Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SITAGLIPTIN PHOSPHATE 100MG TB

Facility

$88.57

Service Code	NDC 6027728
Hospital Charge Code	60630092
Hospital Revenue Code	250
Min. Negotiated Rate	$13.29
Max. Negotiated Rate	$13.29
Rate for Payer: Qualcare PPO/HMO/WC	$13.29

Sitagliptin Phosphate 25 MG TA

Facility

$88.57

Service Code	NDC 6022128
Hospital Charge Code	60630090
Hospital Revenue Code	250
Min. Negotiated Rate	$13.29
Max. Negotiated Rate	$13.29
Rate for Payer: Qualcare PPO/HMO/WC	$13.29

Sitagliptin Phosphate 25 MG TA

Facility

$88.57

Service Code	NDC 6022128
Hospital Charge Code	60630090
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

SITAGLIPTIN PHOSPHATE 50MG TAB

Facility

$88.57

Service Code	NDC 6011228
Hospital Charge Code	60630091
Hospital Revenue Code	250
Min. Negotiated Rate	$13.29
Max. Negotiated Rate	$13.29
Rate for Payer: Qualcare PPO/HMO/WC	$13.29

SITAGLIPTIN PHOSPHATE 50MG TAB

Facility

$88.57

Service Code	NDC 6011228
Hospital Charge Code	60630091
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

SITE SOLUTION ADMIN SET

Facility

$36.00

Hospital Charge Code	270331116
Hospital Revenue Code	272
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna Commercial	$13.68
Rate for Payer: Aetna Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.18
Rate for Payer: Cigna Commercial	$18.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.36
Rate for Payer: Oxford Commercial	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$5.40
Rate for Payer: UnitedHealthcare Commercial	$7.20
Rate for Payer: UnitedHealthcare Community & State	$1.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1.02

SITE SOLUTION ADMIN SET

Facility

$36.00

Hospital Charge Code	270331116
Hospital Revenue Code	272
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$5.40
Rate for Payer: Qualcare PPO/HMO/WC	$5.40

SITZ BATH

Facility

$10.74

Hospital Charge Code	270649928
Hospital Revenue Code	272
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$1.61
Rate for Payer: Qualcare PPO/HMO/WC	$1.61

SITZ BATH

Facility

$10.74

Hospital Charge Code	270649928
Hospital Revenue Code	272
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$5.37
Rate for Payer: Aetna Commercial	$4.08
Rate for Payer: Aetna Medicare Advantage	$3.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.74
Rate for Payer: Cigna Commercial	$5.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.79
Rate for Payer: Oxford Commercial	$2.15
Rate for Payer: Qualcare PPO/HMO/WC	$1.61
Rate for Payer: UnitedHealthcare Commercial	$2.15
Rate for Payer: UnitedHealthcare Community & State	$0.34
Rate for Payer: Wellpoint Medicaid Managed Care	$0.31

SITZ BATH PLASTIC

Facility

$5.32

Hospital Charge Code	270301980
Hospital Revenue Code	270
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$2.66
Rate for Payer: Aetna Commercial	$2.02
Rate for Payer: Aetna Medicare Advantage	$1.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.36
Rate for Payer: Cigna Commercial	$2.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.38
Rate for Payer: Oxford Commercial	$1.06
Rate for Payer: Qualcare PPO/HMO/WC	$0.80
Rate for Payer: UnitedHealthcare Commercial	$1.06
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

SITZ BATH PLASTIC

Facility

$5.32

Hospital Charge Code	270301980
Hospital Revenue Code	270
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.80

SIXING SET FLEX HINGE TOE

Facility

$491.88

Hospital Charge Code	270623471
Hospital Revenue Code	272
Min. Negotiated Rate	$73.78
Max. Negotiated Rate	$73.78
Rate for Payer: Qualcare PPO/HMO/WC	$73.78

