Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TRAILBLAZER ANGLE .014X150

Facility

$5,280.00

Service Code	HCPCS C1887
Hospital Charge Code	270683674N
Hospital Revenue Code	278
Min. Negotiated Rate	$149.95
Max. Negotiated Rate	$2,640.00
Rate for Payer: Aetna Commercial	$2,006.40
Rate for Payer: Aetna Medicare Advantage	$1,584.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,346.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,346.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,056.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,346.40
Rate for Payer: Cigna Commercial	$2,640.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,277.76
Rate for Payer: Qualcare PPO/HMO/WC	$792.00
Rate for Payer: UnitedHealthcare Community & State	$166.85
Rate for Payer: Wellpoint Medicaid Managed Care	$149.95

TRAILBLAZER ANGLE .014X150

Facility

$5,280.00

Service Code	HCPCS C1887
Hospital Charge Code	270683674N
Hospital Revenue Code	278
Min. Negotiated Rate	$792.00
Max. Negotiated Rate	$1,277.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,056.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,277.76
Rate for Payer: Qualcare PPO/HMO/WC	$792.00

TRAILBLAZER ANGLE .014X150

Facility

$5,280.00

Service Code	HCPCS C1887
Hospital Charge Code	270683674S
Hospital Revenue Code	278
Min. Negotiated Rate	$792.00
Max. Negotiated Rate	$1,277.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,056.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,277.76
Rate for Payer: Qualcare PPO/HMO/WC	$792.00

Trailblazer Angle .018 x 150

Facility

$5,280.00

Service Code	HCPCS C1887
Hospital Charge Code	270683675N
Hospital Revenue Code	278
Min. Negotiated Rate	$149.95
Max. Negotiated Rate	$2,640.00
Rate for Payer: Aetna Commercial	$2,006.40
Rate for Payer: Aetna Medicare Advantage	$1,584.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,346.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,346.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,056.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,346.40
Rate for Payer: Cigna Commercial	$2,640.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,277.76
Rate for Payer: Qualcare PPO/HMO/WC	$792.00
Rate for Payer: UnitedHealthcare Community & State	$166.85
Rate for Payer: Wellpoint Medicaid Managed Care	$149.95

Trailblazer Angle .018 x 150

Facility

$5,280.00

Service Code	HCPCS C1887
Hospital Charge Code	270683675S
Hospital Revenue Code	278
Min. Negotiated Rate	$792.00
Max. Negotiated Rate	$1,277.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,056.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,277.76
Rate for Payer: Qualcare PPO/HMO/WC	$792.00

Trailblazer Angle .018 x 150

Facility

$5,280.00

Service Code	HCPCS C1887
Hospital Charge Code	270683675S
Hospital Revenue Code	278
Min. Negotiated Rate	$149.95
Max. Negotiated Rate	$2,640.00
Rate for Payer: Aetna Commercial	$2,006.40
Rate for Payer: Aetna Medicare Advantage	$1,584.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,346.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,346.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,056.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,346.40
Rate for Payer: Cigna Commercial	$2,640.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,277.76
Rate for Payer: Qualcare PPO/HMO/WC	$792.00
Rate for Payer: UnitedHealthcare Community & State	$166.85
Rate for Payer: Wellpoint Medicaid Managed Care	$149.95

Trailblazer Angle .018 x 150

Facility

$5,280.00

Service Code	HCPCS C1887
Hospital Charge Code	270683675N
Hospital Revenue Code	278
Min. Negotiated Rate	$792.00
Max. Negotiated Rate	$1,277.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,056.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,277.76
Rate for Payer: Qualcare PPO/HMO/WC	$792.00

Trailblazer Angle .035 x 150

Facility

$5,280.00

Service Code	HCPCS C1887
Hospital Charge Code	270683677S
Hospital Revenue Code	278
Min. Negotiated Rate	$792.00
Max. Negotiated Rate	$1,277.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,056.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,277.76
Rate for Payer: Qualcare PPO/HMO/WC	$792.00

Trailblazer Angle .035 x 150

Facility

$5,280.00

Service Code	HCPCS C1887
Hospital Charge Code	270683677S
Hospital Revenue Code	278
Min. Negotiated Rate	$149.95
Max. Negotiated Rate	$2,640.00
Rate for Payer: Aetna Commercial	$2,006.40
Rate for Payer: Aetna Medicare Advantage	$1,584.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,346.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,346.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,056.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,346.40
Rate for Payer: Cigna Commercial	$2,640.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,277.76
Rate for Payer: Qualcare PPO/HMO/WC	$792.00
Rate for Payer: UnitedHealthcare Community & State	$166.85
Rate for Payer: Wellpoint Medicaid Managed Care	$149.95

