Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TRIATHLONX3TBICSSZTYPCS11ST

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270691184
Hospital Revenue Code	278
Min. Negotiated Rate	$144.34
Max. Negotiated Rate	$2,541.18
Rate for Payer: Aetna Commercial	$1,931.29
Rate for Payer: Aetna Medicare Advantage	$1,524.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,296.00
Rate for Payer: Cigna Commercial	$2,541.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: Qualcare PPO/HMO/WC	$762.35
Rate for Payer: UnitedHealthcare Community & State	$160.60
Rate for Payer: Wellpoint Medicaid Managed Care	$144.34

TRIATHLON X3 TBI PS 7 X 9MM

Facility

$4,985.25

Service Code	HCPCS C1776
Hospital Charge Code	270691171
Hospital Revenue Code	278
Min. Negotiated Rate	$747.79
Max. Negotiated Rate	$1,206.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.43
Rate for Payer: Qualcare PPO/HMO/WC	$747.79

TRIATHLON X3 TBI PS 7 X 9MM

Facility

$4,985.25

Service Code	HCPCS C1776
Hospital Charge Code	270691171
Hospital Revenue Code	278
Min. Negotiated Rate	$141.58
Max. Negotiated Rate	$2,492.62
Rate for Payer: Aetna Commercial	$1,894.39
Rate for Payer: Aetna Medicare Advantage	$1,495.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,271.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,271.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,271.24
Rate for Payer: Cigna Commercial	$2,492.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.43
Rate for Payer: Qualcare PPO/HMO/WC	$747.79
Rate for Payer: UnitedHealthcare Community & State	$157.53
Rate for Payer: Wellpoint Medicaid Managed Care	$141.58

TRIATHLON X3 TBI SZ 5 CS 9MM

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270691177
Hospital Revenue Code	278
Min. Negotiated Rate	$762.35
Max. Negotiated Rate	$1,229.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: Qualcare PPO/HMO/WC	$762.35

TRIATHLON X3 TBI SZ 5 CS 9MM

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270691177
Hospital Revenue Code	278
Min. Negotiated Rate	$144.34
Max. Negotiated Rate	$2,541.18
Rate for Payer: Aetna Commercial	$1,931.29
Rate for Payer: Aetna Medicare Advantage	$1,524.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,296.00
Rate for Payer: Cigna Commercial	$2,541.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: Qualcare PPO/HMO/WC	$762.35
Rate for Payer: UnitedHealthcare Community & State	$160.60
Rate for Payer: Wellpoint Medicaid Managed Care	$144.34

TRIATHLON X3 TBI SZ6 CS 11MM

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270692909
Hospital Revenue Code	278
Min. Negotiated Rate	$144.34
Max. Negotiated Rate	$2,541.18
Rate for Payer: Aetna Commercial	$1,931.29
Rate for Payer: Aetna Medicare Advantage	$1,524.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,296.00
Rate for Payer: Cigna Commercial	$2,541.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: Qualcare PPO/HMO/WC	$762.35
Rate for Payer: UnitedHealthcare Community & State	$160.60
Rate for Payer: Wellpoint Medicaid Managed Care	$144.34

TRIATHLON X3 TBI SZ6 CS 11MM

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270692909
Hospital Revenue Code	278
Min. Negotiated Rate	$762.35
Max. Negotiated Rate	$1,229.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: Qualcare PPO/HMO/WC	$762.35

TRIATHLON X3 TIBIAL BEARING 13

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270694783
Hospital Revenue Code	278
Min. Negotiated Rate	$144.34
Max. Negotiated Rate	$2,541.18
Rate for Payer: Aetna Commercial	$1,931.29
Rate for Payer: Aetna Medicare Advantage	$1,524.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,296.00
Rate for Payer: Cigna Commercial	$2,541.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: Qualcare PPO/HMO/WC	$762.35
Rate for Payer: UnitedHealthcare Community & State	$160.60
Rate for Payer: Wellpoint Medicaid Managed Care	$144.34

TRIATHLON X3 TIBIAL BEARING 13

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270694783
Hospital Revenue Code	278
Min. Negotiated Rate	$762.35
Max. Negotiated Rate	$1,229.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: Qualcare PPO/HMO/WC	$762.35

TRIATH TIBINSX3 TS TI SZ3 11MM

Facility

$5,542.30

Service Code	HCPCS C1776
Hospital Charge Code	270697488
Hospital Revenue Code	278
Min. Negotiated Rate	$831.35
Max. Negotiated Rate	$1,341.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,108.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,341.24
Rate for Payer: Qualcare PPO/HMO/WC	$831.35

TRIATH TIBINSX3 TS TI SZ3 11MM

Facility

$5,542.30

Service Code	HCPCS C1776
Hospital Charge Code	270697488
Hospital Revenue Code	278
Min. Negotiated Rate	$157.40
Max. Negotiated Rate	$2,771.15
Rate for Payer: Aetna Commercial	$2,106.07
Rate for Payer: Aetna Medicare Advantage	$1,662.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,413.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,413.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,108.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,413.29
Rate for Payer: Cigna Commercial	$2,771.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,341.24
Rate for Payer: Qualcare PPO/HMO/WC	$831.35
Rate for Payer: UnitedHealthcare Community & State	$175.14
Rate for Payer: Wellpoint Medicaid Managed Care	$157.40

TRIATH TRITAN BSPLT SZ2

Facility

$6,837.05

Service Code	HCPCS C1776
Hospital Charge Code	270693814
Hospital Revenue Code	278
Min. Negotiated Rate	$1,025.56
Max. Negotiated Rate	$1,654.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,367.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,654.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,025.56

