Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ONDANSETRON 8 MG TAB

Facility

$276.44

Service Code	NDC 51079052520
Hospital Charge Code	6008718
Hospital Revenue Code	250
Min. Negotiated Rate	$41.47
Max. Negotiated Rate	$41.47
Rate for Payer: Qualcare PPO/HMO/WC	$41.47

ONDANSETRON 8 MG TAB

Facility

$276.44

Service Code	NDC 51079052520
Hospital Charge Code	6008718
Hospital Revenue Code	250
Min. Negotiated Rate	$7.85
Max. Negotiated Rate	$138.22
Rate for Payer: Aetna Commercial	$105.05
Rate for Payer: Aetna Medicare Advantage	$82.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.49
Rate for Payer: Cigna Commercial	$138.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.87
Rate for Payer: Oxford Commercial	$55.29
Rate for Payer: Qualcare PPO/HMO/WC	$41.47
Rate for Payer: UnitedHealthcare Commercial	$55.29
Rate for Payer: UnitedHealthcare Community & State	$8.74
Rate for Payer: Wellpoint Medicaid Managed Care	$7.85

ONDANSTRN ORL SOL 4MG/5ML

Facility

$160.13

Service Code	HCPCS Q0162
Hospital Charge Code	60635699
Hospital Revenue Code	636
Min. Negotiated Rate	$24.02
Max. Negotiated Rate	$38.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.75
Rate for Payer: Qualcare PPO/HMO/WC	$24.02

ONDANSTRN ORL SOL 4MG/5ML

Facility

$160.13

Service Code	HCPCS Q0162
Hospital Charge Code	60635699
Hospital Revenue Code	636
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$80.06
Rate for Payer: Aetna Commercial	$60.85
Rate for Payer: Aetna Medicare Advantage	$48.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.83
Rate for Payer: Cigna Commercial	$80.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.75
Rate for Payer: Qualcare PPO/HMO/WC	$24.02
Rate for Payer: UnitedHealthcare Community & State	$5.06
Rate for Payer: Wellpoint Medicaid Managed Care	$4.55

ONE STEP CATH 5FR. 10CM

Facility

$450.00

Hospital Charge Code	270665909
Hospital Revenue Code	278
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$108.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.90
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

ONE STEP CATH 5FR. 10CM

Facility

$450.00

Hospital Charge Code	270665909
Hospital Revenue Code	278
Min. Negotiated Rate	$12.78
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$171.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.90
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Community & State	$14.22
Rate for Payer: Wellpoint Medicaid Managed Care	$12.78

ONE STEP CATH 5FR. 15CM

Facility

$450.00

Hospital Charge Code	270665910
Hospital Revenue Code	278
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$108.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.90
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

ONE STEP CATH 5FR. 15CM

Facility

$450.00

Hospital Charge Code	270665910
Hospital Revenue Code	278
Min. Negotiated Rate	$12.78
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$171.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.90
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Community & State	$14.22
Rate for Payer: Wellpoint Medicaid Managed Care	$12.78

ONE STEP CENTESIS CATHETER

Facility

$82.40

Hospital Charge Code	270653940
Hospital Revenue Code	270
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$41.20
Rate for Payer: Aetna Commercial	$31.31
Rate for Payer: Aetna Medicare Advantage	$24.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.01
Rate for Payer: Cigna Commercial	$41.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.42
Rate for Payer: Oxford Commercial	$16.48
Rate for Payer: Qualcare PPO/HMO/WC	$12.36
Rate for Payer: UnitedHealthcare Commercial	$16.48
Rate for Payer: UnitedHealthcare Community & State	$2.60
Rate for Payer: Wellpoint Medicaid Managed Care	$2.34

ONE STEP CENTESIS CATHETER

Facility

$82.40

Hospital Charge Code	270653940
Hospital Revenue Code	270
Min. Negotiated Rate	$12.36
Max. Negotiated Rate	$12.36
Rate for Payer: Qualcare PPO/HMO/WC	$12.36

ONLAY TIBIAL INSERT SZ 1 10MM

Facility

$3,935.00

Hospital Charge Code	270668783
Hospital Revenue Code	278
Min. Negotiated Rate	$590.25
Max. Negotiated Rate	$952.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25

ONLAY TIBIAL INSERT SZ 1 10MM

Facility

$3,935.00

Hospital Charge Code	270668783
Hospital Revenue Code	278
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$1,967.50
Rate for Payer: Aetna Commercial	$1,495.30
Rate for Payer: Aetna Medicare Advantage	$1,180.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,003.42
Rate for Payer: Cigna Commercial	$1,967.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25
Rate for Payer: UnitedHealthcare Community & State	$124.35
Rate for Payer: Wellpoint Medicaid Managed Care	$111.75

