Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SILDENAFIL 10MG (HALF TAB)

Facility

$141.17

Service Code	HCPCS S0090
Hospital Charge Code	606390401
Hospital Revenue Code	636
Min. Negotiated Rate	$4.01
Max. Negotiated Rate	$70.58
Rate for Payer: Aetna Commercial	$53.64
Rate for Payer: Aetna Medicare Advantage	$42.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.00
Rate for Payer: Cigna Commercial	$70.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.16
Rate for Payer: Qualcare PPO/HMO/WC	$21.18
Rate for Payer: UnitedHealthcare Community & State	$4.46
Rate for Payer: Wellpoint Medicaid Managed Care	$4.01

SILDENAFIL CITRATE 20 MG TAB

Facility

$141.17

Service Code	NDC 13668018505
Hospital Charge Code	60630054
Hospital Revenue Code	250
Min. Negotiated Rate	$21.18
Max. Negotiated Rate	$21.18
Rate for Payer: Qualcare PPO/HMO/WC	$21.18

SILDENAFIL CITRATE 20 MG TAB

Facility

$141.17

Service Code	NDC 13668018505
Hospital Charge Code	60630054
Hospital Revenue Code	250
Min. Negotiated Rate	$4.01
Max. Negotiated Rate	$70.58
Rate for Payer: Aetna Commercial	$53.64
Rate for Payer: Aetna Medicare Advantage	$42.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.00
Rate for Payer: Cigna Commercial	$70.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.70
Rate for Payer: Oxford Commercial	$28.23
Rate for Payer: Qualcare PPO/HMO/WC	$21.18
Rate for Payer: UnitedHealthcare Commercial	$28.23
Rate for Payer: UnitedHealthcare Community & State	$4.46
Rate for Payer: Wellpoint Medicaid Managed Care	$4.01

SILICONE TUBING SET

Facility

$235.00

Hospital Charge Code	270332544
Hospital Revenue Code	272
Min. Negotiated Rate	$35.25
Max. Negotiated Rate	$35.25
Rate for Payer: Qualcare PPO/HMO/WC	$35.25

SILICONE TUBING SET

Facility

$235.00

Hospital Charge Code	270332544
Hospital Revenue Code	272
Min. Negotiated Rate	$6.67
Max. Negotiated Rate	$117.50
Rate for Payer: Aetna Commercial	$89.30
Rate for Payer: Aetna Medicare Advantage	$70.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.92
Rate for Payer: Cigna Commercial	$117.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.10
Rate for Payer: Oxford Commercial	$47.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.25
Rate for Payer: UnitedHealthcare Commercial	$47.00
Rate for Payer: UnitedHealthcare Community & State	$7.43
Rate for Payer: Wellpoint Medicaid Managed Care	$6.67

SILSPORT W/CANNULA 5-12MM

Facility

$3,041.04

Hospital Charge Code	270664790
Hospital Revenue Code	272
Min. Negotiated Rate	$86.37
Max. Negotiated Rate	$1,520.52
Rate for Payer: Aetna Commercial	$1,155.60
Rate for Payer: Aetna Medicare Advantage	$912.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$775.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$775.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$775.47
Rate for Payer: Cigna Commercial	$1,520.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$790.67
Rate for Payer: Oxford Commercial	$608.21
Rate for Payer: Qualcare PPO/HMO/WC	$456.16
Rate for Payer: UnitedHealthcare Commercial	$608.21
Rate for Payer: UnitedHealthcare Community & State	$96.10
Rate for Payer: Wellpoint Medicaid Managed Care	$86.37

SILSPORT W/CANNULA 5-12MM

Facility

$3,041.04

Hospital Charge Code	270664790
Hospital Revenue Code	272
Min. Negotiated Rate	$456.16
Max. Negotiated Rate	$456.16
Rate for Payer: Qualcare PPO/HMO/WC	$456.16

SI LUTION SCREW 12X45MM

Facility

$15,625.00

Hospital Charge Code	270702341
Hospital Revenue Code	278
Min. Negotiated Rate	$2,343.75
Max. Negotiated Rate	$3,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,781.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,343.75

SI LUTION SCREW 12X45MM

Facility

$15,625.00

Hospital Charge Code	270702341
Hospital Revenue Code	278
Min. Negotiated Rate	$443.75
Max. Negotiated Rate	$7,812.50
Rate for Payer: Aetna Commercial	$5,937.50
Rate for Payer: Aetna Medicare Advantage	$4,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,984.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,984.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,984.38
Rate for Payer: Cigna Commercial	$7,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,781.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,343.75
Rate for Payer: UnitedHealthcare Community & State	$493.75
Rate for Payer: Wellpoint Medicaid Managed Care	$443.75

SILVADINE CREAM 20 GM

Facility

$13.20

Hospital Charge Code	60628363W
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$6.60
Rate for Payer: Aetna Commercial	$5.02
Rate for Payer: Aetna Medicare Advantage	$3.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.37
Rate for Payer: Cigna Commercial	$6.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.43
Rate for Payer: Oxford Commercial	$2.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.98
Rate for Payer: UnitedHealthcare Commercial	$2.64
Rate for Payer: UnitedHealthcare Community & State	$0.42
Rate for Payer: Wellpoint Medicaid Managed Care	$0.37

