Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

OMNIPAQUE 350MG/50ML

Facility

$372.86

Service Code	HCPCS Q9967
Hospital Charge Code	60630240
Hospital Revenue Code	255
Min. Negotiated Rate	$10.59
Max. Negotiated Rate	$186.43
Rate for Payer: Aetna Commercial	$141.69
Rate for Payer: Aetna Medicare Advantage	$111.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.08
Rate for Payer: Cigna Commercial	$186.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.94
Rate for Payer: Oxford Commercial	$74.57
Rate for Payer: Qualcare PPO/HMO/WC	$55.93
Rate for Payer: UnitedHealthcare Commercial	$74.57
Rate for Payer: UnitedHealthcare Community & State	$11.78
Rate for Payer: Wellpoint Medicaid Managed Care	$10.59

OMNISCAN 15ML

Facility

$496.60

Hospital Charge Code	7412028
Hospital Revenue Code	636
Min. Negotiated Rate	$74.49
Max. Negotiated Rate	$120.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.18
Rate for Payer: Qualcare PPO/HMO/WC	$74.49

OMNISCAN 15ML

Facility

$496.60

Service Code	HCPCS A9579
Hospital Charge Code	2680405
Hospital Revenue Code	255
Min. Negotiated Rate	$74.49
Max. Negotiated Rate	$74.49
Rate for Payer: Qualcare PPO/HMO/WC	$74.49

OMNISCAN 15ML

Facility

$496.60

Service Code	HCPCS A9579
Hospital Charge Code	2680405
Hospital Revenue Code	255
Min. Negotiated Rate	$14.10
Max. Negotiated Rate	$248.30
Rate for Payer: Aetna Commercial	$188.71
Rate for Payer: Aetna Medicare Advantage	$148.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.63
Rate for Payer: Cigna Commercial	$248.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.12
Rate for Payer: Oxford Commercial	$99.32
Rate for Payer: Qualcare PPO/HMO/WC	$74.49
Rate for Payer: UnitedHealthcare Commercial	$99.32
Rate for Payer: UnitedHealthcare Community & State	$15.69
Rate for Payer: Wellpoint Medicaid Managed Care	$14.10

OMNISCAN 15ML

Facility

$496.60

Hospital Charge Code	7412028
Hospital Revenue Code	636
Min. Negotiated Rate	$14.10
Max. Negotiated Rate	$248.30
Rate for Payer: Aetna Commercial	$188.71
Rate for Payer: Aetna Medicare Advantage	$148.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.63
Rate for Payer: Cigna Commercial	$248.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.18
Rate for Payer: Qualcare PPO/HMO/WC	$74.49
Rate for Payer: UnitedHealthcare Community & State	$15.69
Rate for Payer: Wellpoint Medicaid Managed Care	$14.10

OMNISCAN 15 ML

Facility

$131.25

Service Code	HCPCS A9579
Hospital Charge Code	2011540
Hospital Revenue Code	255
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$65.62
Rate for Payer: Aetna Commercial	$49.88
Rate for Payer: Aetna Medicare Advantage	$39.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.47
Rate for Payer: Cigna Commercial	$65.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.12
Rate for Payer: Oxford Commercial	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$19.69
Rate for Payer: UnitedHealthcare Commercial	$26.25
Rate for Payer: UnitedHealthcare Community & State	$4.15
Rate for Payer: Wellpoint Medicaid Managed Care	$3.73

OMNISCAN 15 ML

Facility

$131.25

Service Code	HCPCS A9579
Hospital Charge Code	2011540
Hospital Revenue Code	255
Min. Negotiated Rate	$19.69
Max. Negotiated Rate	$19.69
Rate for Payer: Qualcare PPO/HMO/WC	$19.69

OMNISCAN 20ml

Facility

$246.00

Service Code	HCPCS A9579
Hospital Charge Code	635147
Hospital Revenue Code	255
Min. Negotiated Rate	$36.90
Max. Negotiated Rate	$36.90
Rate for Payer: Qualcare PPO/HMO/WC	$36.90

