Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ORTHOTIC CHECKOUT EA 15 MINS

Facility

$299.00

Service Code	HCPCS 97763GP
Hospital Charge Code	1008370
Hospital Revenue Code	420
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$44.85
Rate for Payer: Qualcare PPO/HMO/WC	$44.85

ORTHOTIC FIT/TRAINING 15MIN

Facility

$135.00

Service Code	HCPCS 97760GO
Hospital Charge Code	1008350
Hospital Revenue Code	430
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$20.25
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

ORTHOTIC FIT/TRAINING 15MIN

Facility

$135.00

Service Code	HCPCS 97760GO
Hospital Charge Code	1008350
Hospital Revenue Code	430
Min. Negotiated Rate	$3.83
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna Medicare Advantage	$40.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.42
Rate for Payer: Cigna Commercial	$67.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.10
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.25
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$4.27
Rate for Payer: Wellpoint Medicaid Managed Care	$3.83

ORTHOTIC MNG/TRAIN/15 MIN 1ST

Facility

$137.00

Service Code	HCPCS 97760
Hospital Charge Code	9808175
Hospital Revenue Code	420
Min. Negotiated Rate	$20.55
Max. Negotiated Rate	$20.55
Rate for Payer: Qualcare PPO/HMO/WC	$20.55

ORTHOTIC MNG/TRAIN/15 MIN 1ST

Facility

$137.00

Service Code	HCPCS 97760
Hospital Charge Code	9808175
Hospital Revenue Code	420
Min. Negotiated Rate	$3.89
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$52.06
Rate for Payer: Aetna Medicare Advantage	$41.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.94
Rate for Payer: Cigna Commercial	$68.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.62
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.55
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$4.33
Rate for Payer: Wellpoint Medicaid Managed Care	$3.89

ORTHOTIC TRNG EA 15 MIN CQ

Facility

$137.00

Service Code	HCPCS 97760GP
Hospital Charge Code	409197760Q
Hospital Revenue Code	420
Min. Negotiated Rate	$3.89
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$52.06
Rate for Payer: Aetna Medicare Advantage	$41.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.94
Rate for Payer: Cigna Commercial	$68.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.62
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.55
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$4.33
Rate for Payer: Wellpoint Medicaid Managed Care	$3.89

ORTHOTIC TRNG EA 15 MIN CQ

Facility

$137.00

Service Code	HCPCS 97760GP
Hospital Charge Code	409197760Q
Hospital Revenue Code	420
Min. Negotiated Rate	$20.55
Max. Negotiated Rate	$20.55
Rate for Payer: Qualcare PPO/HMO/WC	$20.55

ORTH/PROS MNG SUBSEQ/15 MIN

Facility

$86.40

Service Code	HCPCS 97763GO
Hospital Charge Code	74203140
Hospital Revenue Code	430
Min. Negotiated Rate	$12.96
Max. Negotiated Rate	$12.96
Rate for Payer: Qualcare PPO/HMO/WC	$12.96

ORTH/PROS MNG SUBSEQ/15 MIN

Facility

$86.40

Service Code	HCPCS 97763GO
Hospital Charge Code	74203140
Hospital Revenue Code	430
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$32.83
Rate for Payer: Aetna Medicare Advantage	$25.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.03
Rate for Payer: Cigna Commercial	$43.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.46
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.96
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.73
Rate for Payer: Wellpoint Medicaid Managed Care	$2.45

OSCAL 500+D

Facility

$4.00

Service Code	NDC 904546061
Hospital Charge Code	60635136
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

OSCAL 500+D

Facility

$4.00

Service Code	NDC 904546061
Hospital Charge Code	60635136
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

OSCILLATING SAW ATTACHMENT

Facility

$9,924.00

Hospital Charge Code	270674162
Hospital Revenue Code	272
Min. Negotiated Rate	$281.84
Max. Negotiated Rate	$4,962.00
Rate for Payer: Aetna Commercial	$3,771.12
Rate for Payer: Aetna Medicare Advantage	$2,977.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,530.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,530.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,530.62
Rate for Payer: Cigna Commercial	$4,962.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,580.24
Rate for Payer: Oxford Commercial	$1,984.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,488.60
Rate for Payer: UnitedHealthcare Commercial	$1,984.80
Rate for Payer: UnitedHealthcare Community & State	$313.60
Rate for Payer: Wellpoint Medicaid Managed Care	$281.84

OSCILLATING SAW ATTACHMENT

Facility

$9,924.00

Hospital Charge Code	270674162
Hospital Revenue Code	272
Min. Negotiated Rate	$1,488.60
Max. Negotiated Rate	$1,488.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,488.60

OSELTAMAVIR COMPOUNDED 15MG/ML

Facility

$19.36

Service Code	NDC 93818064
Hospital Charge Code	606390534
Hospital Revenue Code	250
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$2.90
Rate for Payer: Qualcare PPO/HMO/WC	$2.90

