Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

OXAZEPAM

Facility

$127.15

Service Code	HCPCS 80346
Hospital Charge Code	39900445
Hospital Revenue Code	301
Min. Negotiated Rate	$19.07
Max. Negotiated Rate	$19.07
Rate for Payer: Qualcare PPO/HMO/WC	$19.07

OXCARBAZEPINE 150 MG TAB

Facility

$9.65

Service Code	NDC 51991029201
Hospital Charge Code	60629111
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

OXCARBAZEPINE 150 MG TAB

Facility

$9.65

Service Code	NDC 51991029201
Hospital Charge Code	60629111
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$3.67
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.51
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$1.93
Rate for Payer: UnitedHealthcare Community & State	$0.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

OXCARBAZEPINE 300 MG TAB

Facility

$17.62

Service Code	NDC 51991029301
Hospital Charge Code	60628978
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$8.81
Rate for Payer: Aetna Commercial	$6.70
Rate for Payer: Aetna Medicare Advantage	$5.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.49
Rate for Payer: Cigna Commercial	$8.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.58
Rate for Payer: Oxford Commercial	$3.52
Rate for Payer: Qualcare PPO/HMO/WC	$2.64
Rate for Payer: UnitedHealthcare Commercial	$3.52
Rate for Payer: UnitedHealthcare Community & State	$0.56
Rate for Payer: Wellpoint Medicaid Managed Care	$0.50

OXCARBAZEPINE 300 MG TAB

Facility

$17.62

Service Code	NDC 51991029301
Hospital Charge Code	60628978
Hospital Revenue Code	250
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$2.64
Rate for Payer: Qualcare PPO/HMO/WC	$2.64

OXCARBAZEPINE, DRUG QUANTITATI

Facility

$127.00

Service Code	HCPCS 83789
Hospital Charge Code	38472340
Hospital Revenue Code	301
Min. Negotiated Rate	$19.05
Max. Negotiated Rate	$19.05
Rate for Payer: Qualcare PPO/HMO/WC	$19.05

OXCARBAZEPINE, DRUG QUANTITATI

Facility

$127.00

Service Code	HCPCS 83789
Hospital Charge Code	38472340
Hospital Revenue Code	301
Min. Negotiated Rate	$3.61
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$65.58
Rate for Payer: Aetna Medicare Advantage	$78.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.46
Rate for Payer: Cigna Commercial	$63.50
Rate for Payer: Cigna Medicare Advantage	$24.11
Rate for Payer: Clover Medicare Advantage	$22.90
Rate for Payer: EmblemHealth Commercial	$72.33
Rate for Payer: Humana Medicare Advantage	$24.83
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.02
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.05
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$19.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.11
Rate for Payer: Wellcare Medicare Advantage	$24.11
Rate for Payer: Wellpoint Medicaid Managed Care	$3.61

OXCARBAZEPINE METABOLITE SERUM

Facility

$667.59

Service Code	HCPCS 80183
Hospital Charge Code	3036033
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

OXCARBAZEPINE METABOLITE SERUM

Facility

$667.59

Service Code	HCPCS 80183
Hospital Charge Code	3036033
Hospital Revenue Code	301
Min. Negotiated Rate	$10.60
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$36.04
Rate for Payer: Aetna Medicare Advantage	$42.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.06
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$13.25
Rate for Payer: Clover Medicare Advantage	$12.59
Rate for Payer: EmblemHealth Commercial	$39.75
Rate for Payer: Humana Medicare Advantage	$13.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.25
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	$10.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.25
Rate for Payer: Wellcare Medicare Advantage	$13.25
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

OXCARBEZEPINE 300 MG/5ML SUSPN

Facility

$36.58

Service Code	NDC 65162064978
Hospital Charge Code	606351007
Hospital Revenue Code	250
Min. Negotiated Rate	$5.49
Max. Negotiated Rate	$5.49
Rate for Payer: Qualcare PPO/HMO/WC	$5.49

