Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SILVER SULFADIAZINE 50 GM CRE

Facility

$311.22

Service Code	NDC 49999014350
Hospital Charge Code	60628365
Hospital Revenue Code	250
Min. Negotiated Rate	$46.68
Max. Negotiated Rate	$46.68
Rate for Payer: Qualcare PPO/HMO/WC	$46.68

SILVER SULFADIAZINE 50 GM CRE

Facility

$311.22

Service Code	NDC 49999014350
Hospital Charge Code	60628365
Hospital Revenue Code	250
Min. Negotiated Rate	$8.84
Max. Negotiated Rate	$155.61
Rate for Payer: Aetna Commercial	$118.26
Rate for Payer: Aetna Medicare Advantage	$93.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.36
Rate for Payer: Cigna Commercial	$155.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.92
Rate for Payer: Oxford Commercial	$62.24
Rate for Payer: Qualcare PPO/HMO/WC	$46.68
Rate for Payer: UnitedHealthcare Commercial	$62.24
Rate for Payer: UnitedHealthcare Community & State	$9.83
Rate for Payer: Wellpoint Medicaid Managed Care	$8.84

SILVR SULFADIAZIN 1% CRM 25 GM

Facility

$90.79

Service Code	NDC 67877012425
Hospital Charge Code	606390116
Hospital Revenue Code	250
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$45.40
Rate for Payer: Aetna Commercial	$34.50
Rate for Payer: Aetna Medicare Advantage	$27.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.15
Rate for Payer: Cigna Commercial	$45.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.61
Rate for Payer: Oxford Commercial	$18.16
Rate for Payer: Qualcare PPO/HMO/WC	$13.62
Rate for Payer: UnitedHealthcare Commercial	$18.16
Rate for Payer: UnitedHealthcare Community & State	$2.87
Rate for Payer: Wellpoint Medicaid Managed Care	$2.58

SILVR SULFADIAZIN 1% CRM 25 GM

Facility

$90.79

Service Code	NDC 67877012425
Hospital Charge Code	606390116
Hospital Revenue Code	250
Min. Negotiated Rate	$13.62
Max. Negotiated Rate	$13.62
Rate for Payer: Qualcare PPO/HMO/WC	$13.62

SIMETHICONE 125 MG CHE

Facility

$4.00

Service Code	NDC 536453408
Hospital Charge Code	60628122
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SIMETHICONE 125 MG CHE

Facility

$4.00

Service Code	NDC 536453408
Hospital Charge Code	60628122
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

SIMETHICONE 80 MG CHE

Facility

$4.00

Service Code	NDC 63739022510
Hospital Charge Code	60628121
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SIMETHICONE 80 MG CHE

Facility

$4.00

Service Code	NDC 63739022510
Hospital Charge Code	60628121
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

SIMETHICONE LQ 40MG/.6ML 30ML

Facility

$4.00

Service Code	NDC 536222075
Hospital Charge Code	6004915
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SIMETHICONE LQ 40MG/.6ML 30ML

Facility

$4.00

Service Code	NDC 536222075
Hospital Charge Code	6004915
Hospital Revenue Code	251
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

SIMILAC PROBIOTIC TRI-BLEND

Facility

$37.92

Service Code	NDC 99999999999
Hospital Charge Code	606390389
Hospital Revenue Code	250
Min. Negotiated Rate	$5.69
Max. Negotiated Rate	$5.69
Rate for Payer: Qualcare PPO/HMO/WC	$5.69

SIMILAC PROBIOTIC TRI-BLEND

Facility

$37.92

Service Code	NDC 99999999999
Hospital Charge Code	606390389
Hospital Revenue Code	250
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$18.96
Rate for Payer: Aetna Commercial	$14.41
Rate for Payer: Aetna Medicare Advantage	$11.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.67
Rate for Payer: Cigna Commercial	$18.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.86
Rate for Payer: Oxford Commercial	$7.58
Rate for Payer: Qualcare PPO/HMO/WC	$5.69
Rate for Payer: UnitedHealthcare Commercial	$7.58
Rate for Payer: UnitedHealthcare Community & State	$1.20
Rate for Payer: Wellpoint Medicaid Managed Care	$1.08

