Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TIB&SCRW AUG BLK11MM RLAT/LMED

Facility

$3,861.00

Service Code	HCPCS C1713
Hospital Charge Code	270680669
Hospital Revenue Code	278
Min. Negotiated Rate	$579.15
Max. Negotiated Rate	$934.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.36
Rate for Payer: Qualcare PPO/HMO/WC	$579.15

TI CAGE 9MM MEDIUM

Facility

$10,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705744
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

TI CAGE 9MM MEDIUM

Facility

$10,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705744
Hospital Revenue Code	278
Min. Negotiated Rate	$298.20
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$331.80
Rate for Payer: Wellpoint Medicaid Managed Care	$298.20

TICAGRELOR 90MG TAB

Facility

$36.45

Service Code	NDC 186077739
Hospital Charge Code	60630216
Hospital Revenue Code	250
Min. Negotiated Rate	$5.47
Max. Negotiated Rate	$5.47
Rate for Payer: Qualcare PPO/HMO/WC	$5.47

TICAGRELOR 90MG TAB

Facility

$36.45

Service Code	NDC 186077739
Hospital Charge Code	60630216
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$18.23
Rate for Payer: Aetna Commercial	$13.85
Rate for Payer: Aetna Medicare Advantage	$10.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.29
Rate for Payer: Cigna Commercial	$18.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.48
Rate for Payer: Oxford Commercial	$7.29
Rate for Payer: Qualcare PPO/HMO/WC	$5.47
Rate for Payer: UnitedHealthcare Commercial	$7.29
Rate for Payer: UnitedHealthcare Community & State	$1.15
Rate for Payer: Wellpoint Medicaid Managed Care	$1.04

TI CANN FRN 10MM GT400MM

Facility

$8,788.00

Service Code	HCPCS C1713
Hospital Charge Code	270688033
Hospital Revenue Code	278
Min. Negotiated Rate	$249.58
Max. Negotiated Rate	$4,394.00
Rate for Payer: Aetna Commercial	$3,339.44
Rate for Payer: Aetna Medicare Advantage	$2,636.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,240.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,240.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,757.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,240.94
Rate for Payer: Cigna Commercial	$4,394.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,126.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,318.20
Rate for Payer: UnitedHealthcare Community & State	$277.70
Rate for Payer: Wellpoint Medicaid Managed Care	$249.58

TI CANN FRN 10MM GT400MM

Facility

$8,788.00

Service Code	HCPCS C1713
Hospital Charge Code	270688033
Hospital Revenue Code	278
Min. Negotiated Rate	$1,318.20
Max. Negotiated Rate	$2,126.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,757.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,126.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,318.20

TICK IDENTIFICATION

Facility

$390.00

Service Code	HCPCS 87172
Hospital Charge Code	3006833
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TICK IDENTIFICATION

Facility

$106.00

Service Code	HCPCS 87168
Hospital Charge Code	38475095
Hospital Revenue Code	309
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$11.61
Rate for Payer: Aetna Medicare Advantage	$13.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.49
Rate for Payer: Cigna Commercial	$53.00
Rate for Payer: Cigna Medicare Advantage	$4.27
Rate for Payer: Clover Medicare Advantage	$4.06
Rate for Payer: EmblemHealth Commercial	$12.81
Rate for Payer: Humana Medicare Advantage	$4.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.56
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.90
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.27
Rate for Payer: Wellcare Medicare Advantage	$4.27
Rate for Payer: Wellpoint Medicaid Managed Care	$3.01

TICK IDENTIFICATION

Facility

$29.35

Service Code	HCPCS 87168
Hospital Charge Code	39900274
Hospital Revenue Code	309
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$4.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.40

TICK IDENTIFICATION

Facility

$29.35

Service Code	HCPCS 87168
Hospital Charge Code	39900274
Hospital Revenue Code	309
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$11.61
Rate for Payer: Aetna Medicare Advantage	$13.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.49
Rate for Payer: Cigna Commercial	$14.68
Rate for Payer: Cigna Medicare Advantage	$4.27
Rate for Payer: Clover Medicare Advantage	$4.06
Rate for Payer: EmblemHealth Commercial	$12.81
Rate for Payer: Humana Medicare Advantage	$4.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.63
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.40
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.27
Rate for Payer: Wellcare Medicare Advantage	$4.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.83

TICK IDENTIFICATION

Facility

$390.00

Service Code	HCPCS 87172
Hospital Charge Code	3006833
Hospital Revenue Code	309
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$11.61
Rate for Payer: Aetna Medicare Advantage	$13.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.49
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$4.27
Rate for Payer: Clover Medicare Advantage	$4.06
Rate for Payer: EmblemHealth Commercial	$12.81
Rate for Payer: Humana Medicare Advantage	$4.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.27
Rate for Payer: Wellcare Medicare Advantage	$4.27
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

TICK IDENTIFICATION

Facility

$106.00

Service Code	HCPCS 87168
Hospital Charge Code	38475095
Hospital Revenue Code	309
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$15.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.90