OXCARBEZEPINE 300 MG/5ML SUSPN

Facility

$36.58

Service Code	NDC 65162064978
Hospital Charge Code	606351007
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$18.29
Rate for Payer: Aetna Commercial	$13.90
Rate for Payer: Aetna Medicare Advantage	$10.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.33
Rate for Payer: Cigna Commercial	$18.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.51
Rate for Payer: Oxford Commercial	$7.32
Rate for Payer: Qualcare PPO/HMO/WC	$5.49
Rate for Payer: UnitedHealthcare Commercial	$7.32
Rate for Payer: UnitedHealthcare Community & State	$1.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1.04

OXF ANAT BRG LT MD SIZE 4 PMA

Facility

$7,200.00

Service Code	HCPCS C1776
Hospital Charge Code	270665189
Hospital Revenue Code	278
Min. Negotiated Rate	$204.48
Max. Negotiated Rate	$3,600.00
Rate for Payer: Aetna Commercial	$2,736.00
Rate for Payer: Aetna Medicare Advantage	$2,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,836.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,836.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,440.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,836.00
Rate for Payer: Cigna Commercial	$3,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,742.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,080.00
Rate for Payer: UnitedHealthcare Community & State	$227.52
Rate for Payer: Wellpoint Medicaid Managed Care	$204.48

OXF ANAT BRG LT MD SIZE 4 PMA

Facility

$7,200.00

Service Code	HCPCS C1776
Hospital Charge Code	270665189
Hospital Revenue Code	278
Min. Negotiated Rate	$1,080.00
Max. Negotiated Rate	$1,742.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,440.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,742.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,080.00

OXF SAWBLADE STRYKER CMNTD 3PK

Facility

$2,625.00

Hospital Charge Code	270684057
Hospital Revenue Code	272
Min. Negotiated Rate	$393.75
Max. Negotiated Rate	$393.75
Rate for Payer: Qualcare PPO/HMO/WC	$393.75

OXF SAWBLADE STRYKER CMNTD 3PK

Facility

$2,625.00

Hospital Charge Code	270684057
Hospital Revenue Code	272
Min. Negotiated Rate	$74.55
Max. Negotiated Rate	$1,312.50
Rate for Payer: Aetna Commercial	$997.50
Rate for Payer: Aetna Medicare Advantage	$787.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$669.38
Rate for Payer: Cigna Commercial	$1,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$682.50
Rate for Payer: Oxford Commercial	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$393.75
Rate for Payer: UnitedHealthcare Commercial	$525.00
Rate for Payer: UnitedHealthcare Community & State	$82.95
Rate for Payer: Wellpoint Medicaid Managed Care	$74.55

OXF TWIN PEG CMNTD FEM MD PMA

Facility

$14,100.00

Service Code	HCPCS C1776
Hospital Charge Code	270665188
Hospital Revenue Code	278
Min. Negotiated Rate	$2,115.00
Max. Negotiated Rate	$3,412.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,820.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,412.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,115.00

OXF TWIN PEG CMNTD FEM MD PMA

Facility

$14,100.00

Service Code	HCPCS C1776
Hospital Charge Code	270665188
Hospital Revenue Code	278
Min. Negotiated Rate	$400.44
Max. Negotiated Rate	$7,050.00
Rate for Payer: Aetna Commercial	$5,358.00
Rate for Payer: Aetna Medicare Advantage	$4,230.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,595.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,595.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,820.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,595.50
Rate for Payer: Cigna Commercial	$7,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,412.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,115.00
Rate for Payer: UnitedHealthcare Community & State	$445.56
Rate for Payer: Wellpoint Medicaid Managed Care	$400.44

OXF UNI TIB TRAY SZA RM/LL PMA

Facility

$9,900.00

Service Code	HCPCS C1776
Hospital Charge Code	270684056
Hospital Revenue Code	278
Min. Negotiated Rate	$1,485.00
Max. Negotiated Rate	$2,395.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,980.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,395.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,485.00