SIXING SET FLEX HINGE TOE

Facility

$491.88

Hospital Charge Code	270623471
Hospital Revenue Code	272
Min. Negotiated Rate	$13.97
Max. Negotiated Rate	$245.94
Rate for Payer: Aetna Commercial	$186.91
Rate for Payer: Aetna Medicare Advantage	$147.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$125.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$125.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$125.43
Rate for Payer: Cigna Commercial	$245.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.89
Rate for Payer: Oxford Commercial	$98.38
Rate for Payer: Qualcare PPO/HMO/WC	$73.78
Rate for Payer: UnitedHealthcare Commercial	$98.38
Rate for Payer: UnitedHealthcare Community & State	$15.54
Rate for Payer: Wellpoint Medicaid Managed Care	$13.97

SIZE 1 STD STEM REF:8810003201

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703598
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

SIZE 1 STD STEM REF:8810003201

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703598
Hospital Revenue Code	278
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

SIZE .5 (A105-20122118-0/0)

Facility

$4,475.00

Hospital Charge Code	270662434
Hospital Revenue Code	270
Min. Negotiated Rate	$671.25
Max. Negotiated Rate	$671.25
Rate for Payer: Qualcare PPO/HMO/WC	$671.25

SIZE .5 (A105-20122118-0/0)

Facility

$4,475.00

Hospital Charge Code	270662434
Hospital Revenue Code	270
Min. Negotiated Rate	$127.09
Max. Negotiated Rate	$2,237.50
Rate for Payer: Aetna Commercial	$1,700.50
Rate for Payer: Aetna Medicare Advantage	$1,342.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,141.12
Rate for Payer: Cigna Commercial	$2,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,163.50
Rate for Payer: Oxford Commercial	$895.00
Rate for Payer: Qualcare PPO/HMO/WC	$671.25
Rate for Payer: UnitedHealthcare Commercial	$895.00
Rate for Payer: UnitedHealthcare Community & State	$141.41
Rate for Payer: Wellpoint Medicaid Managed Care	$127.09

SIZER CIRCULAR 25/29/33MM

Facility

$822.65

Hospital Charge Code	270608835
Hospital Revenue Code	272
Min. Negotiated Rate	$23.36
Max. Negotiated Rate	$411.32
Rate for Payer: Aetna Commercial	$312.61
Rate for Payer: Aetna Medicare Advantage	$246.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$209.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$209.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$209.78
Rate for Payer: Cigna Commercial	$411.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$213.89
Rate for Payer: Oxford Commercial	$164.53
Rate for Payer: Qualcare PPO/HMO/WC	$123.40
Rate for Payer: UnitedHealthcare Commercial	$164.53
Rate for Payer: UnitedHealthcare Community & State	$26.00
Rate for Payer: Wellpoint Medicaid Managed Care	$23.36

SIZER CIRCULAR 25/29/33MM

Facility

$822.65

Hospital Charge Code	270608835
Hospital Revenue Code	272
Min. Negotiated Rate	$123.40
Max. Negotiated Rate	$123.40
Rate for Payer: Qualcare PPO/HMO/WC	$123.40

SIZER EXTRA HIGH PROFILE 500cc

Facility

$1,000.00

Hospital Charge Code	270673558
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

SIZER EXTRA HIGH PROFILE 500cc

Facility

$1,000.00

Hospital Charge Code	270673558
Hospital Revenue Code	278
Min. Negotiated Rate	$28.40
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$31.60
Rate for Payer: Wellpoint Medicaid Managed Care	$28.40

SIZER EXTRA HIGH PROFILE 550CC

Facility

$1,000.00

Hospital Charge Code	270673559
Hospital Revenue Code	278
Min. Negotiated Rate	$28.40
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$31.60
Rate for Payer: Wellpoint Medicaid Managed Care	$28.40

SIZER EXTRA HIGH PROFILE 550CC

Facility

$1,000.00

Hospital Charge Code	270673559
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

SIZER EXTRA HIGH PROFILE 600CC

Facility

$1,000.00

Hospital Charge Code	270673560
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

SIZER EXTRA HIGH PROFILE 600CC

Facility

$1,000.00

Hospital Charge Code	270673560
Hospital Revenue Code	278
Min. Negotiated Rate	$28.40
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$31.60
Rate for Payer: Wellpoint Medicaid Managed Care	$28.40

Know your out-of-pocket cost for care.

All Charges