SIMPLE BLADDER IRRIGATE LAVAGE

Facility

$26,701.00

Service Code	HCPCS 25545
Hospital Charge Code	16000618
Hospital Revenue Code	360
Min. Negotiated Rate	$4,005.15
Max. Negotiated Rate	$4,005.15
Rate for Payer: Qualcare PPO/HMO/WC	$4,005.15

SIMPLE BLADDER IRRIGATE LAVAGE

Facility

$26,701.00

Service Code	HCPCS 25545
Hospital Charge Code	16000618
Hospital Revenue Code	360
Min. Negotiated Rate	$758.31
Max. Negotiated Rate	$31,271.12
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31,271.12
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,942.26
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,005.15
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$843.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$758.31

SIMPLE CYSTOMETROGRAM

Facility

$4,978.50

Service Code	HCPCS 51725
Hospital Charge Code	1600000534
Hospital Revenue Code	360
Min. Negotiated Rate	$141.39
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$807.38
Rate for Payer: Aetna Medicare Advantage	$961.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,076.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,076.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$296.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,076.75
Rate for Payer: Cigna Commercial	$594.98
Rate for Payer: Cigna Medicare Advantage	$296.83
Rate for Payer: Clover Medicare Advantage	$281.99
Rate for Payer: EmblemHealth Commercial	$890.49
Rate for Payer: Humana Medicare Advantage	$305.73
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$296.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,294.41
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$746.77
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$157.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$296.83
Rate for Payer: Wellcare Medicare Advantage	$296.83
Rate for Payer: Wellpoint Medicaid Managed Care	$141.39

SIMPLE CYSTOMETROGRAM

Facility

$4,978.50

Service Code	HCPCS 51725
Hospital Charge Code	1600000534
Hospital Revenue Code	360
Min. Negotiated Rate	$746.77
Max. Negotiated Rate	$746.77
Rate for Payer: Qualcare PPO/HMO/WC	$746.77

SIMPLE OTHR LOC LAC REP TO 2.5

Facility

$1,473.00

Service Code	HCPCS 12001
Hospital Charge Code	1600000706
Hospital Revenue Code	360
Min. Negotiated Rate	$41.83
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$864.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$864.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$864.65
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$382.98
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$220.95
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$46.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$41.83

SIMPLE OTHR LOC LAC REP TO 2.5

Facility

$1,473.00

Service Code	HCPCS 12001
Hospital Charge Code	1600000706
Hospital Revenue Code	360
Min. Negotiated Rate	$220.95
Max. Negotiated Rate	$220.95
Rate for Payer: Qualcare PPO/HMO/WC	$220.95

SIMPLE PNEUMONIA AND PLEURISY WITH CC

Facility

$44,925.91

Service Code	MSDRG 194
Min. Negotiated Rate	$13,679.36
Max. Negotiated Rate	$44,925.91
Rate for Payer: Aetna Commercial	$33,855.27
Rate for Payer: Aetna Medicare Advantage	$44,925.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22,718.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22,718.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14,399.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22,718.10
Rate for Payer: Cigna Commercial	$17,965.93
Rate for Payer: Cigna Medicare Advantage	$14,399.33
Rate for Payer: Clover Medicare Advantage	$13,679.36
Rate for Payer: EmblemHealth Commercial	$43,197.99
Rate for Payer: Humana Medicare Advantage	$14,831.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14,399.33
Rate for Payer: Oxford Commercial	$14,199.96
Rate for Payer: UnitedHealthcare Commercial	$19,007.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$14,399.33
Rate for Payer: Wellcare Medicare Advantage	$14,399.33