OXF UNI TIB TRAY SZA RM/LL PMA

Facility

$9,900.00

Service Code	HCPCS C1776
Hospital Charge Code	270684056
Hospital Revenue Code	278
Min. Negotiated Rate	$281.16
Max. Negotiated Rate	$4,950.00
Rate for Payer: Aetna Commercial	$3,762.00
Rate for Payer: Aetna Medicare Advantage	$2,970.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,524.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,524.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,524.50
Rate for Payer: Cigna Commercial	$4,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,395.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,485.00
Rate for Payer: UnitedHealthcare Community & State	$312.84
Rate for Payer: Wellpoint Medicaid Managed Care	$281.16

OXIDIZED CELLULOSE ABSORB HEMS

Facility

$98.50

Hospital Charge Code	60628454R
Hospital Revenue Code	250
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$49.25
Rate for Payer: Aetna Commercial	$37.43
Rate for Payer: Aetna Medicare Advantage	$29.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.12
Rate for Payer: Cigna Commercial	$49.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.61
Rate for Payer: Oxford Commercial	$19.70
Rate for Payer: Qualcare PPO/HMO/WC	$14.78
Rate for Payer: UnitedHealthcare Commercial	$19.70
Rate for Payer: UnitedHealthcare Community & State	$3.11
Rate for Payer: Wellpoint Medicaid Managed Care	$2.80

OXIDIZED CELLULOSE ABSORB HEMS

Facility

$98.50

Hospital Charge Code	60628454R
Hospital Revenue Code	250
Min. Negotiated Rate	$14.78
Max. Negotiated Rate	$14.78
Rate for Payer: Qualcare PPO/HMO/WC	$14.78

OXIDIZED CELLULOSE ABSORB HEMS

Facility

$341.50

Service Code	NDC 8290375846
Hospital Charge Code	60628454
Hospital Revenue Code	250
Min. Negotiated Rate	$51.23
Max. Negotiated Rate	$51.23
Rate for Payer: Qualcare PPO/HMO/WC	$51.23

OXIDIZED CELLULOSE ABSORB HEMS

Facility

$341.50

Service Code	NDC 8290375846
Hospital Charge Code	60628454
Hospital Revenue Code	250
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$170.75
Rate for Payer: Aetna Commercial	$129.77
Rate for Payer: Aetna Medicare Advantage	$102.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.08
Rate for Payer: Cigna Commercial	$170.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.79
Rate for Payer: Oxford Commercial	$68.30
Rate for Payer: Qualcare PPO/HMO/WC	$51.23
Rate for Payer: UnitedHealthcare Commercial	$68.30
Rate for Payer: UnitedHealthcare Community & State	$10.79
Rate for Payer: Wellpoint Medicaid Managed Care	$9.70

OXISENSOR ADULT DISP

Facility

$51.04

Hospital Charge Code	270649181
Hospital Revenue Code	272
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$25.52
Rate for Payer: Aetna Commercial	$19.40
Rate for Payer: Aetna Medicare Advantage	$15.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.02
Rate for Payer: Cigna Commercial	$25.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.27
Rate for Payer: Oxford Commercial	$10.21
Rate for Payer: Qualcare PPO/HMO/WC	$7.66
Rate for Payer: UnitedHealthcare Commercial	$10.21
Rate for Payer: UnitedHealthcare Community & State	$1.61
Rate for Payer: Wellpoint Medicaid Managed Care	$1.45

OXISENSOR ADULT DISP

Facility

$51.04

Hospital Charge Code	270649181
Hospital Revenue Code	272
Min. Negotiated Rate	$7.66
Max. Negotiated Rate	$7.66
Rate for Payer: Qualcare PPO/HMO/WC	$7.66

Know your out-of-pocket cost for care.

All Charges