Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

Sulfacetamide 10% opht soln 15

Facility

$351.97

Hospital Charge Code	6063943294
Hospital Revenue Code	250
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$175.99
Rate for Payer: Aetna Commercial	$133.75
Rate for Payer: Aetna Medicare Advantage	$105.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.75
Rate for Payer: Cigna Commercial	$175.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.51
Rate for Payer: Oxford Commercial	$70.39
Rate for Payer: Qualcare PPO/HMO/WC	$52.80
Rate for Payer: UnitedHealthcare Commercial	$70.39
Rate for Payer: UnitedHealthcare Community & State	$11.12
Rate for Payer: Wellpoint Medicaid Managed Care	$10.00

SULFACE TAM-PRED OPH OIN 3.5GR

Facility

$772.78

Service Code	NDC 23031304
Hospital Charge Code	60628802
Hospital Revenue Code	250
Min. Negotiated Rate	$115.92
Max. Negotiated Rate	$115.92
Rate for Payer: Qualcare PPO/HMO/WC	$115.92

SULFACE TAM-PRED OPH OIN 3.5GR

Facility

$772.78

Service Code	NDC 23031304
Hospital Charge Code	60628802
Hospital Revenue Code	250
Min. Negotiated Rate	$21.95
Max. Negotiated Rate	$386.39
Rate for Payer: Aetna Commercial	$293.66
Rate for Payer: Aetna Medicare Advantage	$231.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.06
Rate for Payer: Cigna Commercial	$386.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.92
Rate for Payer: Oxford Commercial	$154.56
Rate for Payer: Qualcare PPO/HMO/WC	$115.92
Rate for Payer: UnitedHealthcare Commercial	$154.56
Rate for Payer: UnitedHealthcare Community & State	$24.42
Rate for Payer: Wellpoint Medicaid Managed Care	$21.95

SULFADIAZINE 500 MG TAB

Facility

$33.84

Service Code	NDC 185075701
Hospital Charge Code	60629052
Hospital Revenue Code	250
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$16.92
Rate for Payer: Aetna Commercial	$12.86
Rate for Payer: Aetna Medicare Advantage	$10.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.63
Rate for Payer: Cigna Commercial	$16.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.80
Rate for Payer: Oxford Commercial	$6.77
Rate for Payer: Qualcare PPO/HMO/WC	$5.08
Rate for Payer: UnitedHealthcare Commercial	$6.77
Rate for Payer: UnitedHealthcare Community & State	$1.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.96

SULFADIAZINE 500 MG TAB

Facility

$33.84

Service Code	NDC 185075701
Hospital Charge Code	60629052
Hospital Revenue Code	250
Min. Negotiated Rate	$5.08
Max. Negotiated Rate	$5.08
Rate for Payer: Qualcare PPO/HMO/WC	$5.08

SULFAMETH TRIME 200/40MG/5ML

Facility

$4.00

Service Code	NDC 50383082416
Hospital Charge Code	60627357
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SULFAMETH TRIME 200/40MG/5ML

Facility

$4.00

Service Code	NDC 50383082416
Hospital Charge Code	60627357
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

SULFAMETH TRIME TABDS800/160MG

Facility

$9.38

Service Code	NDC 53746027201
Hospital Charge Code	60627359
Hospital Revenue Code	251
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$4.69
Rate for Payer: Aetna Commercial	$3.56
Rate for Payer: Aetna Medicare Advantage	$2.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.39
Rate for Payer: Cigna Commercial	$4.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.44
Rate for Payer: Oxford Commercial	$1.88
Rate for Payer: Qualcare PPO/HMO/WC	$1.41
Rate for Payer: UnitedHealthcare Commercial	$1.88
Rate for Payer: UnitedHealthcare Community & State	$0.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

SULFAMETH TRIME TABDS800/160MG

Facility

$9.38

Service Code	NDC 53746027201
Hospital Charge Code	60627359
Hospital Revenue Code	251
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$1.41
Rate for Payer: Qualcare PPO/HMO/WC	$1.41

SULFAMETH TRIME TAB SS400/80MG

Facility

$4.96

Service Code	NDC 68084074795
Hospital Charge Code	60627360
Hospital Revenue Code	251
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$0.74
Rate for Payer: Qualcare PPO/HMO/WC	$0.74

SULFAMETH TRIME TAB SS400/80MG

Facility

$4.96

Service Code	NDC 68084074795
Hospital Charge Code	60627360
Hospital Revenue Code	251
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.48
Rate for Payer: Aetna Commercial	$1.88
Rate for Payer: Aetna Medicare Advantage	$1.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.26
Rate for Payer: Cigna Commercial	$2.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.29
Rate for Payer: Oxford Commercial	$0.99
Rate for Payer: Qualcare PPO/HMO/WC	$0.74
Rate for Payer: UnitedHealthcare Commercial	$0.99
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

SULFAMETH-TRIMETH

Facility

$4,033.40

Service Code	NDC 703950303
Hospital Charge Code	60627358
Hospital Revenue Code	250
Min. Negotiated Rate	$605.01
Max. Negotiated Rate	$605.01
Rate for Payer: Qualcare PPO/HMO/WC	$605.01

