Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

OLIVEWIRE

Facility

$3,885.00

Hospital Charge Code	270703513
Hospital Revenue Code	278
Min. Negotiated Rate	$582.75
Max. Negotiated Rate	$940.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$777.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$940.17
Rate for Payer: Qualcare PPO/HMO/WC	$582.75

OLIVEWIRE

Facility

$3,885.00

Hospital Charge Code	270703513
Hospital Revenue Code	278
Min. Negotiated Rate	$110.33
Max. Negotiated Rate	$1,942.50
Rate for Payer: Aetna Commercial	$1,476.30
Rate for Payer: Aetna Medicare Advantage	$1,165.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$990.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$990.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$777.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$990.67
Rate for Payer: Cigna Commercial	$1,942.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$940.17
Rate for Payer: Qualcare PPO/HMO/WC	$582.75
Rate for Payer: UnitedHealthcare Community & State	$122.77
Rate for Payer: Wellpoint Medicaid Managed Care	$110.33

OLIVE WIRE 0.062

Facility

$225.00

Service Code	HCPCS C1713
Hospital Charge Code	270702089
Hospital Revenue Code	278
Min. Negotiated Rate	$6.39
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna Commercial	$85.50
Rate for Payer: Aetna Medicare Advantage	$67.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.38
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.45
Rate for Payer: Qualcare PPO/HMO/WC	$33.75
Rate for Payer: UnitedHealthcare Community & State	$7.11
Rate for Payer: Wellpoint Medicaid Managed Care	$6.39

OLIVE WIRE 0.062

Facility

$225.00

Service Code	HCPCS C1713
Hospital Charge Code	270702089
Hospital Revenue Code	278
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$54.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.45
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

OLIVE WIRE 15MM

Facility

$5,195.00

Hospital Charge Code	270703260
Hospital Revenue Code	279
Min. Negotiated Rate	$147.54
Max. Negotiated Rate	$2,597.50
Rate for Payer: Aetna Commercial	$1,974.10
Rate for Payer: Aetna Medicare Advantage	$1,558.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,324.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,324.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,324.72
Rate for Payer: Cigna Commercial	$2,597.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,350.70
Rate for Payer: Oxford Commercial	$1,039.00
Rate for Payer: Qualcare PPO/HMO/WC	$779.25
Rate for Payer: UnitedHealthcare Commercial	$1,039.00
Rate for Payer: UnitedHealthcare Community & State	$164.16
Rate for Payer: Wellpoint Medicaid Managed Care	$147.54

OLIVE WIRE 15MM

Facility

$5,195.00

Hospital Charge Code	270703620
Hospital Revenue Code	279
Min. Negotiated Rate	$779.25
Max. Negotiated Rate	$779.25
Rate for Payer: Qualcare PPO/HMO/WC	$779.25

OLIVE WIRE 15MM

Facility

$5,195.00

Hospital Charge Code	270703260
Hospital Revenue Code	279
Min. Negotiated Rate	$779.25
Max. Negotiated Rate	$779.25
Rate for Payer: Qualcare PPO/HMO/WC	$779.25

OLIVE WIRE 15MM

Facility

$5,195.00

Hospital Charge Code	270703620
Hospital Revenue Code	279
Min. Negotiated Rate	$147.54
Max. Negotiated Rate	$2,597.50
Rate for Payer: Aetna Commercial	$1,974.10
Rate for Payer: Aetna Medicare Advantage	$1,558.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,324.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,324.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,324.72
Rate for Payer: Cigna Commercial	$2,597.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,350.70
Rate for Payer: Oxford Commercial	$1,039.00
Rate for Payer: Qualcare PPO/HMO/WC	$779.25
Rate for Payer: UnitedHealthcare Commercial	$1,039.00
Rate for Payer: UnitedHealthcare Community & State	$164.16
Rate for Payer: Wellpoint Medicaid Managed Care	$147.54

