Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

OFLOXACIN .3% EYEDROP 5ML

Facility

$140.30

Service Code	NDC 17478071310
Hospital Charge Code	60635790
Hospital Revenue Code	250
Min. Negotiated Rate	$21.05
Max. Negotiated Rate	$21.05
Rate for Payer: Qualcare PPO/HMO/WC	$21.05

OIL CARTRIDGE MAESTRO

Facility

$103.50

Hospital Charge Code	270672676
Hospital Revenue Code	272
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$51.75
Rate for Payer: Aetna Commercial	$39.33
Rate for Payer: Aetna Medicare Advantage	$31.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.39
Rate for Payer: Cigna Commercial	$51.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.91
Rate for Payer: Oxford Commercial	$20.70
Rate for Payer: Qualcare PPO/HMO/WC	$15.53
Rate for Payer: UnitedHealthcare Commercial	$20.70
Rate for Payer: UnitedHealthcare Community & State	$3.27
Rate for Payer: Wellpoint Medicaid Managed Care	$2.94

OIL CARTRIDGE MAESTRO

Facility

$103.50

Hospital Charge Code	270672676
Hospital Revenue Code	272
Min. Negotiated Rate	$15.53
Max. Negotiated Rate	$15.53
Rate for Payer: Qualcare PPO/HMO/WC	$15.53

OINTMENT ANTIFUNGAL 2oz

Facility

$15.33

Hospital Charge Code	270651551
Hospital Revenue Code	270
Min. Negotiated Rate	$2.30
Max. Negotiated Rate	$2.30
Rate for Payer: Qualcare PPO/HMO/WC	$2.30

OINTMENT ANTIFUNGAL 2oz

Facility

$15.33

Hospital Charge Code	270651551
Hospital Revenue Code	270
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$7.67
Rate for Payer: Aetna Commercial	$5.83
Rate for Payer: Aetna Medicare Advantage	$4.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.91
Rate for Payer: Cigna Commercial	$7.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.99
Rate for Payer: Oxford Commercial	$3.07
Rate for Payer: Qualcare PPO/HMO/WC	$2.30
Rate for Payer: UnitedHealthcare Commercial	$3.07
Rate for Payer: UnitedHealthcare Community & State	$0.48
Rate for Payer: Wellpoint Medicaid Managed Care	$0.44

OINTMENT HEMORROHOIDAL

Facility

$4.00

Service Code	NDC 45802018816
Hospital Charge Code	60630001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

OINTMENT HEMORROHOIDAL

Facility

$4.00

Service Code	NDC 45802018816
Hospital Charge Code	60630001
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

OLANZAPINE 10 MG PDS

Facility

$314.03

Service Code	NDC 2759701
Hospital Charge Code	6063943222
Hospital Revenue Code	250
Min. Negotiated Rate	$47.10
Max. Negotiated Rate	$47.10
Rate for Payer: Qualcare PPO/HMO/WC	$47.10

OLANZAPINE 10 MG PDS

Facility

$314.03

Service Code	NDC 2759701
Hospital Charge Code	6063943222
Hospital Revenue Code	250
Min. Negotiated Rate	$8.92
Max. Negotiated Rate	$157.01
Rate for Payer: Aetna Commercial	$119.33
Rate for Payer: Aetna Medicare Advantage	$94.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.08
Rate for Payer: Cigna Commercial	$157.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.65
Rate for Payer: Oxford Commercial	$62.81
Rate for Payer: Qualcare PPO/HMO/WC	$47.10
Rate for Payer: UnitedHealthcare Commercial	$62.81
Rate for Payer: UnitedHealthcare Community & State	$9.92
Rate for Payer: Wellpoint Medicaid Managed Care	$8.92

OLANZAPINE 10 MG TAB

Facility

$148.27

Service Code	NDC 2411730
Hospital Charge Code	60627812
Hospital Revenue Code	250
Min. Negotiated Rate	$22.24
Max. Negotiated Rate	$22.24
Rate for Payer: Qualcare PPO/HMO/WC	$22.24

OLANZAPINE 10 MG TAB

Facility

$148.27

Service Code	NDC 2411730
Hospital Charge Code	60627812
Hospital Revenue Code	250
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$74.14
Rate for Payer: Aetna Commercial	$56.34
Rate for Payer: Aetna Medicare Advantage	$44.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.81
Rate for Payer: Cigna Commercial	$74.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.55
Rate for Payer: Oxford Commercial	$29.65
Rate for Payer: Qualcare PPO/HMO/WC	$22.24
Rate for Payer: UnitedHealthcare Commercial	$29.65
Rate for Payer: UnitedHealthcare Community & State	$4.69
Rate for Payer: Wellpoint Medicaid Managed Care	$4.21

OLANZAPINE 2.5 MG TAB

Facility

$75.04

Service Code	NDC 904628361
Hospital Charge Code	60627813
Hospital Revenue Code	250
Min. Negotiated Rate	$11.26
Max. Negotiated Rate	$11.26
Rate for Payer: Qualcare PPO/HMO/WC	$11.26

OLANZAPINE 2.5 MG TAB

Facility

$75.04

Service Code	NDC 904628361
Hospital Charge Code	60627813
Hospital Revenue Code	250
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$37.52
Rate for Payer: Aetna Commercial	$28.52
Rate for Payer: Aetna Medicare Advantage	$22.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.14
Rate for Payer: Cigna Commercial	$37.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.51
Rate for Payer: Oxford Commercial	$15.01
Rate for Payer: Qualcare PPO/HMO/WC	$11.26
Rate for Payer: UnitedHealthcare Commercial	$15.01
Rate for Payer: UnitedHealthcare Community & State	$2.37
Rate for Payer: Wellpoint Medicaid Managed Care	$2.13