SULFAMETH-TRIMETH

Facility

$4,033.40

Service Code	NDC 703950303
Hospital Charge Code	60627358
Hospital Revenue Code	250
Min. Negotiated Rate	$114.55
Max. Negotiated Rate	$2,016.70
Rate for Payer: Aetna Commercial	$1,532.69
Rate for Payer: Aetna Medicare Advantage	$1,210.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,028.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,028.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,028.52
Rate for Payer: Cigna Commercial	$2,016.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,048.68
Rate for Payer: Oxford Commercial	$806.68
Rate for Payer: Qualcare PPO/HMO/WC	$605.01
Rate for Payer: UnitedHealthcare Commercial	$806.68
Rate for Payer: UnitedHealthcare Community & State	$127.46
Rate for Payer: Wellpoint Medicaid Managed Care	$114.55

SULFANILAMIDE 15%CR 120GM/AVC

Facility

$58.02

Service Code	NDC 37663104
Hospital Charge Code	60632092
Hospital Revenue Code	250
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$29.01
Rate for Payer: Aetna Commercial	$22.05
Rate for Payer: Aetna Medicare Advantage	$17.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.80
Rate for Payer: Cigna Commercial	$29.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.09
Rate for Payer: Oxford Commercial	$11.60
Rate for Payer: Qualcare PPO/HMO/WC	$8.70
Rate for Payer: UnitedHealthcare Commercial	$11.60
Rate for Payer: UnitedHealthcare Community & State	$1.83
Rate for Payer: Wellpoint Medicaid Managed Care	$1.65

SULFANILAMIDE 15%CR 120GM/AVC

Facility

$58.02

Service Code	NDC 37663104
Hospital Charge Code	60632092
Hospital Revenue Code	250
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$8.70
Rate for Payer: Qualcare PPO/HMO/WC	$8.70

SULFANILAMIDE (AVC) VAG CREAM

Facility

$217.55

Service Code	NDC 37663104
Hospital Charge Code	6063943247
Hospital Revenue Code	250
Min. Negotiated Rate	$32.63
Max. Negotiated Rate	$32.63
Rate for Payer: Qualcare PPO/HMO/WC	$32.63

SULFANILAMIDE (AVC) VAG CREAM

Facility

$217.55

Service Code	NDC 37663104
Hospital Charge Code	6063943247
Hospital Revenue Code	250
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$108.78
Rate for Payer: Aetna Commercial	$82.67
Rate for Payer: Aetna Medicare Advantage	$65.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.48
Rate for Payer: Cigna Commercial	$108.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.56
Rate for Payer: Oxford Commercial	$43.51
Rate for Payer: Qualcare PPO/HMO/WC	$32.63
Rate for Payer: UnitedHealthcare Commercial	$43.51
Rate for Payer: UnitedHealthcare Community & State	$6.87
Rate for Payer: Wellpoint Medicaid Managed Care	$6.18

SULFASALAZINE 500 MG TAB

Facility

$4.00

Service Code	NDC 603580121
Hospital Charge Code	60628716
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SULFASALAZINE 500 MG TAB

Facility

$4.00

Service Code	NDC 603580121
Hospital Charge Code	60628716
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

SULFATE URINE

Facility

$390.00

Service Code	HCPCS 84392
Hospital Charge Code	39990241K
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SULFATE URINE

Facility

$390.00

Service Code	HCPCS 84392
Hospital Charge Code	39990241K
Hospital Revenue Code	301
Min. Negotiated Rate	$4.39
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$14.93
Rate for Payer: Aetna Medicare Advantage	$17.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.91
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.49
Rate for Payer: Clover Medicare Advantage	$5.22
Rate for Payer: EmblemHealth Commercial	$16.47
Rate for Payer: Humana Medicare Advantage	$5.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.49
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	$4.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.49
Rate for Payer: Wellcare Medicare Advantage	$5.49
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

SULFATE, URINE

Facility

$33.00

Service Code	HCPCS 84392
Hospital Charge Code	38477036
Hospital Revenue Code	301
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

SULFATE, URINE

Facility

$33.00

Service Code	HCPCS 84392
Hospital Charge Code	38477036
Hospital Revenue Code	301
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$14.93
Rate for Payer: Aetna Medicare Advantage	$17.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.91
Rate for Payer: Cigna Commercial	$16.50
Rate for Payer: Cigna Medicare Advantage	$5.49
Rate for Payer: Clover Medicare Advantage	$5.22
Rate for Payer: EmblemHealth Commercial	$16.47
Rate for Payer: Humana Medicare Advantage	$5.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.58
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.95
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.49
Rate for Payer: Wellcare Medicare Advantage	$5.49
Rate for Payer: Wellpoint Medicaid Managed Care	$0.94

SULFA TRIPLE 1MG

Facility

$61.63

Hospital Charge Code	270669738
Hospital Revenue Code	272
Min. Negotiated Rate	$9.24
Max. Negotiated Rate	$9.24
Rate for Payer: Qualcare PPO/HMO/WC	$9.24

SULFA TRIPLE 1MG

Facility

$61.63

Hospital Charge Code	270669738
Hospital Revenue Code	272
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$30.82
Rate for Payer: Aetna Commercial	$23.42
Rate for Payer: Aetna Medicare Advantage	$18.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.72
Rate for Payer: Cigna Commercial	$30.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.02
Rate for Payer: Oxford Commercial	$12.33
Rate for Payer: Qualcare PPO/HMO/WC	$9.24
Rate for Payer: UnitedHealthcare Commercial	$12.33
Rate for Payer: UnitedHealthcare Community & State	$1.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1.75

Know your out-of-pocket cost for care.

All Charges