OMNISCAN 20ml

Facility

$246.00

Service Code	HCPCS A9579
Hospital Charge Code	635147
Hospital Revenue Code	255
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$123.00
Rate for Payer: Aetna Commercial	$93.48
Rate for Payer: Aetna Medicare Advantage	$73.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.73
Rate for Payer: Cigna Commercial	$123.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.96
Rate for Payer: Oxford Commercial	$49.20
Rate for Payer: Qualcare PPO/HMO/WC	$36.90
Rate for Payer: UnitedHealthcare Commercial	$49.20
Rate for Payer: UnitedHealthcare Community & State	$7.77
Rate for Payer: Wellpoint Medicaid Managed Care	$6.99

OMNISCAN 20 ML

Facility

$150.00

Service Code	HCPCS A9579
Hospital Charge Code	2011545
Hospital Revenue Code	255
Min. Negotiated Rate	$4.26
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.00
Rate for Payer: Oxford Commercial	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$30.00
Rate for Payer: UnitedHealthcare Community & State	$4.74
Rate for Payer: Wellpoint Medicaid Managed Care	$4.26

OMNISCAN 20 ML

Facility

$150.00

Service Code	HCPCS A9579
Hospital Charge Code	2011545
Hospital Revenue Code	255
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

OMNISCAN 287MG INJ 20ML VIAL

Facility

$703.50

Service Code	NDC 407069020
Hospital Charge Code	60630198
Hospital Revenue Code	255
Min. Negotiated Rate	$105.53
Max. Negotiated Rate	$105.53
Rate for Payer: Qualcare PPO/HMO/WC	$105.53

OMNISCAN 287MG INJ 20ML VIAL

Facility

$703.50

Service Code	NDC 407069020
Hospital Charge Code	60630198
Hospital Revenue Code	255
Min. Negotiated Rate	$19.98
Max. Negotiated Rate	$351.75
Rate for Payer: Aetna Commercial	$267.33
Rate for Payer: Aetna Medicare Advantage	$211.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$179.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$179.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$179.39
Rate for Payer: Cigna Commercial	$351.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.91
Rate for Payer: Oxford Commercial	$140.70
Rate for Payer: Qualcare PPO/HMO/WC	$105.53
Rate for Payer: UnitedHealthcare Commercial	$140.70
Rate for Payer: UnitedHealthcare Community & State	$22.23
Rate for Payer: Wellpoint Medicaid Managed Care	$19.98

ONCO 2 PROTEINS

Facility

$2,348.00

Service Code	HCPCS 81500
Hospital Charge Code	401081500
Hospital Revenue Code	301
Min. Negotiated Rate	$352.20
Max. Negotiated Rate	$352.20
Rate for Payer: Qualcare PPO/HMO/WC	$352.20

ONCO 2 PROTEINS

Facility

$2,348.00

Service Code	HCPCS 81500
Hospital Charge Code	401081500
Hospital Revenue Code	301
Min. Negotiated Rate	$66.68
Max. Negotiated Rate	$1,174.00
Rate for Payer: Aetna Commercial	$708.56
Rate for Payer: Aetna Medicare Advantage	$844.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$944.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$944.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$260.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$944.96
Rate for Payer: Cigna Commercial	$1,174.00
Rate for Payer: Cigna Medicare Advantage	$260.50
Rate for Payer: Clover Medicare Advantage	$247.47
Rate for Payer: EmblemHealth Commercial	$781.50
Rate for Payer: Humana Medicare Advantage	$268.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$260.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$610.48
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$352.20
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$208.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$260.50
Rate for Payer: Wellcare Medicare Advantage	$260.50
Rate for Payer: Wellpoint Medicaid Managed Care	$66.68

ONCOPROTEIN DCP

Facility

$290.79

Service Code	HCPCS 83951
Hospital Charge Code	401183951
Hospital Revenue Code	301
Min. Negotiated Rate	$43.62
Max. Negotiated Rate	$43.62
Rate for Payer: Qualcare PPO/HMO/WC	$43.62

