Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TRIDENT II TRITAN SOLIDBK 60G

Facility

$12,287.50

Service Code	HCPCS C1776
Hospital Charge Code	270699343
Hospital Revenue Code	278
Min. Negotiated Rate	$348.96
Max. Negotiated Rate	$6,143.75
Rate for Payer: Aetna Commercial	$4,669.25
Rate for Payer: Aetna Medicare Advantage	$3,686.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,133.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,133.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,457.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,133.31
Rate for Payer: Cigna Commercial	$6,143.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,973.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,843.12
Rate for Payer: UnitedHealthcare Community & State	$388.29
Rate for Payer: Wellpoint Medicaid Managed Care	$348.96

TRIDENT LINER X3 10D INST 36MM

Facility

$4,275.85

Service Code	HCPCS C1776
Hospital Charge Code	270692859
Hospital Revenue Code	278
Min. Negotiated Rate	$641.38
Max. Negotiated Rate	$1,034.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$855.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,034.76
Rate for Payer: Qualcare PPO/HMO/WC	$641.38

TRIDENT LINER X3 10D INST 36MM

Facility

$4,275.85

Service Code	HCPCS C1776
Hospital Charge Code	270692859
Hospital Revenue Code	278
Min. Negotiated Rate	$121.43
Max. Negotiated Rate	$2,137.93
Rate for Payer: Aetna Commercial	$1,624.82
Rate for Payer: Aetna Medicare Advantage	$1,282.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,090.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,090.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$855.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,090.34
Rate for Payer: Cigna Commercial	$2,137.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,034.76
Rate for Payer: Qualcare PPO/HMO/WC	$641.38
Rate for Payer: UnitedHealthcare Community & State	$135.12
Rate for Payer: Wellpoint Medicaid Managed Care	$121.43

TRIDENTX3 10DPOLY INSERT 36MMG

Facility

$4,458.50

Service Code	HCPCS C1776
Hospital Charge Code	270695399
Hospital Revenue Code	278
Min. Negotiated Rate	$126.62
Max. Negotiated Rate	$2,229.25
Rate for Payer: Aetna Commercial	$1,694.23
Rate for Payer: Aetna Medicare Advantage	$1,337.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,136.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,136.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$891.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,136.92
Rate for Payer: Cigna Commercial	$2,229.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,078.96
Rate for Payer: Qualcare PPO/HMO/WC	$668.77
Rate for Payer: UnitedHealthcare Community & State	$140.89
Rate for Payer: Wellpoint Medicaid Managed Care	$126.62

TRIDENTX3 10DPOLY INSERT 36MMG

Facility

$4,458.50

Service Code	HCPCS C1776
Hospital Charge Code	270695399
Hospital Revenue Code	278
Min. Negotiated Rate	$668.77
Max. Negotiated Rate	$1,078.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$891.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,078.96
Rate for Payer: Qualcare PPO/HMO/WC	$668.77

TRIDTIIPSLCLUSTHOLEHAACESH52MM

Facility

$4,765.00

Service Code	HCPCS C1776
Hospital Charge Code	270691240
Hospital Revenue Code	278
Min. Negotiated Rate	$135.33
Max. Negotiated Rate	$2,382.50
Rate for Payer: Aetna Commercial	$1,810.70
Rate for Payer: Aetna Medicare Advantage	$1,429.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,215.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,215.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$953.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,215.08
Rate for Payer: Cigna Commercial	$2,382.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,153.13
Rate for Payer: Qualcare PPO/HMO/WC	$714.75
Rate for Payer: UnitedHealthcare Community & State	$150.57
Rate for Payer: Wellpoint Medicaid Managed Care	$135.33

TRIDTIIPSLCLUSTHOLEHAACESH52MM

Facility

$4,765.00

Service Code	HCPCS C1776
Hospital Charge Code	270691240
Hospital Revenue Code	278
Min. Negotiated Rate	$714.75
Max. Negotiated Rate	$1,153.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$953.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,153.13
Rate for Payer: Qualcare PPO/HMO/WC	$714.75

