Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TRAY TRIPLE LUM CATH AK25703A

Facility

$642.75

Service Code	HCPCS C1751
Hospital Charge Code	270302270
Hospital Revenue Code	278
Min. Negotiated Rate	$18.25
Max. Negotiated Rate	$321.38
Rate for Payer: Aetna Commercial	$244.25
Rate for Payer: Aetna Medicare Advantage	$192.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$128.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.90
Rate for Payer: Cigna Commercial	$321.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.55
Rate for Payer: Qualcare PPO/HMO/WC	$96.41
Rate for Payer: UnitedHealthcare Community & State	$20.31
Rate for Payer: Wellpoint Medicaid Managed Care	$18.25

TRAY TRIPLE LUM CATH AK25703A

Facility

$642.75

Service Code	HCPCS C1751
Hospital Charge Code	270302270
Hospital Revenue Code	278
Min. Negotiated Rate	$96.41
Max. Negotiated Rate	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$128.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.55
Rate for Payer: Qualcare PPO/HMO/WC	$96.41

TRAY TSR SHOULDER REV 0MM OFFS

Facility

$17,420.00

Service Code	HCPCS C1776
Hospital Charge Code	270697092
Hospital Revenue Code	278
Min. Negotiated Rate	$494.73
Max. Negotiated Rate	$8,710.00
Rate for Payer: Aetna Commercial	$6,619.60
Rate for Payer: Aetna Medicare Advantage	$5,226.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,442.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,442.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,442.10
Rate for Payer: Cigna Commercial	$8,710.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,215.64
Rate for Payer: Qualcare PPO/HMO/WC	$2,613.00
Rate for Payer: UnitedHealthcare Community & State	$550.47
Rate for Payer: Wellpoint Medicaid Managed Care	$494.73

TRAY TSR SHOULDER REV 0MM OFFS

Facility

$17,420.00

Service Code	HCPCS C1776
Hospital Charge Code	270697092
Hospital Revenue Code	278
Min. Negotiated Rate	$2,613.00
Max. Negotiated Rate	$4,215.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,484.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,215.64
Rate for Payer: Qualcare PPO/HMO/WC	$2,613.00

TRAY URETHRAL

Facility

$1,266.45

Hospital Charge Code	270679643
Hospital Revenue Code	272
Min. Negotiated Rate	$189.97
Max. Negotiated Rate	$189.97
Rate for Payer: Qualcare PPO/HMO/WC	$189.97

TRAY URETHRAL

Facility

$1,266.45

Hospital Charge Code	270679643
Hospital Revenue Code	272
Min. Negotiated Rate	$35.97
Max. Negotiated Rate	$633.23
Rate for Payer: Aetna Commercial	$481.25
Rate for Payer: Aetna Medicare Advantage	$379.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$322.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$322.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$322.94
Rate for Payer: Cigna Commercial	$633.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$329.28
Rate for Payer: Oxford Commercial	$253.29
Rate for Payer: Qualcare PPO/HMO/WC	$189.97
Rate for Payer: UnitedHealthcare Commercial	$253.29
Rate for Payer: UnitedHealthcare Community & State	$40.02
Rate for Payer: Wellpoint Medicaid Managed Care	$35.97

TRAY URETHRAL CATH 14FR

Facility

$8.30

Hospital Charge Code	270650179
Hospital Revenue Code	272
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$4.15
Rate for Payer: Aetna Commercial	$3.15
Rate for Payer: Aetna Medicare Advantage	$2.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.12
Rate for Payer: Cigna Commercial	$4.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.16
Rate for Payer: Oxford Commercial	$1.66
Rate for Payer: Qualcare PPO/HMO/WC	$1.25
Rate for Payer: UnitedHealthcare Commercial	$1.66
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

TRAY URETHRAL CATH 14FR

Facility

$8.30

Hospital Charge Code	270650179
Hospital Revenue Code	272
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$1.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.25

TRAY URETHRL W/STR CATH 772414

Facility

$11.82

Hospital Charge Code	270302232
Hospital Revenue Code	272
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$5.91
Rate for Payer: Aetna Commercial	$4.49
Rate for Payer: Aetna Medicare Advantage	$3.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.01
Rate for Payer: Cigna Commercial	$5.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.07
Rate for Payer: Oxford Commercial	$2.36
Rate for Payer: Qualcare PPO/HMO/WC	$1.77
Rate for Payer: UnitedHealthcare Commercial	$2.36
Rate for Payer: UnitedHealthcare Community & State	$0.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

TRAY URETHRL W/STR CATH 772414

Facility

$11.82

Hospital Charge Code	270302232
Hospital Revenue Code	272
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$1.77
Rate for Payer: Qualcare PPO/HMO/WC	$1.77

TRAY VENOUS CUT DOWN NON-DISP

Facility

$408.85

Hospital Charge Code	2708002438
Hospital Revenue Code	272
Min. Negotiated Rate	$11.61
Max. Negotiated Rate	$204.43
Rate for Payer: Aetna Commercial	$155.36
Rate for Payer: Aetna Medicare Advantage	$122.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.26
Rate for Payer: Cigna Commercial	$204.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.30
Rate for Payer: Oxford Commercial	$81.77
Rate for Payer: Qualcare PPO/HMO/WC	$61.33
Rate for Payer: UnitedHealthcare Commercial	$81.77
Rate for Payer: UnitedHealthcare Community & State	$12.92
Rate for Payer: Wellpoint Medicaid Managed Care	$11.61