TICLOPIDINE 250 MG TAB

Facility

$13.33

Service Code	NDC 57664032786
Hospital Charge Code	60628554
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$6.67
Rate for Payer: Aetna Commercial	$5.07
Rate for Payer: Aetna Medicare Advantage	$4.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.40
Rate for Payer: Cigna Commercial	$6.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.47
Rate for Payer: Oxford Commercial	$2.67
Rate for Payer: Qualcare PPO/HMO/WC	$2.00
Rate for Payer: UnitedHealthcare Commercial	$2.67
Rate for Payer: UnitedHealthcare Community & State	$0.42
Rate for Payer: Wellpoint Medicaid Managed Care	$0.38

TICLOPIDINE 250 MG TAB

Facility

$13.33

Service Code	NDC 57664032786
Hospital Charge Code	60628554
Hospital Revenue Code	250
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.00

TI END CAP TIBIAL NAIL STRDRV

Facility

$1,103.15

Service Code	HCPCS C1713
Hospital Charge Code	270678634
Hospital Revenue Code	278
Min. Negotiated Rate	$165.47
Max. Negotiated Rate	$266.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$220.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$266.96
Rate for Payer: Qualcare PPO/HMO/WC	$165.47

TI END CAP TIBIAL NAIL STRDRV

Facility

$1,103.15

Service Code	HCPCS C1713
Hospital Charge Code	270678634
Hospital Revenue Code	278
Min. Negotiated Rate	$31.33
Max. Negotiated Rate	$551.58
Rate for Payer: Aetna Commercial	$419.20
Rate for Payer: Aetna Medicare Advantage	$330.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$281.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$281.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$220.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$281.30
Rate for Payer: Cigna Commercial	$551.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$266.96
Rate for Payer: Qualcare PPO/HMO/WC	$165.47
Rate for Payer: UnitedHealthcare Community & State	$34.86
Rate for Payer: Wellpoint Medicaid Managed Care	$31.33

TIGERSTICK

Facility

$250.00

Hospital Charge Code	270663951
Hospital Revenue Code	270
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

TIGERSTICK

Facility

$250.00

Hospital Charge Code	270663951
Hospital Revenue Code	270
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.00
Rate for Payer: Oxford Commercial	$50.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$50.00
Rate for Payer: UnitedHealthcare Community & State	$7.90
Rate for Payer: Wellpoint Medicaid Managed Care	$7.10

TIGER TAPE 2MM 7 WHITE/BLACK

Facility

$250.00

Hospital Charge Code	270673984
Hospital Revenue Code	272
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.00
Rate for Payer: Oxford Commercial	$50.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$50.00
Rate for Payer: UnitedHealthcare Community & State	$7.90
Rate for Payer: Wellpoint Medicaid Managed Care	$7.10

TIGER TAPE 2MM 7 WHITE/BLACK

Facility

$250.00

Hospital Charge Code	270673984
Hospital Revenue Code	272
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

TIGERTAPE CERCLAGE W/O NDL 2MM

Facility

$2,574.00

Service Code	HCPCS C1713
Hospital Charge Code	270698125
Hospital Revenue Code	278
Min. Negotiated Rate	$73.10
Max. Negotiated Rate	$1,287.00
Rate for Payer: Aetna Commercial	$978.12
Rate for Payer: Aetna Medicare Advantage	$772.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$656.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$656.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$514.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$656.37
Rate for Payer: Cigna Commercial	$1,287.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$622.91
Rate for Payer: Qualcare PPO/HMO/WC	$386.10
Rate for Payer: UnitedHealthcare Community & State	$81.34
Rate for Payer: Wellpoint Medicaid Managed Care	$73.10

TIGERTAPE CERCLAGE W/O NDL 2MM

Facility

$2,574.00

Service Code	HCPCS C1713
Hospital Charge Code	270698125
Hospital Revenue Code	278
Min. Negotiated Rate	$386.10
Max. Negotiated Rate	$622.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$514.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$622.91
Rate for Payer: Qualcare PPO/HMO/WC	$386.10

TIGERTRIEVER 13 SYST 20.5M

Facility

$34,000.00

Service Code	HCPCS C1757
Hospital Charge Code	270698109S
Hospital Revenue Code	278
Min. Negotiated Rate	$5,100.00
Max. Negotiated Rate	$8,228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,228.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,100.00

TIGERTRIEVER 13 SYST 20.5M

Facility

$34,000.00

Service Code	HCPCS C1757
Hospital Charge Code	270698109S
Hospital Revenue Code	278
Min. Negotiated Rate	$965.60
Max. Negotiated Rate	$17,000.00
Rate for Payer: Aetna Commercial	$12,920.00
Rate for Payer: Aetna Medicare Advantage	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,670.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,670.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,670.00
Rate for Payer: Cigna Commercial	$17,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,228.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,100.00
Rate for Payer: UnitedHealthcare Community & State	$1,074.40
Rate for Payer: Wellpoint Medicaid Managed Care	$965.60

Know your out-of-pocket cost for care.

All Charges