Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SINGULAIR 5MG CHEW TAB

Facility

$37.92

Service Code	NDC 54028913
Hospital Charge Code	60635505
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

SINGULAIR 5MG CHEW TAB

Facility

$37.92

Service Code	NDC 54028913
Hospital Charge Code	60635505
Hospital Revenue Code	250
Min. Negotiated Rate	$5.69
Max. Negotiated Rate	$5.69
Rate for Payer: Qualcare PPO/HMO/WC	$5.69

SINGULAR 4MG ORAL GRANULE

Facility

$50.05

Service Code	NDC 6384130
Hospital Charge Code	60635657
Hospital Revenue Code	250
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$25.02
Rate for Payer: Aetna Commercial	$19.02
Rate for Payer: Aetna Medicare Advantage	$15.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.76
Rate for Payer: Cigna Commercial	$25.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.01
Rate for Payer: Oxford Commercial	$10.01
Rate for Payer: Qualcare PPO/HMO/WC	$7.51
Rate for Payer: UnitedHealthcare Commercial	$10.01
Rate for Payer: UnitedHealthcare Community & State	$1.58
Rate for Payer: Wellpoint Medicaid Managed Care	$1.42

SINGULAR 4MG ORAL GRANULE

Facility

$50.05

Service Code	NDC 6384130
Hospital Charge Code	60635657
Hospital Revenue Code	250
Min. Negotiated Rate	$7.51
Max. Negotiated Rate	$7.51
Rate for Payer: Qualcare PPO/HMO/WC	$7.51

SINU FOAM

Facility

$405.00

Hospital Charge Code	270686807
Hospital Revenue Code	272
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$60.75
Rate for Payer: Qualcare PPO/HMO/WC	$60.75

SINU FOAM

Facility

$405.00

Hospital Charge Code	270686807
Hospital Revenue Code	272
Min. Negotiated Rate	$11.50
Max. Negotiated Rate	$202.50
Rate for Payer: Aetna Commercial	$153.90
Rate for Payer: Aetna Medicare Advantage	$121.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.28
Rate for Payer: Cigna Commercial	$202.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.30
Rate for Payer: Oxford Commercial	$81.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.75
Rate for Payer: UnitedHealthcare Commercial	$81.00
Rate for Payer: UnitedHealthcare Community & State	$12.80
Rate for Payer: Wellpoint Medicaid Managed Care	$11.50

SINUS AND MASTOID PROCEDURES WITH CC/MCC

Facility

$88,022.69

Service Code	MSDRG 135
Min. Negotiated Rate	$26,801.78
Max. Negotiated Rate	$88,022.69
Rate for Payer: Aetna Commercial	$64,549.27
Rate for Payer: Aetna Medicare Advantage	$88,022.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73,418.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73,418.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$28,212.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73,418.25
Rate for Payer: Cigna Commercial	$47,154.15
Rate for Payer: Cigna Medicare Advantage	$28,212.40
Rate for Payer: Clover Medicare Advantage	$26,801.78
Rate for Payer: EmblemHealth Commercial	$84,637.20
Rate for Payer: Humana Medicare Advantage	$29,058.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$28,212.40
Rate for Payer: Oxford Commercial	$37,269.82
Rate for Payer: UnitedHealthcare Commercial	$49,886.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$28,212.40
Rate for Payer: Wellcare Medicare Advantage	$28,212.40

SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC

Facility

$51,541.56

Service Code	MSDRG 136
Min. Negotiated Rate	$15,693.74
Max. Negotiated Rate	$51,541.56
Rate for Payer: Aetna Commercial	$38,567.01
Rate for Payer: Aetna Medicare Advantage	$51,541.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28,813.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28,813.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16,519.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28,813.20
Rate for Payer: Cigna Commercial	$22,634.08
Rate for Payer: Cigna Medicare Advantage	$16,519.73
Rate for Payer: Clover Medicare Advantage	$15,693.74
Rate for Payer: EmblemHealth Commercial	$49,559.19
Rate for Payer: Humana Medicare Advantage	$17,015.32
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16,519.73
Rate for Payer: Oxford Commercial	$17,889.59
Rate for Payer: UnitedHealthcare Commercial	$23,945.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$16,519.73
Rate for Payer: Wellcare Medicare Advantage	$16,519.73

