Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TRICHOPHYTON MENTAGROPHYT

Facility

$19.03

Service Code	NDC 268043202
Hospital Charge Code	60634535
Hospital Revenue Code	250
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$9.52
Rate for Payer: Aetna Commercial	$7.23
Rate for Payer: Aetna Medicare Advantage	$5.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.85
Rate for Payer: Cigna Commercial	$9.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.95
Rate for Payer: Oxford Commercial	$3.81
Rate for Payer: Qualcare PPO/HMO/WC	$2.85
Rate for Payer: UnitedHealthcare Commercial	$3.81
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.54

TRICHOPHYTON MENTAGROPHYT

Facility

$19.03

Service Code	NDC 268043202
Hospital Charge Code	60634535
Hospital Revenue Code	250
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$2.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.85

TRICHROME STAIN

Facility

$244.00

Service Code	HCPCS 87209
Hospital Charge Code	38475089
Hospital Revenue Code	309
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$48.91
Rate for Payer: Aetna Medicare Advantage	$58.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.22
Rate for Payer: Cigna Commercial	$122.00
Rate for Payer: Cigna Medicare Advantage	$17.98
Rate for Payer: Clover Medicare Advantage	$17.08
Rate for Payer: EmblemHealth Commercial	$53.94
Rate for Payer: Humana Medicare Advantage	$18.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.44
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.60
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.98
Rate for Payer: Wellcare Medicare Advantage	$17.98
Rate for Payer: Wellpoint Medicaid Managed Care	$6.93

TRICHROME STAIN

Facility

$244.00

Service Code	HCPCS 87209
Hospital Charge Code	38475089
Hospital Revenue Code	309
Min. Negotiated Rate	$36.60
Max. Negotiated Rate	$36.60
Rate for Payer: Qualcare PPO/HMO/WC	$36.60

TRI CRU RETAIN FEM SZ 1 LT CR

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270697570
Hospital Revenue Code	278
Min. Negotiated Rate	$299.04
Max. Negotiated Rate	$5,264.73
Rate for Payer: Aetna Commercial	$4,001.19
Rate for Payer: Aetna Medicare Advantage	$3,158.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,685.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,685.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,685.01
Rate for Payer: Cigna Commercial	$5,264.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42
Rate for Payer: UnitedHealthcare Community & State	$332.73
Rate for Payer: Wellpoint Medicaid Managed Care	$299.04

TRI CRU RETAIN FEM SZ 1 LT CR

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270697570
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.42
Max. Negotiated Rate	$2,548.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42

TRICYCLIC & CYCLICALS 6/MORE

Facility

$190.45

Service Code	HCPCS 80337
Hospital Charge Code	3039018
Hospital Revenue Code	301
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.52
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

TRICYCLIC & CYCLICALS 6/MORE

Facility

$190.45

Service Code	HCPCS 80337
Hospital Charge Code	38430018
Hospital Revenue Code	301
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.52
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

TRICYCLIC & CYCLICALS 6/MORE

Facility

$190.45

Service Code	HCPCS 80337
Hospital Charge Code	39990218
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

TRICYCLIC & CYCLICALS 6/MORE

Facility

$190.45

Service Code	HCPCS 80337
Hospital Charge Code	39990218
Hospital Revenue Code	301
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.52
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

TRICYCLIC & CYCLICALS 6/MORE

Facility

$190.45

Service Code	HCPCS 80337
Hospital Charge Code	38430018
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

TRICYCLIC & CYCLICALS 6/MORE

Facility

$190.45

Service Code	HCPCS 80337
Hospital Charge Code	3039018
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

TRIDENT 0 DEG INSERT 40MM

Facility

$4,434.25

Service Code	HCPCS C1776
Hospital Charge Code	270697216
Hospital Revenue Code	278
Min. Negotiated Rate	$665.14
Max. Negotiated Rate	$1,073.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$886.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,073.09
Rate for Payer: Qualcare PPO/HMO/WC	$665.14

TRIDENT 0 DEG INSERT 40MM

Facility

$4,434.25

Service Code	HCPCS C1776
Hospital Charge Code	270697216
Hospital Revenue Code	278
Min. Negotiated Rate	$125.93
Max. Negotiated Rate	$2,217.12
Rate for Payer: Aetna Commercial	$1,685.02
Rate for Payer: Aetna Medicare Advantage	$1,330.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,130.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,130.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$886.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,130.73
Rate for Payer: Cigna Commercial	$2,217.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,073.09
Rate for Payer: Qualcare PPO/HMO/WC	$665.14
Rate for Payer: UnitedHealthcare Community & State	$140.12
Rate for Payer: Wellpoint Medicaid Managed Care	$125.93

TRIDENT 10 X 3 INSERT 36MM ID

Facility

$5,146.35

Service Code	HCPCS C1776
Hospital Charge Code	270681085
Hospital Revenue Code	278
Min. Negotiated Rate	$146.16
Max. Negotiated Rate	$2,573.18
Rate for Payer: Aetna Commercial	$1,955.61
Rate for Payer: Aetna Medicare Advantage	$1,543.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,312.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,312.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,029.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,312.32
Rate for Payer: Cigna Commercial	$2,573.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,245.42
Rate for Payer: Qualcare PPO/HMO/WC	$771.95
Rate for Payer: UnitedHealthcare Community & State	$162.62
Rate for Payer: Wellpoint Medicaid Managed Care	$146.16