OSELTAMAVIR COMPOUNDED 15MG/ML

Facility

$19.36

Service Code	NDC 93818064
Hospital Charge Code	606390534
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$9.68
Rate for Payer: Aetna Commercial	$7.36
Rate for Payer: Aetna Medicare Advantage	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.94
Rate for Payer: Cigna Commercial	$9.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.03
Rate for Payer: Oxford Commercial	$3.87
Rate for Payer: Qualcare PPO/HMO/WC	$2.90
Rate for Payer: UnitedHealthcare Commercial	$3.87
Rate for Payer: UnitedHealthcare Community & State	$0.61
Rate for Payer: Wellpoint Medicaid Managed Care	$0.55

OSELTAMIVIR 45MG CAP

Facility

$4.55

Hospital Charge Code	606390582
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.27
Rate for Payer: Aetna Commercial	$1.73
Rate for Payer: Aetna Medicare Advantage	$1.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.16
Rate for Payer: Cigna Commercial	$2.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.18
Rate for Payer: Oxford Commercial	$0.91
Rate for Payer: Qualcare PPO/HMO/WC	$0.68
Rate for Payer: UnitedHealthcare Commercial	$0.91
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

OSELTAMIVIR 45MG CAP

Facility

$95.01

Service Code	NDC 31722063131
Hospital Charge Code	606390603
Hospital Revenue Code	250
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$14.25
Rate for Payer: Qualcare PPO/HMO/WC	$14.25

OSELTAMIVIR 45MG CAP

Facility

$4.55

Hospital Charge Code	606390582
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

OSELTAMIVIR 45MG CAP

Facility

$95.01

Service Code	NDC 31722063131
Hospital Charge Code	606390603
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$47.51
Rate for Payer: Aetna Commercial	$36.10
Rate for Payer: Aetna Medicare Advantage	$28.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.23
Rate for Payer: Cigna Commercial	$47.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.70
Rate for Payer: Oxford Commercial	$19.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.25
Rate for Payer: UnitedHealthcare Commercial	$19.00
Rate for Payer: UnitedHealthcare Community & State	$3.00
Rate for Payer: Wellpoint Medicaid Managed Care	$2.70

OSELTAMIVIR 75 MG CAP

Facility

$96.95

Service Code	NDC 4080085
Hospital Charge Code	60629906
Hospital Revenue Code	250
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$48.48
Rate for Payer: Aetna Commercial	$36.84
Rate for Payer: Aetna Medicare Advantage	$29.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.72
Rate for Payer: Cigna Commercial	$48.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.21
Rate for Payer: Oxford Commercial	$19.39
Rate for Payer: Qualcare PPO/HMO/WC	$14.54
Rate for Payer: UnitedHealthcare Commercial	$19.39
Rate for Payer: UnitedHealthcare Community & State	$3.06
Rate for Payer: Wellpoint Medicaid Managed Care	$2.75

OSELTAMIVIR 75 MG CAP

Facility

$96.95

Service Code	NDC 4080085
Hospital Charge Code	60629906
Hospital Revenue Code	250
Min. Negotiated Rate	$14.54
Max. Negotiated Rate	$14.54
Rate for Payer: Qualcare PPO/HMO/WC	$14.54

OSELTAMIVIR PHOSPHATE CAP 30MG

Facility

$95.01

Service Code	NDC 47781046813
Hospital Charge Code	606390168
Hospital Revenue Code	250
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$14.25
Rate for Payer: Qualcare PPO/HMO/WC	$14.25

OSELTAMIVIR PHOSPHATE CAP 30MG

Facility

$95.01

Service Code	NDC 47781046813
Hospital Charge Code	606390168
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$47.51
Rate for Payer: Aetna Commercial	$36.10
Rate for Payer: Aetna Medicare Advantage	$28.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.23
Rate for Payer: Cigna Commercial	$47.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.70
Rate for Payer: Oxford Commercial	$19.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.25
Rate for Payer: UnitedHealthcare Commercial	$19.00
Rate for Payer: UnitedHealthcare Community & State	$3.00
Rate for Payer: Wellpoint Medicaid Managed Care	$2.70

OSMOLALITY, SERUM

Facility

$667.59

Service Code	HCPCS 83930
Hospital Charge Code	3002003
Hospital Revenue Code	301
Min. Negotiated Rate	$5.29
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$17.98
Rate for Payer: Aetna Medicare Advantage	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.98
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$6.61
Rate for Payer: Clover Medicare Advantage	$6.28
Rate for Payer: EmblemHealth Commercial	$19.83
Rate for Payer: Humana Medicare Advantage	$6.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.57
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$5.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.61
Rate for Payer: Wellcare Medicare Advantage	$6.61
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

OSMOLALITY, SERUM

Facility

$667.59

Service Code	HCPCS 83930
Hospital Charge Code	3002003
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

Know your out-of-pocket cost for care.

All Charges