SINUS GUIDE CATH GC000/GC070

Facility

$512.00

Hospital Charge Code	270335942
Hospital Revenue Code	278
Min. Negotiated Rate	$14.54
Max. Negotiated Rate	$256.00
Rate for Payer: Aetna Commercial	$194.56
Rate for Payer: Aetna Medicare Advantage	$153.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$130.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$130.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$102.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$130.56
Rate for Payer: Cigna Commercial	$256.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.90
Rate for Payer: Qualcare PPO/HMO/WC	$76.80
Rate for Payer: UnitedHealthcare Community & State	$16.18
Rate for Payer: Wellpoint Medicaid Managed Care	$14.54

SINUS GUIDE CATH GC000/GC070

Facility

$512.00

Hospital Charge Code	270335942
Hospital Revenue Code	278
Min. Negotiated Rate	$76.80
Max. Negotiated Rate	$123.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$102.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.90
Rate for Payer: Qualcare PPO/HMO/WC	$76.80

SINUS GUIDEWIRE TW35080V

Facility

$385.00

Hospital Charge Code	270335943
Hospital Revenue Code	278
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$93.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.17
Rate for Payer: Qualcare PPO/HMO/WC	$57.75

SINUS GUIDEWIRE TW35080V

Facility

$385.00

Hospital Charge Code	270335943
Hospital Revenue Code	278
Min. Negotiated Rate	$10.93
Max. Negotiated Rate	$192.50
Rate for Payer: Aetna Commercial	$146.30
Rate for Payer: Aetna Medicare Advantage	$115.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.17
Rate for Payer: Cigna Commercial	$192.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.17
Rate for Payer: Qualcare PPO/HMO/WC	$57.75
Rate for Payer: UnitedHealthcare Community & State	$12.17
Rate for Payer: Wellpoint Medicaid Managed Care	$10.93

SIROLIMUS

Facility

$94.35

Service Code	HCPCS 80195
Hospital Charge Code	39900010
Hospital Revenue Code	301
Min. Negotiated Rate	$14.15
Max. Negotiated Rate	$14.15
Rate for Payer: Qualcare PPO/HMO/WC	$14.15

SIROLIMUS

Facility

$94.35

Service Code	HCPCS 80195
Hospital Charge Code	39900010
Hospital Revenue Code	301
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$37.35
Rate for Payer: Aetna Medicare Advantage	$44.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.81
Rate for Payer: Cigna Commercial	$47.17
Rate for Payer: Cigna Medicare Advantage	$13.73
Rate for Payer: Clover Medicare Advantage	$13.04
Rate for Payer: EmblemHealth Commercial	$41.19
Rate for Payer: Humana Medicare Advantage	$14.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.53
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.15
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.73
Rate for Payer: Wellcare Medicare Advantage	$13.73
Rate for Payer: Wellpoint Medicaid Managed Care	$2.68

SIROLIMUS

Facility

$390.00

Service Code	HCPCS 80195
Hospital Charge Code	38477217
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SIROLIMUS

Facility

$390.00

Service Code	HCPCS 80195
Hospital Charge Code	38477217
Hospital Revenue Code	301
Min. Negotiated Rate	$10.98
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$37.35
Rate for Payer: Aetna Medicare Advantage	$44.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.81
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$13.73
Rate for Payer: Clover Medicare Advantage	$13.04
Rate for Payer: EmblemHealth Commercial	$41.19
Rate for Payer: Humana Medicare Advantage	$14.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.73
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	$10.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.73
Rate for Payer: Wellcare Medicare Advantage	$13.73
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