Trailblazer Angle .035 x 150

Facility

$5,280.00

Service Code	HCPCS C1887
Hospital Charge Code	270683677N
Hospital Revenue Code	278
Min. Negotiated Rate	$792.00
Max. Negotiated Rate	$1,277.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,056.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,277.76
Rate for Payer: Qualcare PPO/HMO/WC	$792.00

Trailblazer Angle .035 x 150

Facility

$5,280.00

Service Code	HCPCS C1887
Hospital Charge Code	270683677N
Hospital Revenue Code	278
Min. Negotiated Rate	$149.95
Max. Negotiated Rate	$2,640.00
Rate for Payer: Aetna Commercial	$2,006.40
Rate for Payer: Aetna Medicare Advantage	$1,584.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,346.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,346.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,056.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,346.40
Rate for Payer: Cigna Commercial	$2,640.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,277.76
Rate for Payer: Qualcare PPO/HMO/WC	$792.00
Rate for Payer: UnitedHealthcare Community & State	$166.85
Rate for Payer: Wellpoint Medicaid Managed Care	$149.95

Trailblazer Angle .035 x 90

Facility

$5,280.00

Service Code	HCPCS C1887
Hospital Charge Code	270683676N
Hospital Revenue Code	278
Min. Negotiated Rate	$792.00
Max. Negotiated Rate	$1,277.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,056.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,277.76
Rate for Payer: Qualcare PPO/HMO/WC	$792.00

Trailblazer Angle .035 x 90

Facility

$5,280.00

Service Code	HCPCS C1887
Hospital Charge Code	270683676N
Hospital Revenue Code	278
Min. Negotiated Rate	$149.95
Max. Negotiated Rate	$2,640.00
Rate for Payer: Aetna Commercial	$2,006.40
Rate for Payer: Aetna Medicare Advantage	$1,584.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,346.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,346.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,056.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,346.40
Rate for Payer: Cigna Commercial	$2,640.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,277.76
Rate for Payer: Qualcare PPO/HMO/WC	$792.00
Rate for Payer: UnitedHealthcare Community & State	$166.85
Rate for Payer: Wellpoint Medicaid Managed Care	$149.95

Trailblazer Angle .035 x 90

Facility

$5,280.00

Service Code	HCPCS C1887
Hospital Charge Code	270683676S
Hospital Revenue Code	278
Min. Negotiated Rate	$149.95
Max. Negotiated Rate	$2,640.00
Rate for Payer: Aetna Commercial	$2,006.40
Rate for Payer: Aetna Medicare Advantage	$1,584.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,346.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,346.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,056.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,346.40
Rate for Payer: Cigna Commercial	$2,640.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,277.76
Rate for Payer: Qualcare PPO/HMO/WC	$792.00
Rate for Payer: UnitedHealthcare Community & State	$166.85
Rate for Payer: Wellpoint Medicaid Managed Care	$149.95

Trailblazer Angle .035 x 90

Facility

$5,280.00

Service Code	HCPCS C1887
Hospital Charge Code	270683676S
Hospital Revenue Code	278
Min. Negotiated Rate	$792.00
Max. Negotiated Rate	$1,277.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,056.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,277.76
Rate for Payer: Qualcare PPO/HMO/WC	$792.00

TRAMADOL 50 MG TAB

Facility

$5.36

Service Code	NDC 51079099120
Hospital Charge Code	60627720
Hospital Revenue Code	250
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.80

TRAMADOL 50 MG TAB

Facility

$5.36

Service Code	NDC 51079099120
Hospital Charge Code	60627720
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$2.68
Rate for Payer: Aetna Commercial	$2.04
Rate for Payer: Aetna Medicare Advantage	$1.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.37
Rate for Payer: Cigna Commercial	$2.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.39
Rate for Payer: Oxford Commercial	$1.07
Rate for Payer: Qualcare PPO/HMO/WC	$0.80
Rate for Payer: UnitedHealthcare Commercial	$1.07
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

