TBO-FILGRASTIM 300 MCG/0.5 ML

Facility

$2,008.93

Service Code	HCPCS J1447
Hospital Charge Code	606380015
Hospital Revenue Code	636
Min. Negotiated Rate	$301.34
Max. Negotiated Rate	$486.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$486.16
Rate for Payer: Qualcare PPO/HMO/WC	$301.34

TB TEST-QUANTIFERON/AG-GI RS

Facility

$436.00

Service Code	HCPCS 86480
Hospital Charge Code	38478078
Hospital Revenue Code	300
Min. Negotiated Rate	$12.38
Max. Negotiated Rate	$224.83
Rate for Payer: Aetna Commercial	$168.59
Rate for Payer: Aetna Medicare Advantage	$200.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$224.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$224.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$61.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$66.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$224.83
Rate for Payer: Cigna Commercial	$218.00
Rate for Payer: Cigna Medicare Advantage	$61.98
Rate for Payer: Clover Medicare Advantage	$58.88
Rate for Payer: EmblemHealth Commercial	$185.94
Rate for Payer: Humana Medicare Advantage	$63.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$61.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.36
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.40
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$49.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.98
Rate for Payer: Wellcare Medicare Advantage	$61.98
Rate for Payer: Wellpoint Medicaid Managed Care	$12.38

TB TEST-QUANTIFERON/AG-GI RS

Facility

$436.00

Service Code	HCPCS 86480
Hospital Charge Code	38478078
Hospital Revenue Code	300
Min. Negotiated Rate	$65.40
Max. Negotiated Rate	$65.40
Rate for Payer: Qualcare PPO/HMO/WC	$65.40

TC99 EXAMETAZIME UP TO 25MCI

Facility

$5,838.74

Service Code	HCPCS A9521
Hospital Charge Code	4509072
Hospital Revenue Code	343
Min. Negotiated Rate	$875.81
Max. Negotiated Rate	$875.81
Rate for Payer: Qualcare PPO/HMO/WC	$875.81

TC99 EXAMETAZIME UP TO 25MCI

Facility

$5,838.74

Service Code	HCPCS A9521
Hospital Charge Code	4509072
Hospital Revenue Code	343
Min. Negotiated Rate	$165.82
Max. Negotiated Rate	$2,919.37
Rate for Payer: Aetna Commercial	$2,218.72
Rate for Payer: Aetna Medicare Advantage	$1,751.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,488.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,488.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,488.88
Rate for Payer: Cigna Commercial	$2,919.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,518.07
Rate for Payer: Qualcare PPO/HMO/WC	$875.81
Rate for Payer: UnitedHealthcare Community & State	$184.50
Rate for Payer: Wellpoint Medicaid Managed Care	$165.82

TC99M CERETEC WBC 10,0 MCI

Facility

$258.67

Service Code	HCPCS A9569
Hospital Charge Code	4509093
Hospital Revenue Code	343
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$38.80
Rate for Payer: Qualcare PPO/HMO/WC	$38.80

TC99M CERETEC WBC 10,0 MCI

Facility

$258.67

Service Code	HCPCS A9569
Hospital Charge Code	4509093
Hospital Revenue Code	343
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$3,388.56
Rate for Payer: Aetna Commercial	$2,540.83
Rate for Payer: Aetna Medicare Advantage	$3,026.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,388.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,388.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$934.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$686.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,388.56
Rate for Payer: Cigna Medicare Advantage	$653.89
Rate for Payer: Clover Medicare Advantage	$887.42
Rate for Payer: EmblemHealth Commercial	$2,802.39
Rate for Payer: Humana Medicare Advantage	$962.15
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$934.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.25
Rate for Payer: Qualcare PPO/HMO/WC	$38.80
Rate for Payer: UnitedHealthcare Community & State	$8.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$934.13
Rate for Payer: Wellcare Medicare Advantage	$934.13
Rate for Payer: Wellpoint Medicaid Managed Care	$7.35

TC99 MDP/STUDY UP TO 30 MCI

Facility

$557.00

Service Code	HCPCS A9503
Hospital Charge Code	36540018
Hospital Revenue Code	343
Min. Negotiated Rate	$83.55
Max. Negotiated Rate	$83.55
Rate for Payer: Qualcare PPO/HMO/WC	$83.55

TC99 MDP/STUDY UP TO 30 MCI

Facility

$557.00

Service Code	HCPCS A9503
Hospital Charge Code	36540018
Hospital Revenue Code	343
Min. Negotiated Rate	$15.82
Max. Negotiated Rate	$278.50
Rate for Payer: Aetna Commercial	$211.66
Rate for Payer: Aetna Medicare Advantage	$167.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$142.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$142.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$142.03
Rate for Payer: Cigna Commercial	$278.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.82
Rate for Payer: Qualcare PPO/HMO/WC	$83.55
Rate for Payer: UnitedHealthcare Community & State	$17.60
Rate for Payer: Wellpoint Medicaid Managed Care	$15.82

TC99MEB CHOLETECDOSEUPTO15MCI

Facility

$1,433.00

Service Code	HCPCS A9537
Hospital Charge Code	4500302
Hospital Revenue Code	343
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$716.50
Rate for Payer: Aetna Commercial	$544.54
Rate for Payer: Aetna Medicare Advantage	$429.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$365.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$365.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$365.42
Rate for Payer: Cigna Commercial	$716.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.58
Rate for Payer: Qualcare PPO/HMO/WC	$214.95
Rate for Payer: UnitedHealthcare Community & State	$45.28
Rate for Payer: Wellpoint Medicaid Managed Care	$40.70

TC99MEB CHOLETECDOSEUPTO15MCI

Facility

$1,433.00

Service Code	HCPCS A9537
Hospital Charge Code	4500302
Hospital Revenue Code	343
Min. Negotiated Rate	$214.95
Max. Negotiated Rate	$214.95
Rate for Payer: Qualcare PPO/HMO/WC	$214.95

TC99M MEBROFENIN UP TO 15MCI

Facility

$232.80

Service Code	HCPCS A9537
Hospital Charge Code	4509082
Hospital Revenue Code	343
Min. Negotiated Rate	$34.92
Max. Negotiated Rate	$34.92
Rate for Payer: Qualcare PPO/HMO/WC	$34.92

TC99M MEBROFENIN UP TO 15MCI

Facility

$232.80

Service Code	HCPCS A9537
Hospital Charge Code	4509082
Hospital Revenue Code	343
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$116.40
Rate for Payer: Aetna Commercial	$88.46
Rate for Payer: Aetna Medicare Advantage	$69.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.36
Rate for Payer: Cigna Commercial	$116.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.53
Rate for Payer: Qualcare PPO/HMO/WC	$34.92
Rate for Payer: UnitedHealthcare Community & State	$7.36
Rate for Payer: Wellpoint Medicaid Managed Care	$6.61

TC99M MEDRONATE

Facility

$66.16

Service Code	HCPCS A9503
Hospital Charge Code	4507015
Hospital Revenue Code	343
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$9.92
Rate for Payer: Qualcare PPO/HMO/WC	$9.92

Know your out-of-pocket cost for care.

All Charges