SI SCREW FULLY THREADED 12X50M

Facility

$15,625.00

Hospital Charge Code	270702056
Hospital Revenue Code	270
Min. Negotiated Rate	$2,343.75
Max. Negotiated Rate	$2,343.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,343.75

SI SCREW FULLY THREADED 12X50M

Facility

$15,625.00

Hospital Charge Code	270702056
Hospital Revenue Code	270
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) PPO	$3,984.38
Rate for Payer: Cigna Commercial	$7,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,062.50
Rate for Payer: Oxford Commercial	$3,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,343.75
Rate for Payer: UnitedHealthcare Commercial	$3,125.00
Rate for Payer: UnitedHealthcare Community & State	$493.75
Rate for Payer: Wellpoint Medicaid Managed Care	$443.75

SI SCREW FULLY THREADED 12X70M

Facility

$15,625.00

Hospital Charge Code	270702057
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 SCREW FULLY THREADED 12X70M

Facility

$15,625.00

Hospital Charge Code	270702057
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

S&I STENT/CHEST VERT ART

Facility

$37,614.35

Service Code	HCPCS 0076T
Hospital Charge Code	36680076T
Hospital Revenue Code	361
Min. Negotiated Rate	$5,642.15
Max. Negotiated Rate	$5,642.15
Rate for Payer: Qualcare PPO/HMO/WC	$5,642.15

S&I STENT/CHEST VERT ART

Facility

$37,614.35

Service Code	HCPCS 0076T
Hospital Charge Code	36680076T
Hospital Revenue Code	361
Min. Negotiated Rate	$1,068.25
Max. Negotiated Rate	$18,807.17
Rate for Payer: Aetna Commercial	$14,293.45
Rate for Payer: Aetna Medicare Advantage	$11,284.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,591.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,591.66
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	$9,591.66
Rate for Payer: Cigna Commercial	$18,807.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,779.73
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,642.15
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$1,188.61
Rate for Payer: Wellpoint Medicaid Managed Care	$1,068.25

S&I STENT/CHEST VERT ART

Facility

$37,614.35

Service Code	HCPCS 0076T
Hospital Charge Code	41100076T
Hospital Revenue Code	361
Min. Negotiated Rate	$1,068.25
Max. Negotiated Rate	$18,807.17
Rate for Payer: Aetna Commercial	$14,293.45
Rate for Payer: Aetna Medicare Advantage	$11,284.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,591.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,591.66
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	$9,591.66
Rate for Payer: Cigna Commercial	$18,807.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,779.73
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,642.15
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$1,188.61
Rate for Payer: Wellpoint Medicaid Managed Care	$1,068.25

S&I STENT/CHEST VERT ART

Facility

$37,614.35

Service Code	HCPCS 0076T
Hospital Charge Code	41100076T
Hospital Revenue Code	361
Min. Negotiated Rate	$5,642.15
Max. Negotiated Rate	$5,642.15
Rate for Payer: Qualcare PPO/HMO/WC	$5,642.15

SITAGLIPTIN PHOSPHATE 100MG TB

Facility

$88.57

Service Code	NDC 6027728
Hospital Charge Code	60630092
Hospital Revenue Code	250
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$44.28
Rate for Payer: Aetna Commercial	$33.66
Rate for Payer: Aetna Medicare Advantage	$26.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.59
Rate for Payer: Cigna Commercial	$44.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.03
Rate for Payer: Oxford Commercial	$17.71
Rate for Payer: Qualcare PPO/HMO/WC	$13.29
Rate for Payer: UnitedHealthcare Commercial	$17.71
Rate for Payer: UnitedHealthcare Community & State	$2.80
Rate for Payer: Wellpoint Medicaid Managed Care	$2.52

Know your out-of-pocket cost for care.

All Charges