OLOPATADINE OPTHALMIC 0.1% SOL

Facility

$1,909.50

Service Code	NDC 65027105
Hospital Charge Code	60629908
Hospital Revenue Code	250
Min. Negotiated Rate	$54.23
Max. Negotiated Rate	$954.75
Rate for Payer: Aetna Commercial	$725.61
Rate for Payer: Aetna Medicare Advantage	$572.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$486.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$486.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$486.92
Rate for Payer: Cigna Commercial	$954.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$496.47
Rate for Payer: Oxford Commercial	$381.90
Rate for Payer: Qualcare PPO/HMO/WC	$286.43
Rate for Payer: UnitedHealthcare Commercial	$381.90
Rate for Payer: UnitedHealthcare Community & State	$60.34
Rate for Payer: Wellpoint Medicaid Managed Care	$54.23

OLOPATADINE OPTHALMIC 0.1% SOL

Facility

$1,909.50

Service Code	NDC 65027105
Hospital Charge Code	60629908
Hospital Revenue Code	250
Min. Negotiated Rate	$286.43
Max. Negotiated Rate	$286.43
Rate for Payer: Qualcare PPO/HMO/WC	$286.43

OMENTECTOMY EPIPLOECTOMY

Facility

$13,267.95

Service Code	HCPCS 49255
Hospital Charge Code	1600000496
Hospital Revenue Code	360
Min. Negotiated Rate	$376.81
Max. Negotiated Rate	$27,899.36
Rate for Payer: Aetna Commercial	$20,919.71
Rate for Payer: Aetna Medicare Advantage	$24,919.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27,899.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27,899.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,691.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27,899.36
Rate for Payer: Cigna Commercial	$15,416.72
Rate for Payer: Cigna Medicare Advantage	$7,691.07
Rate for Payer: Clover Medicare Advantage	$7,306.52
Rate for Payer: EmblemHealth Commercial	$23,073.21
Rate for Payer: Humana Medicare Advantage	$7,921.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,691.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,449.67
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,990.19
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$419.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,691.07
Rate for Payer: Wellcare Medicare Advantage	$7,691.07
Rate for Payer: Wellpoint Medicaid Managed Care	$376.81

OMENTECTOMY EPIPLOECTOMY

Facility

$13,267.95

Service Code	HCPCS 49255
Hospital Charge Code	1600000496
Hospital Revenue Code	360
Min. Negotiated Rate	$1,990.19
Max. Negotiated Rate	$1,990.19
Rate for Payer: Qualcare PPO/HMO/WC	$1,990.19

OMNIA VARIABLE SELF DRILL

Facility

$6,750.00

Hospital Charge Code	270693192
Hospital Revenue Code	272
Min. Negotiated Rate	$191.70
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,565.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,755.00
Rate for Payer: Oxford Commercial	$1,350.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Commercial	$1,350.00
Rate for Payer: UnitedHealthcare Community & State	$213.30
Rate for Payer: Wellpoint Medicaid Managed Care	$191.70

OMNIA VARIABLE SELF DRILL

Facility

$6,750.00

Hospital Charge Code	270693192
Hospital Revenue Code	272
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,012.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

OMNIPAQUE 240MGI/ML 10ML

Facility

$104.12

Service Code	NDC 407141210
Hospital Charge Code	606390113
Hospital Revenue Code	255
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$52.06
Rate for Payer: Aetna Commercial	$39.57
Rate for Payer: Aetna Medicare Advantage	$31.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.55
Rate for Payer: Cigna Commercial	$52.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.07
Rate for Payer: Oxford Commercial	$20.82
Rate for Payer: Qualcare PPO/HMO/WC	$15.62
Rate for Payer: UnitedHealthcare Commercial	$20.82
Rate for Payer: UnitedHealthcare Community & State	$3.29
Rate for Payer: Wellpoint Medicaid Managed Care	$2.96

OMNIPAQUE 240MGI/ML 10ML

Facility

$104.12

Service Code	NDC 407141210
Hospital Charge Code	606390113
Hospital Revenue Code	255
Min. Negotiated Rate	$15.62
Max. Negotiated Rate	$15.62
Rate for Payer: Qualcare PPO/HMO/WC	$15.62