TRIATH TRITAN BSPLT SZ2

Facility

$6,837.05

Service Code	HCPCS C1776
Hospital Charge Code	270693814
Hospital Revenue Code	278
Min. Negotiated Rate	$194.17
Max. Negotiated Rate	$3,418.53
Rate for Payer: Aetna Commercial	$2,598.08
Rate for Payer: Aetna Medicare Advantage	$2,051.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,743.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,743.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,367.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,743.45
Rate for Payer: Cigna Commercial	$3,418.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,654.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,025.56
Rate for Payer: UnitedHealthcare Community & State	$216.05
Rate for Payer: Wellpoint Medicaid Managed Care	$194.17

TRIATH X3 SYM PATELLA 8MM-CAP

Facility

$2,200.15

Service Code	HCPCS C1776
Hospital Charge Code	270692888
Hospital Revenue Code	278
Min. Negotiated Rate	$62.48
Max. Negotiated Rate	$1,100.08
Rate for Payer: Aetna Commercial	$836.06
Rate for Payer: Aetna Medicare Advantage	$660.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$561.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$561.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$440.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$561.04
Rate for Payer: Cigna Commercial	$1,100.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$532.44
Rate for Payer: Qualcare PPO/HMO/WC	$330.02
Rate for Payer: UnitedHealthcare Community & State	$69.52
Rate for Payer: Wellpoint Medicaid Managed Care	$62.48

TRIATH X3 SYM PATELLA 8MM-CAP

Facility

$2,200.15

Service Code	HCPCS C1776
Hospital Charge Code	270692888
Hospital Revenue Code	278
Min. Negotiated Rate	$330.02
Max. Negotiated Rate	$532.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$440.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$532.44
Rate for Payer: Qualcare PPO/HMO/WC	$330.02

TRIATH X3 TBI CS 11MM SZ2-CAP

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270692887
Hospital Revenue Code	278
Min. Negotiated Rate	$762.35
Max. Negotiated Rate	$1,229.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: Qualcare PPO/HMO/WC	$762.35

TRIATH X3 TBI CS 11MM SZ2-CAP

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270692887
Hospital Revenue Code	278
Min. Negotiated Rate	$144.34
Max. Negotiated Rate	$2,541.18
Rate for Payer: Aetna Commercial	$1,931.29
Rate for Payer: Aetna Medicare Advantage	$1,524.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,296.00
Rate for Payer: Cigna Commercial	$2,541.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: Qualcare PPO/HMO/WC	$762.35
Rate for Payer: UnitedHealthcare Community & State	$160.60
Rate for Payer: Wellpoint Medicaid Managed Care	$144.34

TRICHINELLA AB IGG ELISA SERUM

Facility

$182.23

Service Code	HCPCS 86784
Hospital Charge Code	401386784
Hospital Revenue Code	302
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$34.16
Rate for Payer: Aetna Medicare Advantage	$40.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.56
Rate for Payer: Cigna Commercial	$91.11
Rate for Payer: Cigna Medicare Advantage	$12.56
Rate for Payer: Clover Medicare Advantage	$11.93
Rate for Payer: EmblemHealth Commercial	$37.68
Rate for Payer: Humana Medicare Advantage	$12.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.38
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.33
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.56
Rate for Payer: Wellcare Medicare Advantage	$12.56
Rate for Payer: Wellpoint Medicaid Managed Care	$5.18

TRICHINELLA AB IGG ELISA SERUM

Facility

$182.23

Service Code	HCPCS 86784
Hospital Charge Code	401386784
Hospital Revenue Code	302
Min. Negotiated Rate	$27.33
Max. Negotiated Rate	$27.33
Rate for Payer: Qualcare PPO/HMO/WC	$27.33

TRICHINELLA ANTIBODY

Facility

$136.00

Service Code	HCPCS 86784
Hospital Charge Code	38476213
Hospital Revenue Code	302
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$34.16
Rate for Payer: Aetna Medicare Advantage	$40.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.56
Rate for Payer: Cigna Commercial	$68.00
Rate for Payer: Cigna Medicare Advantage	$12.56
Rate for Payer: Clover Medicare Advantage	$11.93
Rate for Payer: EmblemHealth Commercial	$37.68
Rate for Payer: Humana Medicare Advantage	$12.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.36
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.40
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.56
Rate for Payer: Wellcare Medicare Advantage	$12.56
Rate for Payer: Wellpoint Medicaid Managed Care	$3.86

TRICHINELLA ANTIBODY

Facility

$136.00

Service Code	HCPCS 86784
Hospital Charge Code	38476213
Hospital Revenue Code	302
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$20.40
Rate for Payer: Qualcare PPO/HMO/WC	$20.40

TRICHOMONAS VAGINALIS AMPLIF

Facility

$390.00

Service Code	HCPCS 87661
Hospital Charge Code	3990245B
Hospital Revenue Code	306
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$95.44
Rate for Payer: Aetna Medicare Advantage	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.29
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$35.09
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35.09
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	$28.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Medicare Advantage	$35.09
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

TRICHOMONAS VAGINALIS AMPLIF

Facility

$390.00

Service Code	HCPCS 87661
Hospital Charge Code	3990245B
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TRICHOMONAS VAG RNA QUAL TMA

Facility

$390.00

Service Code	HCPCS 87661
Hospital Charge Code	38479745
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$95.44
Rate for Payer: Aetna Medicare Advantage	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.29
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$35.09
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35.09
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	$28.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Medicare Advantage	$35.09
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

TRICHOMONAS VAG RNA QUAL TMA

Facility

$390.00

Service Code	HCPCS 87661
Hospital Charge Code	38479745
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

All Charges