SILVADINE CREAM 20 GM

Facility

$13.20

Hospital Charge Code	60628363W
Hospital Revenue Code	250
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$1.98
Rate for Payer: Qualcare PPO/HMO/WC	$1.98

SILVASORB HYDGEL 1.5 MSC9301EP

Facility

$72.01

Hospital Charge Code	270640870W
Hospital Revenue Code	272
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$36.01
Rate for Payer: Aetna Commercial	$27.36
Rate for Payer: Aetna Medicare Advantage	$21.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.36
Rate for Payer: Cigna Commercial	$36.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.72
Rate for Payer: Oxford Commercial	$14.40
Rate for Payer: Qualcare PPO/HMO/WC	$10.80
Rate for Payer: UnitedHealthcare Commercial	$14.40
Rate for Payer: UnitedHealthcare Community & State	$2.28
Rate for Payer: Wellpoint Medicaid Managed Care	$2.05

SILVASORB HYDGEL 1.5 MSC9301EP

Facility

$72.01

Hospital Charge Code	270640870W
Hospital Revenue Code	272
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.80

SILVASORB WOUND GEL

Facility

$4.00

Service Code	NDC 8327030906
Hospital Charge Code	606361037
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SILVASORB WOUND GEL

Facility

$4.00

Service Code	NDC 8327030906
Hospital Charge Code	606361037
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

SILVER NITRATE APLICATOR 100ML

Facility

$5.00

Hospital Charge Code	60630079W
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

SILVER NITRATE APLICATOR 100ML

Facility

$5.00

Hospital Charge Code	60630079W
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.30
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

SILVER SIRCUIT EKG ELECTRODES

Facility

$22.00

Hospital Charge Code	270331660
Hospital Revenue Code	272
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$3.30
Rate for Payer: Qualcare PPO/HMO/WC	$3.30

SILVER SIRCUIT EKG ELECTRODES

Facility

$22.00

Hospital Charge Code	270331660
Hospital Revenue Code	272
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$11.00
Rate for Payer: Aetna Commercial	$8.36
Rate for Payer: Aetna Medicare Advantage	$6.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.61
Rate for Payer: Cigna Commercial	$11.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.72
Rate for Payer: Oxford Commercial	$4.40
Rate for Payer: Qualcare PPO/HMO/WC	$3.30
Rate for Payer: UnitedHealthcare Commercial	$4.40
Rate for Payer: UnitedHealthcare Community & State	$0.70
Rate for Payer: Wellpoint Medicaid Managed Care	$0.62

SILVER SOAKER CATH PM020-A

Facility

$295.00

Hospital Charge Code	270657264
Hospital Revenue Code	272
Min. Negotiated Rate	$44.25
Max. Negotiated Rate	$44.25
Rate for Payer: Qualcare PPO/HMO/WC	$44.25

SILVER SOAKER CATH PM020-A

Facility

$295.00

Hospital Charge Code	270657264
Hospital Revenue Code	272
Min. Negotiated Rate	$8.38
Max. Negotiated Rate	$147.50
Rate for Payer: Aetna Commercial	$112.10
Rate for Payer: Aetna Medicare Advantage	$88.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.22
Rate for Payer: Cigna Commercial	$147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.70
Rate for Payer: Oxford Commercial	$59.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.25
Rate for Payer: UnitedHealthcare Commercial	$59.00
Rate for Payer: UnitedHealthcare Community & State	$9.32
Rate for Payer: Wellpoint Medicaid Managed Care	$8.38

SILVER SULFAD CRM 1% 400GM

Facility

$4.00

Service Code	NDC 591081046
Hospital Charge Code	60628364
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

SILVER SULFAD CRM 1% 400GM

Facility

$4.00

Service Code	NDC 591081046
Hospital Charge Code	60628364
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SILVER SULFADIAZINE 20 GM CRE

Facility

$17.69

Service Code	NDC 61570013150
Hospital Charge Code	60628363
Hospital Revenue Code	250
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$2.65
Rate for Payer: Qualcare PPO/HMO/WC	$2.65

SILVER SULFADIAZINE 20 GM CRE

Facility

$17.69

Service Code	NDC 61570013150
Hospital Charge Code	60628363
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$8.85
Rate for Payer: Aetna Commercial	$6.72
Rate for Payer: Aetna Medicare Advantage	$5.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.51
Rate for Payer: Cigna Commercial	$8.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.60
Rate for Payer: Oxford Commercial	$3.54
Rate for Payer: Qualcare PPO/HMO/WC	$2.65
Rate for Payer: UnitedHealthcare Commercial	$3.54
Rate for Payer: UnitedHealthcare Community & State	$0.56
Rate for Payer: Wellpoint Medicaid Managed Care	$0.50

Know your out-of-pocket cost for care.

All Charges