ONCOPROTEIN DCP

Facility

$290.79

Service Code	HCPCS 83951
Hospital Charge Code	401183951
Hospital Revenue Code	301
Min. Negotiated Rate	$8.26
Max. Negotiated Rate	$233.65
Rate for Payer: Aetna Commercial	$175.20
Rate for Payer: Aetna Medicare Advantage	$208.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$233.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$233.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$64.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$233.65
Rate for Payer: Cigna Commercial	$145.40
Rate for Payer: Cigna Medicare Advantage	$64.41
Rate for Payer: Clover Medicare Advantage	$61.19
Rate for Payer: EmblemHealth Commercial	$193.23
Rate for Payer: Humana Medicare Advantage	$66.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$64.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.61
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.62
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$51.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.41
Rate for Payer: Wellcare Medicare Advantage	$64.41
Rate for Payer: Wellpoint Medicaid Managed Care	$8.26

ONDANSETRON 4MG/2ML INJ

Facility

$6.70

Service Code	HCPCS J2405
Hospital Charge Code	60628669
Hospital Revenue Code	636
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.00

ONDANSETRON 4MG/2ML INJ

Facility

$6.70

Service Code	HCPCS J2405
Hospital Charge Code	60628669
Hospital Revenue Code	636
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.35
Rate for Payer: Aetna Commercial	$2.55
Rate for Payer: Aetna Medicare Advantage	$2.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.71
Rate for Payer: Cigna Commercial	$3.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

ONDANSETRON 4 MG DISINTEG. TAB

Facility

$26.80

Service Code	NDC 62756024064
Hospital Charge Code	60630085
Hospital Revenue Code	250
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$13.40
Rate for Payer: Aetna Commercial	$10.18
Rate for Payer: Aetna Medicare Advantage	$8.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.83
Rate for Payer: Cigna Commercial	$13.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.97
Rate for Payer: Oxford Commercial	$5.36
Rate for Payer: Qualcare PPO/HMO/WC	$4.02
Rate for Payer: UnitedHealthcare Commercial	$5.36
Rate for Payer: UnitedHealthcare Community & State	$0.85
Rate for Payer: Wellpoint Medicaid Managed Care	$0.76

ONDANSETRON 4 MG DISINTEG. TAB

Facility

$26.80

Service Code	NDC 62756024064
Hospital Charge Code	60630085
Hospital Revenue Code	250
Min. Negotiated Rate	$4.02
Max. Negotiated Rate	$4.02
Rate for Payer: Qualcare PPO/HMO/WC	$4.02

ONDANSETRON 4 MG TAB

Facility

$166.03

Service Code	NDC 63304045830
Hospital Charge Code	60628146
Hospital Revenue Code	250
Min. Negotiated Rate	$24.90
Max. Negotiated Rate	$24.90
Rate for Payer: Qualcare PPO/HMO/WC	$24.90

ONDANSETRON 4 MG TAB

Facility

$166.03

Service Code	NDC 63304045830
Hospital Charge Code	60628146
Hospital Revenue Code	250
Min. Negotiated Rate	$4.72
Max. Negotiated Rate	$83.02
Rate for Payer: Aetna Commercial	$63.09
Rate for Payer: Aetna Medicare Advantage	$49.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.34
Rate for Payer: Cigna Commercial	$83.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.17
Rate for Payer: Oxford Commercial	$33.21
Rate for Payer: Qualcare PPO/HMO/WC	$24.90
Rate for Payer: UnitedHealthcare Commercial	$33.21
Rate for Payer: UnitedHealthcare Community & State	$5.25
Rate for Payer: Wellpoint Medicaid Managed Care	$4.72

ONDANSETRON 8 MG DISINTEG. TAB

Facility

$30.08

Service Code	NDC 54868574900
Hospital Charge Code	60630086
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$15.04
Rate for Payer: Aetna Commercial	$11.43
Rate for Payer: Aetna Medicare Advantage	$9.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.67
Rate for Payer: Cigna Commercial	$15.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.82
Rate for Payer: Oxford Commercial	$6.02
Rate for Payer: Qualcare PPO/HMO/WC	$4.51
Rate for Payer: UnitedHealthcare Commercial	$6.02
Rate for Payer: UnitedHealthcare Community & State	$0.95
Rate for Payer: Wellpoint Medicaid Managed Care	$0.85

ONDANSETRON 8 MG DISINTEG. TAB

Facility

$30.08

Service Code	NDC 54868574900
Hospital Charge Code	60630086
Hospital Revenue Code	250
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$4.51
Rate for Payer: Qualcare PPO/HMO/WC	$4.51

Know your out-of-pocket cost for care.

All Charges