TRIDENT 10 X 3 INSERT 36MM ID

Facility

$5,146.35

Service Code	HCPCS C1776
Hospital Charge Code	270681085
Hospital Revenue Code	278
Min. Negotiated Rate	$771.95
Max. Negotiated Rate	$1,245.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,029.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,245.42
Rate for Payer: Qualcare PPO/HMO/WC	$771.95

TRIDENT 10X3 INSERT 36MM ID

Facility

$4,203.25

Service Code	HCPCS C1776
Hospital Charge Code	270692857
Hospital Revenue Code	278
Min. Negotiated Rate	$630.49
Max. Negotiated Rate	$1,017.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$840.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,017.19
Rate for Payer: Qualcare PPO/HMO/WC	$630.49

TRIDENT 10X3 INSERT 36MM ID

Facility

$4,203.25

Service Code	HCPCS C1776
Hospital Charge Code	270692857
Hospital Revenue Code	278
Min. Negotiated Rate	$119.37
Max. Negotiated Rate	$2,101.62
Rate for Payer: Aetna Commercial	$1,597.23
Rate for Payer: Aetna Medicare Advantage	$1,260.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,071.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,071.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$840.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,071.83
Rate for Payer: Cigna Commercial	$2,101.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,017.19
Rate for Payer: Qualcare PPO/HMO/WC	$630.49
Rate for Payer: UnitedHealthcare Community & State	$132.82
Rate for Payer: Wellpoint Medicaid Managed Care	$119.37

TRIDENT II TI CLUST ACET SHELL

Facility

$6,562.50

Service Code	HCPCS C1776
Hospital Charge Code	270686576
Hospital Revenue Code	278
Min. Negotiated Rate	$984.38
Max. Negotiated Rate	$1,588.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,588.12
Rate for Payer: Qualcare PPO/HMO/WC	$984.38

TRIDENT II TI CLUST ACET SHELL

Facility

$6,562.50

Service Code	HCPCS C1776
Hospital Charge Code	270686576
Hospital Revenue Code	278
Min. Negotiated Rate	$186.38
Max. Negotiated Rate	$3,281.25
Rate for Payer: Aetna Commercial	$2,493.75
Rate for Payer: Aetna Medicare Advantage	$1,968.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,673.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,673.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,673.44
Rate for Payer: Cigna Commercial	$3,281.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,588.12
Rate for Payer: Qualcare PPO/HMO/WC	$984.38
Rate for Payer: UnitedHealthcare Community & State	$207.38
Rate for Payer: Wellpoint Medicaid Managed Care	$186.38

TRIDENT II TRITANIUM CLUSTERHO

Facility

$20,315.00

Service Code	HCPCS C1776
Hospital Charge Code	270684555
Hospital Revenue Code	278
Min. Negotiated Rate	$3,047.25
Max. Negotiated Rate	$4,916.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,063.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,916.23
Rate for Payer: Qualcare PPO/HMO/WC	$3,047.25

TRIDENT II TRITANIUM CLUSTERHO

Facility

$20,315.00

Service Code	HCPCS C1776
Hospital Charge Code	270684555
Hospital Revenue Code	278
Min. Negotiated Rate	$576.95
Max. Negotiated Rate	$10,157.50
Rate for Payer: Aetna Commercial	$7,719.70
Rate for Payer: Aetna Medicare Advantage	$6,094.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,180.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,180.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,063.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,180.32
Rate for Payer: Cigna Commercial	$10,157.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,916.23
Rate for Payer: Qualcare PPO/HMO/WC	$3,047.25
Rate for Payer: UnitedHealthcare Community & State	$641.95
Rate for Payer: Wellpoint Medicaid Managed Care	$576.95

TRIDENT II TRITAN SOLIDBK 56F

Facility

$5,888.55

Service Code	HCPCS C1776
Hospital Charge Code	270699331
Hospital Revenue Code	278
Min. Negotiated Rate	$883.28
Max. Negotiated Rate	$1,425.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,177.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,425.03
Rate for Payer: Qualcare PPO/HMO/WC	$883.28

TRIDENT II TRITAN SOLIDBK 56F

Facility

$5,888.55

Service Code	HCPCS C1776
Hospital Charge Code	270699331
Hospital Revenue Code	278
Min. Negotiated Rate	$167.23
Max. Negotiated Rate	$2,944.28
Rate for Payer: Aetna Commercial	$2,237.65
Rate for Payer: Aetna Medicare Advantage	$1,766.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,501.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,501.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,177.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,501.58
Rate for Payer: Cigna Commercial	$2,944.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,425.03
Rate for Payer: Qualcare PPO/HMO/WC	$883.28
Rate for Payer: UnitedHealthcare Community & State	$186.08
Rate for Payer: Wellpoint Medicaid Managed Care	$167.23

TRIDENT II TRITAN SOLIDBK 60G

Facility

$12,287.50

Service Code	HCPCS C1776
Hospital Charge Code	270699343
Hospital Revenue Code	278
Min. Negotiated Rate	$1,843.12
Max. Negotiated Rate	$2,973.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,457.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,973.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,843.12

Know your out-of-pocket cost for care.

All Charges