Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TRAY THAL-QUICK CHEST TUBE 8FR

Facility

$755.95

Hospital Charge Code	270677080
Hospital Revenue Code	272
Min. Negotiated Rate	$21.47
Max. Negotiated Rate	$377.98
Rate for Payer: Aetna Commercial	$287.26
Rate for Payer: Aetna Medicare Advantage	$226.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$192.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$192.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$192.77
Rate for Payer: Cigna Commercial	$377.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.55
Rate for Payer: Oxford Commercial	$151.19
Rate for Payer: Qualcare PPO/HMO/WC	$113.39
Rate for Payer: UnitedHealthcare Commercial	$151.19
Rate for Payer: UnitedHealthcare Community & State	$23.89
Rate for Payer: Wellpoint Medicaid Managed Care	$21.47

TRAY THAL-QUICK CHEST TUBE 8FR

Facility

$755.95

Hospital Charge Code	270677080
Hospital Revenue Code	272
Min. Negotiated Rate	$113.39
Max. Negotiated Rate	$113.39
Rate for Payer: Qualcare PPO/HMO/WC	$113.39

TRAY THORACENTESIS

Facility

$115.56

Hospital Charge Code	270303235
Hospital Revenue Code	272
Min. Negotiated Rate	$17.33
Max. Negotiated Rate	$17.33
Rate for Payer: Qualcare PPO/HMO/WC	$17.33

TRAY THORACENTESIS

Facility

$115.56

Hospital Charge Code	270303235
Hospital Revenue Code	272
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$57.78
Rate for Payer: Aetna Commercial	$43.91
Rate for Payer: Aetna Medicare Advantage	$34.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.47
Rate for Payer: Cigna Commercial	$57.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.05
Rate for Payer: Oxford Commercial	$23.11
Rate for Payer: Qualcare PPO/HMO/WC	$17.33
Rate for Payer: UnitedHealthcare Commercial	$23.11
Rate for Payer: UnitedHealthcare Community & State	$3.65
Rate for Payer: Wellpoint Medicaid Managed Care	$3.28

TRAY THORACENTESIS 48/CS

Facility

$14.25

Hospital Charge Code	270649810
Hospital Revenue Code	271
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$2.14
Rate for Payer: Qualcare PPO/HMO/WC	$2.14

TRAY THORACENTESIS 48/CS

Facility

$14.25

Hospital Charge Code	270649810
Hospital Revenue Code	271
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$7.12
Rate for Payer: Aetna Commercial	$5.42
Rate for Payer: Aetna Medicare Advantage	$4.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.63
Rate for Payer: Cigna Commercial	$7.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.71
Rate for Payer: Oxford Commercial	$2.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.14
Rate for Payer: UnitedHealthcare Commercial	$2.85
Rate for Payer: UnitedHealthcare Community & State	$0.45
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

TRAY TIBAL FIXD CEMNTD #T3-14R

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681054
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

TRAY TIBAL FIXD CEMNTD #T3-14R

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681054
Hospital Revenue Code	278
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

TRAY TIBAL INFINITY SZ 5 LNG

Facility

$22,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270678155
Hospital Revenue Code	278
Min. Negotiated Rate	$636.16
Max. Negotiated Rate	$11,200.00
Rate for Payer: Aetna Commercial	$8,512.00
Rate for Payer: Aetna Medicare Advantage	$6,720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,712.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,712.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,480.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,712.00
Rate for Payer: Cigna Commercial	$11,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,420.80
Rate for Payer: Qualcare PPO/HMO/WC	$3,360.00
Rate for Payer: UnitedHealthcare Community & State	$707.84
Rate for Payer: Wellpoint Medicaid Managed Care	$636.16

TRAY TIBAL INFINITY SZ 5 LNG

Facility

$22,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270678155
Hospital Revenue Code	278
Min. Negotiated Rate	$3,360.00
Max. Negotiated Rate	$5,420.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,480.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,420.80
Rate for Payer: Qualcare PPO/HMO/WC	$3,360.00

TRAY TIBIAL CRUCIATE 67MM

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270639769
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

TRAY TIBIAL CRUCIATE 67MM

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270639769
Hospital Revenue Code	278
Min. Negotiated Rate	$113.60
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$126.40
Rate for Payer: Wellpoint Medicaid Managed Care	$113.60

TRAY TIBIAL CRUCIATE 79mm

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270640150
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

TRAY TIBIAL CRUCIATE 79mm

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270640150
Hospital Revenue Code	278
Min. Negotiated Rate	$113.60
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$126.40
Rate for Payer: Wellpoint Medicaid Managed Care	$113.60

TRAY TIBIAL F CEMENTED T3-I4 L

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270681129
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

TRAY TIBIAL F CEMENTED T3-I4 L

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270681129
Hospital Revenue Code	278
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

TRAY TIBIAL FIXED SZ3 LEFT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270668533
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

TRAY TIBIAL FIXED SZ3 LEFT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270668533
Hospital Revenue Code	278
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

TRAY TIBIAL FIXED SZ4 RIGHT

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270681407
Hospital Revenue Code	278
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

TRAY TIBIAL FIXED SZ4 RIGHT

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270681407
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

TRAY TIBIAL FIXED SZ4 RIGHT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676913
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

TRAY TIBIAL FIXED SZ4 RIGHT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676913
Hospital Revenue Code	278
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

TRAY TIBIAL FIXED SZ4RIGHT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680716
Hospital Revenue Code	278
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

TRAY TIBIAL FIXED SZ4RIGHT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680716
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

TRAY TIBIAL FIXED SZ5 RIGHT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677519
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

Know your out-of-pocket cost for care.

All Charges