TRAMADOL SCREENW REF/CONF URIN

Facility

$399.05

Service Code	HCPCS 80307
Hospital Charge Code	39708045
Hospital Revenue Code	306
Min. Negotiated Rate	$11.33
Max. Negotiated Rate	$225.41
Rate for Payer: Aetna Commercial	$169.02
Rate for Payer: Aetna Medicare Advantage	$201.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$225.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$225.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$62.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$225.41
Rate for Payer: Cigna Commercial	$199.53
Rate for Payer: Cigna Medicare Advantage	$62.14
Rate for Payer: Clover Medicare Advantage	$59.03
Rate for Payer: EmblemHealth Commercial	$186.42
Rate for Payer: Humana Medicare Advantage	$64.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$62.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.75
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.86
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$49.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$62.14
Rate for Payer: Wellcare Medicare Advantage	$62.14
Rate for Payer: Wellpoint Medicaid Managed Care	$11.33

TRAMADOL SCREENW REF/CONF URIN

Facility

$399.05

Service Code	HCPCS 80307
Hospital Charge Code	39708045
Hospital Revenue Code	306
Min. Negotiated Rate	$59.86
Max. Negotiated Rate	$59.86
Rate for Payer: Qualcare PPO/HMO/WC	$59.86

TRANEXAMIC ACID

Facility

$16.75

Service Code	NDC 517096010
Hospital Charge Code	606380005
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$8.38
Rate for Payer: Aetna Commercial	$6.37
Rate for Payer: Aetna Medicare Advantage	$5.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.27
Rate for Payer: Cigna Commercial	$8.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.36
Rate for Payer: Oxford Commercial	$3.35
Rate for Payer: Qualcare PPO/HMO/WC	$2.51
Rate for Payer: UnitedHealthcare Commercial	$3.35
Rate for Payer: UnitedHealthcare Community & State	$0.53
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

TRANEXAMIC ACID

Facility

$16.75

Service Code	NDC 517096010
Hospital Charge Code	606380005
Hospital Revenue Code	250
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$2.51
Rate for Payer: Qualcare PPO/HMO/WC	$2.51

TRANEXAMIC ACID 1000MG/100ML

Facility

$169.18

Service Code	NDC 51754010803
Hospital Charge Code	606390297
Hospital Revenue Code	250
Min. Negotiated Rate	$25.38
Max. Negotiated Rate	$25.38
Rate for Payer: Qualcare PPO/HMO/WC	$25.38

TRANEXAMIC ACID 1000MG/100ML

Facility

$169.18

Service Code	NDC 51754010803
Hospital Charge Code	606390297
Hospital Revenue Code	250
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$84.59
Rate for Payer: Aetna Commercial	$64.29
Rate for Payer: Aetna Medicare Advantage	$50.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.14
Rate for Payer: Cigna Commercial	$84.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.99
Rate for Payer: Oxford Commercial	$33.84
Rate for Payer: Qualcare PPO/HMO/WC	$25.38
Rate for Payer: UnitedHealthcare Commercial	$33.84
Rate for Payer: UnitedHealthcare Community & State	$5.35
Rate for Payer: Wellpoint Medicaid Managed Care	$4.80

TRAN OR AVULSE OTH SPINAL NRV

Facility

$16,437.00

Service Code	HCPCS 64772
Hospital Charge Code	16000656
Hospital Revenue Code	360
Min. Negotiated Rate	$466.81
Max. Negotiated Rate	$8,415.40
Rate for Payer: Aetna Commercial	$6,310.10
Rate for Payer: Aetna Medicare Advantage	$7,516.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,415.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,415.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,319.89
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	$8,415.40
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: Cigna Medicare Advantage	$2,319.89
Rate for Payer: Clover Medicare Advantage	$2,203.90
Rate for Payer: EmblemHealth Commercial	$6,959.67
Rate for Payer: Humana Medicare Advantage	$2,389.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,319.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,273.62
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,465.55
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$519.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare Medicare Advantage	$2,319.89
Rate for Payer: Wellpoint Medicaid Managed Care	$466.81

TRAN OR AVULSE OTH SPINAL NRV

Facility

$16,437.00

Service Code	HCPCS 64772
Hospital Charge Code	16000656
Hospital Revenue Code	360
Min. Negotiated Rate	$2,465.55
Max. Negotiated Rate	$2,465.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,465.55

Know your out-of-pocket cost for care.

All Charges