TRIDTIIPSLCLUSTHOLEHAACESH54MM

Facility

$4,765.00

Service Code	HCPCS C1776
Hospital Charge Code	270691241
Hospital Revenue Code	278
Min. Negotiated Rate	$714.75
Max. Negotiated Rate	$1,153.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$953.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,153.13
Rate for Payer: Qualcare PPO/HMO/WC	$714.75

TRIDTIIPSLCLUSTHOLEHAACESH54MM

Facility

$4,765.00

Service Code	HCPCS C1776
Hospital Charge Code	270691241
Hospital Revenue Code	278
Min. Negotiated Rate	$135.33
Max. Negotiated Rate	$2,382.50
Rate for Payer: Aetna Commercial	$1,810.70
Rate for Payer: Aetna Medicare Advantage	$1,429.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,215.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,215.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$953.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,215.08
Rate for Payer: Cigna Commercial	$2,382.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,153.13
Rate for Payer: Qualcare PPO/HMO/WC	$714.75
Rate for Payer: UnitedHealthcare Community & State	$150.57
Rate for Payer: Wellpoint Medicaid Managed Care	$135.33

TRIFLUOPERAZINE/1MG/TAB

Facility

$6.03

Service Code	NDC 51079057201
Hospital Charge Code	60634068
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.02
Rate for Payer: Aetna Commercial	$2.29
Rate for Payer: Aetna Medicare Advantage	$1.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.54
Rate for Payer: Cigna Commercial	$3.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.57
Rate for Payer: Oxford Commercial	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.21
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

TRIFLUOPERAZINE/1MG/TAB

Facility

$6.03

Service Code	NDC 51079057201
Hospital Charge Code	60634068
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

TRIFLUOPERAZINE HYDROCHLORID 1

Facility

$16.42

Service Code	NDC 378241001
Hospital Charge Code	6063943257
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.46
Rate for Payer: Qualcare PPO/HMO/WC	$2.46

TRIFLUOPERAZINE HYDROCHLORID 1

Facility

$16.42

Service Code	NDC 378241001
Hospital Charge Code	6063943257
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$8.21
Rate for Payer: Aetna Commercial	$6.24
Rate for Payer: Aetna Medicare Advantage	$4.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.19
Rate for Payer: Cigna Commercial	$8.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.27
Rate for Payer: Oxford Commercial	$3.28
Rate for Payer: Qualcare PPO/HMO/WC	$2.46
Rate for Payer: UnitedHealthcare Commercial	$3.28
Rate for Payer: UnitedHealthcare Community & State	$0.52
Rate for Payer: Wellpoint Medicaid Managed Care	$0.47

TRIFLUOPERAZINE HYDROCHLORID 5

Facility

$10.85

Service Code	NDC 378240501
Hospital Charge Code	6063943258
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$5.42
Rate for Payer: Aetna Commercial	$4.12
Rate for Payer: Aetna Medicare Advantage	$3.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.77
Rate for Payer: Cigna Commercial	$5.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.82
Rate for Payer: Oxford Commercial	$2.17
Rate for Payer: Qualcare PPO/HMO/WC	$1.63
Rate for Payer: UnitedHealthcare Commercial	$2.17
Rate for Payer: UnitedHealthcare Community & State	$0.34
Rate for Payer: Wellpoint Medicaid Managed Care	$0.31

TRIFLUOPERAZINE HYDROCHLORID 5

Facility

$10.85

Service Code	NDC 378240501
Hospital Charge Code	6063943258
Hospital Revenue Code	250
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$1.63
Rate for Payer: Qualcare PPO/HMO/WC	$1.63

TRIFLURIDINE SOL OPH 1%

Facility

$1,768.13

Service Code	NDC 61570003775
Hospital Charge Code	60628026
Hospital Revenue Code	250
Min. Negotiated Rate	$265.22
Max. Negotiated Rate	$265.22
Rate for Payer: Qualcare PPO/HMO/WC	$265.22

TRIFLURIDINE SOL OPH 1%

Facility

$1,768.13

Service Code	NDC 61570003775
Hospital Charge Code	60628026
Hospital Revenue Code	250
Min. Negotiated Rate	$50.21
Max. Negotiated Rate	$884.07
Rate for Payer: Aetna Commercial	$671.89
Rate for Payer: Aetna Medicare Advantage	$530.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.87
Rate for Payer: Cigna Commercial	$884.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$459.71
Rate for Payer: Oxford Commercial	$353.63
Rate for Payer: Qualcare PPO/HMO/WC	$265.22
Rate for Payer: UnitedHealthcare Commercial	$353.63
Rate for Payer: UnitedHealthcare Community & State	$55.87
Rate for Payer: Wellpoint Medicaid Managed Care	$50.21