TRAY VENOUS CUT DOWN NON-DISP

Facility

$408.85

Hospital Charge Code	2708002438
Hospital Revenue Code	272
Min. Negotiated Rate	$61.33
Max. Negotiated Rate	$61.33
Rate for Payer: Qualcare PPO/HMO/WC	$61.33

TRAZODONE 100 MG TAB

Facility

$5.63

Service Code	NDC 13668033005
Hospital Charge Code	60627783
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$2.81
Rate for Payer: Aetna Commercial	$2.14
Rate for Payer: Aetna Medicare Advantage	$1.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.46
Rate for Payer: Oxford Commercial	$1.13
Rate for Payer: Qualcare PPO/HMO/WC	$0.84
Rate for Payer: UnitedHealthcare Commercial	$1.13
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

TRAZODONE 100 MG TAB

Facility

$5.63

Service Code	NDC 13668033005
Hospital Charge Code	60627783
Hospital Revenue Code	250
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$0.84
Rate for Payer: Qualcare PPO/HMO/WC	$0.84

TRAZODONE 50 MG TAB

Facility

$7.17

Service Code	NDC 60505265301
Hospital Charge Code	60627784
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$3.58
Rate for Payer: Aetna Commercial	$2.72
Rate for Payer: Aetna Medicare Advantage	$2.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.83
Rate for Payer: Cigna Commercial	$3.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.86
Rate for Payer: Oxford Commercial	$1.43
Rate for Payer: Qualcare PPO/HMO/WC	$1.08
Rate for Payer: UnitedHealthcare Commercial	$1.43
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

TRAZODONE 50 MG TAB

Facility

$7.17

Service Code	NDC 60505265301
Hospital Charge Code	60627784
Hospital Revenue Code	250
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$1.08
Rate for Payer: Qualcare PPO/HMO/WC	$1.08

TRAZODONE,SERUM (DESYREL)

Facility

$323.00

Service Code	HCPCS 80299
Hospital Charge Code	38473097
Hospital Revenue Code	301
Min. Negotiated Rate	$48.45
Max. Negotiated Rate	$48.45
Rate for Payer: Qualcare PPO/HMO/WC	$48.45

TRAZODONE,SERUM (DESYREL)

Facility

$323.00

Service Code	HCPCS 80299
Hospital Charge Code	38473097
Hospital Revenue Code	301
Min. Negotiated Rate	$9.17
Max. Negotiated Rate	$161.50
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.62
Rate for Payer: Cigna Commercial	$161.50
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.98
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.45
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$9.17

TR BAND LNG W/INFLATOR XXRF06L

Facility

$210.00

Hospital Charge Code	270643741C
Hospital Revenue Code	272
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$31.50
Rate for Payer: Qualcare PPO/HMO/WC	$31.50

TR BAND LNG W/INFLATOR XXRF06L

Facility

$210.00

Hospital Charge Code	270643741C
Hospital Revenue Code	272
Min. Negotiated Rate	$5.96
Max. Negotiated Rate	$105.00
Rate for Payer: Aetna Commercial	$79.80
Rate for Payer: Aetna Medicare Advantage	$63.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.55
Rate for Payer: Cigna Commercial	$105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.60
Rate for Payer: Oxford Commercial	$42.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.50
Rate for Payer: UnitedHealthcare Commercial	$42.00
Rate for Payer: UnitedHealthcare Community & State	$6.64
Rate for Payer: Wellpoint Medicaid Managed Care	$5.96

TR BAND LONG W INFLATR XXRF06L

Facility

$175.00

Hospital Charge Code	270643741N
Hospital Revenue Code	272
Min. Negotiated Rate	$4.97
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$66.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Oxford Commercial	$35.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Commercial	$35.00
Rate for Payer: UnitedHealthcare Community & State	$5.53
Rate for Payer: Wellpoint Medicaid Managed Care	$4.97

TR BAND LONG W INFLATR XXRF06L

Facility

$210.00

Hospital Charge Code	270643741S
Hospital Revenue Code	272
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$31.50
Rate for Payer: Qualcare PPO/HMO/WC	$31.50

TR BAND LONG W INFLATR XXRF06L

Facility

$175.00

Hospital Charge Code	270643741N
Hospital Revenue Code	272
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TR BAND LONG W INFLATR XXRF06L

Facility

$1,150.00

Hospital Charge Code	270643741
Hospital Revenue Code	272
Min. Negotiated Rate	$32.66
Max. Negotiated Rate	$575.00
Rate for Payer: Aetna Commercial	$437.00
Rate for Payer: Aetna Medicare Advantage	$345.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.25
Rate for Payer: Cigna Commercial	$575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$299.00
Rate for Payer: Oxford Commercial	$230.00
Rate for Payer: Qualcare PPO/HMO/WC	$172.50
Rate for Payer: UnitedHealthcare Commercial	$230.00
Rate for Payer: UnitedHealthcare Community & State	$36.34
Rate for Payer: Wellpoint Medicaid Managed Care	$32.66

TR BAND LONG W INFLATR XXRF06L

Facility

$210.00

Hospital Charge Code	270643741S
Hospital Revenue Code	272
Min. Negotiated Rate	$5.96
Max. Negotiated Rate	$105.00
Rate for Payer: Aetna Commercial	$79.80
Rate for Payer: Aetna Medicare Advantage	$63.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.55
Rate for Payer: Cigna Commercial	$105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.60
Rate for Payer: Oxford Commercial	$42.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.50
Rate for Payer: UnitedHealthcare Commercial	$42.00
Rate for Payer: UnitedHealthcare Community & State	$6.64
Rate for Payer: Wellpoint Medicaid Managed Care	$5.96

Know your out-of-pocket cost for care.

All Charges