Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

OXISENSOR II ADULT D25

Facility

$121.05

Hospital Charge Code	270600649
Hospital Revenue Code	272
Min. Negotiated Rate	$18.16
Max. Negotiated Rate	$18.16
Rate for Payer: Qualcare PPO/HMO/WC	$18.16

OXISENSOR II ADULT D25

Facility

$121.05

Hospital Charge Code	270600649
Hospital Revenue Code	272
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$60.52
Rate for Payer: Aetna Commercial	$46.00
Rate for Payer: Aetna Medicare Advantage	$36.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.87
Rate for Payer: Cigna Commercial	$60.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.47
Rate for Payer: Oxford Commercial	$24.21
Rate for Payer: Qualcare PPO/HMO/WC	$18.16
Rate for Payer: UnitedHealthcare Commercial	$24.21
Rate for Payer: UnitedHealthcare Community & State	$3.83
Rate for Payer: Wellpoint Medicaid Managed Care	$3.44

OXISENSOR II NEONATAL/ADULT

Facility

$62.96

Hospital Charge Code	270600462
Hospital Revenue Code	270
Min. Negotiated Rate	$9.44
Max. Negotiated Rate	$9.44
Rate for Payer: Qualcare PPO/HMO/WC	$9.44

OXISENSOR II NEONATAL/ADULT

Facility

$62.96

Hospital Charge Code	270600462
Hospital Revenue Code	270
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$31.48
Rate for Payer: Aetna Commercial	$23.92
Rate for Payer: Aetna Medicare Advantage	$18.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.05
Rate for Payer: Cigna Commercial	$31.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.37
Rate for Payer: Oxford Commercial	$12.59
Rate for Payer: Qualcare PPO/HMO/WC	$9.44
Rate for Payer: UnitedHealthcare Commercial	$12.59
Rate for Payer: UnitedHealthcare Community & State	$1.99
Rate for Payer: Wellpoint Medicaid Managed Care	$1.79

OXISENSOR INFANT I20

Facility

$124.85

Hospital Charge Code	270600650
Hospital Revenue Code	272
Min. Negotiated Rate	$18.73
Max. Negotiated Rate	$18.73
Rate for Payer: Qualcare PPO/HMO/WC	$18.73

OXISENSOR INFANT I20

Facility

$124.85

Hospital Charge Code	270600650
Hospital Revenue Code	272
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$62.42
Rate for Payer: Aetna Commercial	$47.44
Rate for Payer: Aetna Medicare Advantage	$37.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.84
Rate for Payer: Cigna Commercial	$62.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.46
Rate for Payer: Oxford Commercial	$24.97
Rate for Payer: Qualcare PPO/HMO/WC	$18.73
Rate for Payer: UnitedHealthcare Commercial	$24.97
Rate for Payer: UnitedHealthcare Community & State	$3.95
Rate for Payer: Wellpoint Medicaid Managed Care	$3.55

OXISENSOR NEONATAL

Facility

$214.00

Hospital Charge Code	270330838
Hospital Revenue Code	272
Min. Negotiated Rate	$6.08
Max. Negotiated Rate	$107.00
Rate for Payer: Aetna Commercial	$81.32
Rate for Payer: Aetna Medicare Advantage	$64.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.57
Rate for Payer: Cigna Commercial	$107.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.64
Rate for Payer: Oxford Commercial	$42.80
Rate for Payer: Qualcare PPO/HMO/WC	$32.10
Rate for Payer: UnitedHealthcare Commercial	$42.80
Rate for Payer: UnitedHealthcare Community & State	$6.76
Rate for Payer: Wellpoint Medicaid Managed Care	$6.08

OXISENSOR NEONATAL

Facility

$50.61

Hospital Charge Code	270649675
Hospital Revenue Code	270
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$25.30
Rate for Payer: Aetna Commercial	$19.23
Rate for Payer: Aetna Medicare Advantage	$15.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.91
Rate for Payer: Cigna Commercial	$25.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.16
Rate for Payer: Oxford Commercial	$10.12
Rate for Payer: Qualcare PPO/HMO/WC	$7.59
Rate for Payer: UnitedHealthcare Commercial	$10.12
Rate for Payer: UnitedHealthcare Community & State	$1.60
Rate for Payer: Wellpoint Medicaid Managed Care	$1.44

OXISENSOR NEONATAL

Facility

$50.61

Hospital Charge Code	270649675
Hospital Revenue Code	270
Min. Negotiated Rate	$7.59
Max. Negotiated Rate	$7.59
Rate for Payer: Qualcare PPO/HMO/WC	$7.59

OXISENSOR NEONATAL

Facility

$214.00

Hospital Charge Code	270330838
Hospital Revenue Code	272
Min. Negotiated Rate	$32.10
Max. Negotiated Rate	$32.10
Rate for Payer: Qualcare PPO/HMO/WC	$32.10

OXISENSOR OXIMAX ADULT

Facility

$28.75

Hospital Charge Code	270649182
Hospital Revenue Code	270
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$14.38
Rate for Payer: Aetna Commercial	$10.93
Rate for Payer: Aetna Medicare Advantage	$8.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.33
Rate for Payer: Cigna Commercial	$14.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.47
Rate for Payer: Oxford Commercial	$5.75
Rate for Payer: Qualcare PPO/HMO/WC	$4.31
Rate for Payer: UnitedHealthcare Commercial	$5.75
Rate for Payer: UnitedHealthcare Community & State	$0.91
Rate for Payer: Wellpoint Medicaid Managed Care	$0.82