TRIGGER FLEX

Facility

$2,975.00

Hospital Charge Code	270674917
Hospital Revenue Code	272
Min. Negotiated Rate	$446.25
Max. Negotiated Rate	$446.25
Rate for Payer: Qualcare PPO/HMO/WC	$446.25

TRIGGER FLEX

Facility

$2,475.00

Hospital Charge Code	270691475
Hospital Revenue Code	272
Min. Negotiated Rate	$371.25
Max. Negotiated Rate	$371.25
Rate for Payer: Qualcare PPO/HMO/WC	$371.25

TRIGGER FLEX

Facility

$2,975.00

Hospital Charge Code	270674917
Hospital Revenue Code	272
Min. Negotiated Rate	$84.49
Max. Negotiated Rate	$1,487.50
Rate for Payer: Aetna Commercial	$1,130.50
Rate for Payer: Aetna Medicare Advantage	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$758.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$758.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$758.62
Rate for Payer: Cigna Commercial	$1,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$773.50
Rate for Payer: Oxford Commercial	$595.00
Rate for Payer: Qualcare PPO/HMO/WC	$446.25
Rate for Payer: UnitedHealthcare Commercial	$595.00
Rate for Payer: UnitedHealthcare Community & State	$94.01
Rate for Payer: Wellpoint Medicaid Managed Care	$84.49

TRIGGER FLEX

Facility

$2,475.00

Hospital Charge Code	270691475
Hospital Revenue Code	272
Min. Negotiated Rate	$70.29
Max. Negotiated Rate	$1,237.50
Rate for Payer: Aetna Commercial	$940.50
Rate for Payer: Aetna Medicare Advantage	$742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$631.12
Rate for Payer: Cigna Commercial	$1,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$643.50
Rate for Payer: Oxford Commercial	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$371.25
Rate for Payer: UnitedHealthcare Commercial	$495.00
Rate for Payer: UnitedHealthcare Community & State	$78.21
Rate for Payer: Wellpoint Medicaid Managed Care	$70.29

TRIGLYCERIDE,PERICARDIAL FLUID

Facility

$390.00

Service Code	HCPCS 84478
Hospital Charge Code	3002610
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TRIGLYCERIDE,PERICARDIAL FLUID

Facility

$390.00

Service Code	HCPCS 84478
Hospital Charge Code	3002610
Hospital Revenue Code	301
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$15.61
Rate for Payer: Aetna Medicare Advantage	$18.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.82
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.74
Rate for Payer: Clover Medicare Advantage	$5.45
Rate for Payer: EmblemHealth Commercial	$17.22
Rate for Payer: Humana Medicare Advantage	$5.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.74
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	$4.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.74
Rate for Payer: Wellcare Medicare Advantage	$5.74
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

TRIGLYCERIDES

Facility

$306.00

Service Code	HCPCS 84478
Hospital Charge Code	38472654
Hospital Revenue Code	301
Min. Negotiated Rate	$45.90
Max. Negotiated Rate	$45.90
Rate for Payer: Qualcare PPO/HMO/WC	$45.90

TRIGLYCERIDES

Facility

$306.00

Service Code	HCPCS 84478
Hospital Charge Code	38472654
Hospital Revenue Code	301
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$15.61
Rate for Payer: Aetna Medicare Advantage	$18.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.82
Rate for Payer: Cigna Commercial	$153.00
Rate for Payer: Cigna Medicare Advantage	$5.74
Rate for Payer: Clover Medicare Advantage	$5.45
Rate for Payer: EmblemHealth Commercial	$17.22
Rate for Payer: Humana Medicare Advantage	$5.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.56
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.90
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.74
Rate for Payer: Wellcare Medicare Advantage	$5.74
Rate for Payer: Wellpoint Medicaid Managed Care	$8.69

Know your out-of-pocket cost for care.

All Charges