OMNIPAQUE 300 10 ML

Facility

$231.60

Hospital Charge Code	60639492
Hospital Revenue Code	636
Min. Negotiated Rate	$6.58
Max. Negotiated Rate	$115.80
Rate for Payer: Aetna Commercial	$88.01
Rate for Payer: Aetna Medicare Advantage	$69.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.06
Rate for Payer: Cigna Commercial	$115.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.05
Rate for Payer: Qualcare PPO/HMO/WC	$34.74
Rate for Payer: UnitedHealthcare Community & State	$7.32
Rate for Payer: Wellpoint Medicaid Managed Care	$6.58

OMNIPAQUE 300 10 ML

Facility

$231.60

Hospital Charge Code	60639492
Hospital Revenue Code	636
Min. Negotiated Rate	$34.74
Max. Negotiated Rate	$56.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.05
Rate for Payer: Qualcare PPO/HMO/WC	$34.74

OMNIPAQUE 350MG/150ML

Facility

$835.00

Hospital Charge Code	60630247
Hospital Revenue Code	255
Min. Negotiated Rate	$125.25
Max. Negotiated Rate	$125.25
Rate for Payer: Qualcare PPO/HMO/WC	$125.25

OMNIPAQUE 350MG/150ML

Facility

$1,047.34

Service Code	NDC 407141493
Hospital Charge Code	60630241
Hospital Revenue Code	255
Min. Negotiated Rate	$157.10
Max. Negotiated Rate	$157.10
Rate for Payer: Qualcare PPO/HMO/WC	$157.10

OMNIPAQUE 350MG/150ML

Facility

$1,047.34

Service Code	NDC 407141493
Hospital Charge Code	60630241
Hospital Revenue Code	255
Min. Negotiated Rate	$29.74
Max. Negotiated Rate	$523.67
Rate for Payer: Aetna Commercial	$397.99
Rate for Payer: Aetna Medicare Advantage	$314.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.07
Rate for Payer: Cigna Commercial	$523.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.31
Rate for Payer: Oxford Commercial	$209.47
Rate for Payer: Qualcare PPO/HMO/WC	$157.10
Rate for Payer: UnitedHealthcare Commercial	$209.47
Rate for Payer: UnitedHealthcare Community & State	$33.10
Rate for Payer: Wellpoint Medicaid Managed Care	$29.74

OMNIPAQUE 350MG/150ML

Facility

$835.00

Hospital Charge Code	60630247
Hospital Revenue Code	255
Min. Negotiated Rate	$23.71
Max. Negotiated Rate	$417.50
Rate for Payer: Aetna Commercial	$317.30
Rate for Payer: Aetna Medicare Advantage	$250.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.93
Rate for Payer: Cigna Commercial	$417.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.10
Rate for Payer: Oxford Commercial	$167.00
Rate for Payer: Qualcare PPO/HMO/WC	$125.25
Rate for Payer: UnitedHealthcare Commercial	$167.00
Rate for Payer: UnitedHealthcare Community & State	$26.39
Rate for Payer: Wellpoint Medicaid Managed Care	$23.71

OMNIPAQUE 350MG 50ML

Facility

$283.20

Service Code	HCPCS Q9966
Hospital Charge Code	64070010
Hospital Revenue Code	636
Min. Negotiated Rate	$8.04
Max. Negotiated Rate	$141.60
Rate for Payer: Aetna Commercial	$107.62
Rate for Payer: Aetna Medicare Advantage	$84.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.22
Rate for Payer: Cigna Commercial	$141.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.53
Rate for Payer: Qualcare PPO/HMO/WC	$42.48
Rate for Payer: UnitedHealthcare Community & State	$8.95
Rate for Payer: Wellpoint Medicaid Managed Care	$8.04

OMNIPAQUE 350MG 50ML

Facility

$283.20

Service Code	HCPCS Q9966
Hospital Charge Code	64070010
Hospital Revenue Code	636
Min. Negotiated Rate	$42.48
Max. Negotiated Rate	$68.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.53
Rate for Payer: Qualcare PPO/HMO/WC	$42.48

OMNIPAQUE 350MG/50ML

Facility

$372.86

Service Code	HCPCS Q9967
Hospital Charge Code	60630240
Hospital Revenue Code	255
Min. Negotiated Rate	$55.93
Max. Negotiated Rate	$55.93
Rate for Payer: Qualcare PPO/HMO/WC	$55.93

Know your out-of-pocket cost for care.

All Charges