SIMPLE PNEUMONIA AND PLEURISY WITH MCC

Facility

$60,991.23

Service Code	MSDRG 193
Min. Negotiated Rate	$18,571.05
Max. Negotiated Rate	$60,991.23
Rate for Payer: Aetna Commercial	$45,297.15
Rate for Payer: Aetna Medicare Advantage	$60,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36,847.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36,847.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19,548.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36,847.65
Rate for Payer: Cigna Commercial	$29,301.92
Rate for Payer: Cigna Medicare Advantage	$19,548.47
Rate for Payer: Clover Medicare Advantage	$18,571.05
Rate for Payer: EmblemHealth Commercial	$58,645.41
Rate for Payer: Humana Medicare Advantage	$20,134.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19,548.47
Rate for Payer: Oxford Commercial	$23,159.73
Rate for Payer: UnitedHealthcare Commercial	$31,000.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$19,548.47
Rate for Payer: Wellcare Medicare Advantage	$19,548.47

SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC

Facility

$39,321.20

Service Code	MSDRG 195
Min. Negotiated Rate	$11,074.17
Max. Negotiated Rate	$39,321.20
Rate for Payer: Aetna Commercial	$29,863.51
Rate for Payer: Aetna Medicare Advantage	$39,321.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17,454.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17,454.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,602.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17,454.15
Rate for Payer: Cigna Commercial	$14,011.15
Rate for Payer: Cigna Medicare Advantage	$12,602.95
Rate for Payer: Clover Medicare Advantage	$11,972.80
Rate for Payer: EmblemHealth Commercial	$37,808.85
Rate for Payer: Humana Medicare Advantage	$12,981.04
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12,602.95
Rate for Payer: Oxford Commercial	$11,074.17
Rate for Payer: UnitedHealthcare Commercial	$14,823.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,602.95
Rate for Payer: Wellcare Medicare Advantage	$12,602.95

SIMPLIFY DISC SIZE 1 HT 4

Facility

$26,991.25

Service Code	HCPCS C1713
Hospital Charge Code	270704796
Hospital Revenue Code	278
Min. Negotiated Rate	$766.55
Max. Negotiated Rate	$13,495.62
Rate for Payer: Aetna Commercial	$10,256.67
Rate for Payer: Aetna Medicare Advantage	$8,097.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,882.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,882.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,398.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,882.77
Rate for Payer: Cigna Commercial	$13,495.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,531.88
Rate for Payer: Qualcare PPO/HMO/WC	$4,048.69
Rate for Payer: UnitedHealthcare Community & State	$852.92
Rate for Payer: Wellpoint Medicaid Managed Care	$766.55

SIMPLIFY DISC SIZE 1 HT 4

Facility

$26,991.25

Service Code	HCPCS C1713
Hospital Charge Code	270704796
Hospital Revenue Code	278
Min. Negotiated Rate	$4,048.69
Max. Negotiated Rate	$6,531.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,398.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,531.88
Rate for Payer: Qualcare PPO/HMO/WC	$4,048.69

SIMPLIFY DISC SZ 1 HT 4

Facility

$57,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270695024
Hospital Revenue Code	278
Min. Negotiated Rate	$1,633.00
Max. Negotiated Rate	$28,750.00
Rate for Payer: Aetna Commercial	$21,850.00
Rate for Payer: Aetna Medicare Advantage	$17,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,662.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,662.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,662.50
Rate for Payer: Cigna Commercial	$28,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,915.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,625.00
Rate for Payer: UnitedHealthcare Community & State	$1,817.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1,633.00

SIMPLIFY DISC SZ 1 HT 4

Facility

$57,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270695024
Hospital Revenue Code	278
Min. Negotiated Rate	$8,625.00
Max. Negotiated Rate	$13,915.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,915.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,625.00

Know your out-of-pocket cost for care.

All Charges