ONLAY TIBIAL INSERT SZ 1 12MM

Facility

$3,935.00

Hospital Charge Code	270668784
Hospital Revenue Code	278
Min. Negotiated Rate	$590.25
Max. Negotiated Rate	$952.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25

ONLAY TIBIAL INSERT SZ 1 12MM

Facility

$3,935.00

Hospital Charge Code	270668784
Hospital Revenue Code	278
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$1,967.50
Rate for Payer: Aetna Commercial	$1,495.30
Rate for Payer: Aetna Medicare Advantage	$1,180.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,003.42
Rate for Payer: Cigna Commercial	$1,967.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25
Rate for Payer: UnitedHealthcare Community & State	$124.35
Rate for Payer: Wellpoint Medicaid Managed Care	$111.75

ONLAY TIBIAL INSERT SZ 1 8MM

Facility

$3,935.00

Hospital Charge Code	270668781
Hospital Revenue Code	278
Min. Negotiated Rate	$590.25
Max. Negotiated Rate	$952.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25

ONLAY TIBIAL INSERT SZ 1 8MM

Facility

$3,935.00

Hospital Charge Code	270668781
Hospital Revenue Code	278
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$1,967.50
Rate for Payer: Aetna Commercial	$1,495.30
Rate for Payer: Aetna Medicare Advantage	$1,180.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,003.42
Rate for Payer: Cigna Commercial	$1,967.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25
Rate for Payer: UnitedHealthcare Community & State	$124.35
Rate for Payer: Wellpoint Medicaid Managed Care	$111.75

ONLAY TIBIAL INSERT SZ 1 9MM

Facility

$3,935.00

Hospital Charge Code	270668782
Hospital Revenue Code	278
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$1,967.50
Rate for Payer: Aetna Commercial	$1,495.30
Rate for Payer: Aetna Medicare Advantage	$1,180.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,003.42
Rate for Payer: Cigna Commercial	$1,967.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25
Rate for Payer: UnitedHealthcare Community & State	$124.35
Rate for Payer: Wellpoint Medicaid Managed Care	$111.75

ONLAY TIBIAL INSERT SZ 1 9MM

Facility

$3,935.00

Hospital Charge Code	270668782
Hospital Revenue Code	278
Min. Negotiated Rate	$590.25
Max. Negotiated Rate	$952.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25

ONLAY TIBIAL INSERT SZ 2 10MM

Facility

$3,935.00

Hospital Charge Code	270668786
Hospital Revenue Code	278
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$1,967.50
Rate for Payer: Aetna Commercial	$1,495.30
Rate for Payer: Aetna Medicare Advantage	$1,180.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,003.42
Rate for Payer: Cigna Commercial	$1,967.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25
Rate for Payer: UnitedHealthcare Community & State	$124.35
Rate for Payer: Wellpoint Medicaid Managed Care	$111.75

ONLAY TIBIAL INSERT SZ 2 10MM

Facility

$3,935.00

Hospital Charge Code	270668786
Hospital Revenue Code	278
Min. Negotiated Rate	$590.25
Max. Negotiated Rate	$952.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25

ONLAY TIBIAL INSERT SZ 2 12MM

Facility

$3,935.00

Hospital Charge Code	270668787
Hospital Revenue Code	278
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$1,967.50
Rate for Payer: Aetna Commercial	$1,495.30
Rate for Payer: Aetna Medicare Advantage	$1,180.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,003.42
Rate for Payer: Cigna Commercial	$1,967.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25
Rate for Payer: UnitedHealthcare Community & State	$124.35
Rate for Payer: Wellpoint Medicaid Managed Care	$111.75

ONLAY TIBIAL INSERT SZ 2 12MM

Facility

$3,935.00

Hospital Charge Code	270668787
Hospital Revenue Code	278
Min. Negotiated Rate	$590.25
Max. Negotiated Rate	$952.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25

ONLAY TIBIAL INSERT SZ 2 8MM

Facility

$3,935.00

Hospital Charge Code	270668785
Hospital Revenue Code	278
Min. Negotiated Rate	$590.25
Max. Negotiated Rate	$952.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25

ONLAY TIBIAL INSERT SZ 2 8MM

Facility

$3,935.00

Hospital Charge Code	270668785
Hospital Revenue Code	278
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$1,967.50
Rate for Payer: Aetna Commercial	$1,495.30
Rate for Payer: Aetna Medicare Advantage	$1,180.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,003.42
Rate for Payer: Cigna Commercial	$1,967.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25
Rate for Payer: UnitedHealthcare Community & State	$124.35
Rate for Payer: Wellpoint Medicaid Managed Care	$111.75

ONLAY TIBIAL INSERT SZ 3 10MM

Facility

$3,935.00

Service Code	HCPCS C1776
Hospital Charge Code	270668790
Hospital Revenue Code	278
Min. Negotiated Rate	$590.25
Max. Negotiated Rate	$952.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25

Know your out-of-pocket cost for care.

All Charges