OXISENSOR OXIMAX ADULT

Facility

$39.80

Hospital Charge Code	270649182N
Hospital Revenue Code	270
Min. Negotiated Rate	$5.97
Max. Negotiated Rate	$5.97
Rate for Payer: Qualcare PPO/HMO/WC	$5.97

OXISENSOR OXIMAX ADULT

Facility

$39.80

Hospital Charge Code	270649182N
Hospital Revenue Code	270
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$19.90
Rate for Payer: Aetna Commercial	$15.12
Rate for Payer: Aetna Medicare Advantage	$11.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.15
Rate for Payer: Cigna Commercial	$19.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.35
Rate for Payer: Oxford Commercial	$7.96
Rate for Payer: Qualcare PPO/HMO/WC	$5.97
Rate for Payer: UnitedHealthcare Commercial	$7.96
Rate for Payer: UnitedHealthcare Community & State	$1.26
Rate for Payer: Wellpoint Medicaid Managed Care	$1.13

OXISENSOR OXIMAX ADULT

Facility

$28.75

Hospital Charge Code	270649182
Hospital Revenue Code	270
Min. Negotiated Rate	$4.31
Max. Negotiated Rate	$4.31
Rate for Payer: Qualcare PPO/HMO/WC	$4.31

OXISENSOR OXIMAX ADULT

Facility

$28.75

Hospital Charge Code	270649182S
Hospital Revenue Code	270
Min. Negotiated Rate	$4.31
Max. Negotiated Rate	$4.31
Rate for Payer: Qualcare PPO/HMO/WC	$4.31

OXISENSOR OXIMAX ADULT

Facility

$28.75

Hospital Charge Code	270649182S
Hospital Revenue Code	270
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$14.38
Rate for Payer: Aetna Commercial	$10.93
Rate for Payer: Aetna Medicare Advantage	$8.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.33
Rate for Payer: Cigna Commercial	$14.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.47
Rate for Payer: Oxford Commercial	$5.75
Rate for Payer: Qualcare PPO/HMO/WC	$4.31
Rate for Payer: UnitedHealthcare Commercial	$5.75
Rate for Payer: UnitedHealthcare Community & State	$0.91
Rate for Payer: Wellpoint Medicaid Managed Care	$0.82

OXISENSOR PEDIATRIC DIGIT DISP

Facility

$70.54

Hospital Charge Code	270649676
Hospital Revenue Code	270
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$35.27
Rate for Payer: Aetna Commercial	$26.81
Rate for Payer: Aetna Medicare Advantage	$21.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.99
Rate for Payer: Cigna Commercial	$35.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.34
Rate for Payer: Oxford Commercial	$14.11
Rate for Payer: Qualcare PPO/HMO/WC	$10.58
Rate for Payer: UnitedHealthcare Commercial	$14.11
Rate for Payer: UnitedHealthcare Community & State	$2.23
Rate for Payer: Wellpoint Medicaid Managed Care	$2.00

OXISENSOR PEDIATRIC DIGIT DISP

Facility

$70.54

Hospital Charge Code	270649676
Hospital Revenue Code	270
Min. Negotiated Rate	$10.58
Max. Negotiated Rate	$10.58
Rate for Payer: Qualcare PPO/HMO/WC	$10.58

OXISENSOR PULSE PEDIATRIC

Facility

$6.55

Hospital Charge Code	270600746
Hospital Revenue Code	270
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.27
Rate for Payer: Aetna Commercial	$2.49
Rate for Payer: Aetna Medicare Advantage	$1.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.67
Rate for Payer: Cigna Commercial	$3.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.70
Rate for Payer: Oxford Commercial	$1.31
Rate for Payer: Qualcare PPO/HMO/WC	$0.98
Rate for Payer: UnitedHealthcare Commercial	$1.31
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

OXISENSOR PULSE PEDIATRIC

Facility

$6.55

Hospital Charge Code	270600746
Hospital Revenue Code	270
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.98

OXYBUTYNIN 5 MG TAB

Facility

$5.09

Service Code	NDC 60687067001
Hospital Charge Code	60628468
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.54
Rate for Payer: Aetna Commercial	$1.93
Rate for Payer: Aetna Medicare Advantage	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.30
Rate for Payer: Cigna Commercial	$2.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.32
Rate for Payer: Oxford Commercial	$1.02
Rate for Payer: Qualcare PPO/HMO/WC	$0.76
Rate for Payer: UnitedHealthcare Commercial	$1.02
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

OXYBUTYNIN 5 MG TAB

Facility

$5.09

Service Code	NDC 60687067001
Hospital Charge Code	60628468
Hospital Revenue Code	250
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$0.76
Rate for Payer: Qualcare PPO/HMO/WC	$0.76

OXYBUTYNIN SYRP 5MG/5ML

Facility

$4.00

Service Code	NDC 60432009216
Hospital Charge Code	60628469
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

OXYBUTYNIN SYRP 5MG/5ML

Facility

$4.00

Service Code	NDC 60432009216
Hospital Charge Code	60628469
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

OXYBUTYNIN XL 5MG TAB

Facility

$21.98

Service Code	NDC 378660501
Hospital Charge Code	606361015
Hospital Revenue Code	250
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$3.30
Rate for Payer: Qualcare PPO/HMO/WC	$3.30

Know your out-of-pocket cost for care.

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