OLANZAPINE 5 MG TAB

Facility

$98.36

Service Code	NDC 62756055283
Hospital Charge Code	6017800
Hospital Revenue Code	250
Min. Negotiated Rate	$14.75
Max. Negotiated Rate	$14.75
Rate for Payer: Qualcare PPO/HMO/WC	$14.75

OLANZAPINE 5 MG TAB

Facility

$98.36

Service Code	NDC 62756055283
Hospital Charge Code	6017800
Hospital Revenue Code	250
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$49.18
Rate for Payer: Aetna Commercial	$37.38
Rate for Payer: Aetna Medicare Advantage	$29.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.08
Rate for Payer: Cigna Commercial	$49.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.57
Rate for Payer: Oxford Commercial	$19.67
Rate for Payer: Qualcare PPO/HMO/WC	$14.75
Rate for Payer: UnitedHealthcare Commercial	$19.67
Rate for Payer: UnitedHealthcare Community & State	$3.11
Rate for Payer: Wellpoint Medicaid Managed Care	$2.79

OLANZAPINE DISINTEG TAB 5MG

Facility

$106.26

Service Code	NDC 2445385
Hospital Charge Code	60629274
Hospital Revenue Code	250
Min. Negotiated Rate	$3.02
Max. Negotiated Rate	$53.13
Rate for Payer: Aetna Commercial	$40.38
Rate for Payer: Aetna Medicare Advantage	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.10
Rate for Payer: Cigna Commercial	$53.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.63
Rate for Payer: Oxford Commercial	$21.25
Rate for Payer: Qualcare PPO/HMO/WC	$15.94
Rate for Payer: UnitedHealthcare Commercial	$21.25
Rate for Payer: UnitedHealthcare Community & State	$3.36
Rate for Payer: Wellpoint Medicaid Managed Care	$3.02

OLANZAPINE DISINTEG TAB 5MG

Facility

$106.26

Service Code	NDC 2445385
Hospital Charge Code	60629274
Hospital Revenue Code	250
Min. Negotiated Rate	$15.94
Max. Negotiated Rate	$15.94
Rate for Payer: Qualcare PPO/HMO/WC	$15.94

OLIGOCLONAL BANDING

Facility

$227.00

Service Code	HCPCS 83916
Hospital Charge Code	38472678
Hospital Revenue Code	301
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$74.50
Rate for Payer: Aetna Medicare Advantage	$88.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$27.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.36
Rate for Payer: Cigna Commercial	$113.50
Rate for Payer: Cigna Medicare Advantage	$27.39
Rate for Payer: Clover Medicare Advantage	$26.02
Rate for Payer: EmblemHealth Commercial	$82.17
Rate for Payer: Humana Medicare Advantage	$28.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$27.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.02
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.05
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$21.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.39
Rate for Payer: Wellcare Medicare Advantage	$27.39
Rate for Payer: Wellpoint Medicaid Managed Care	$6.45

OLIGOCLONAL BANDING

Facility

$227.00

Service Code	HCPCS 83916
Hospital Charge Code	38472678
Hospital Revenue Code	301
Min. Negotiated Rate	$34.05
Max. Negotiated Rate	$34.05
Rate for Payer: Qualcare PPO/HMO/WC	$34.05

OLIGOCLONAL BANDS,CSF

Facility

$138.20

Service Code	HCPCS 83916
Hospital Charge Code	39900113
Hospital Revenue Code	301
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$74.50
Rate for Payer: Aetna Medicare Advantage	$88.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$27.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.36
Rate for Payer: Cigna Commercial	$69.10
Rate for Payer: Cigna Medicare Advantage	$27.39
Rate for Payer: Clover Medicare Advantage	$26.02
Rate for Payer: EmblemHealth Commercial	$82.17
Rate for Payer: Humana Medicare Advantage	$28.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$27.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.93
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.73
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$21.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.39
Rate for Payer: Wellcare Medicare Advantage	$27.39
Rate for Payer: Wellpoint Medicaid Managed Care	$3.92

OLIGOCLONAL BANDS,CSF

Facility

$138.20

Service Code	HCPCS 83916
Hospital Charge Code	39900113
Hospital Revenue Code	301
Min. Negotiated Rate	$20.73
Max. Negotiated Rate	$20.73
Rate for Payer: Qualcare PPO/HMO/WC	$20.73

OLIGOCLONAL BANDS, SERUM & CSF

Facility

$390.00

Service Code	HCPCS 83916
Hospital Charge Code	3004348
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$74.50
Rate for Payer: Aetna Medicare Advantage	$88.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$27.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.36
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$27.39
Rate for Payer: Clover Medicare Advantage	$26.02
Rate for Payer: EmblemHealth Commercial	$82.17
Rate for Payer: Humana Medicare Advantage	$28.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$27.39
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	$21.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.39
Rate for Payer: Wellcare Medicare Advantage	$27.39
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

OLIGOCLONAL BANDS, SERUM & CSF

Facility

$390.00

Service Code	HCPCS 83916
Hospital Charge Code	3004348
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

OLIVE PIN 1.4 MM

Facility

$850.00

Service Code	HCPCS C1713
Hospital Charge Code	270690335
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

OLIVE PIN 1.4 MM

Facility

$850.00

Service Code	HCPCS C1713
Hospital Charge Code	270690335
Hospital Revenue Code	278
Min. Negotiated Rate	$24.14
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Community & State	$26.86
Rate for Payer: Wellpoint Medicaid Managed Care	$24.14

Know your out-of-pocket cost for care.

All Charges