Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

OXYBUTYNIN XL 5MG TAB

Facility

$21.98

Service Code	NDC 378660501
Hospital Charge Code	606361015
Hospital Revenue Code	250
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$10.99
Rate for Payer: Aetna Commercial	$8.35
Rate for Payer: Aetna Medicare Advantage	$6.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.60
Rate for Payer: Cigna Commercial	$10.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.71
Rate for Payer: Oxford Commercial	$4.40
Rate for Payer: Qualcare PPO/HMO/WC	$3.30
Rate for Payer: UnitedHealthcare Commercial	$4.40
Rate for Payer: UnitedHealthcare Community & State	$0.69
Rate for Payer: Wellpoint Medicaid Managed Care	$0.62

OXYCODONE

Facility

$138.45

Service Code	HCPCS 80361
Hospital Charge Code	3009150
Hospital Revenue Code	301
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$52.61
Rate for Payer: Aetna Medicare Advantage	$41.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.30
Rate for Payer: Cigna Commercial	$69.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.00
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.77
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$22.05
Rate for Payer: Wellpoint Medicaid Managed Care	$3.93

OXYCODONE

Facility

$138.45

Service Code	HCPCS 80361
Hospital Charge Code	3009150
Hospital Revenue Code	301
Min. Negotiated Rate	$20.77
Max. Negotiated Rate	$20.77
Rate for Payer: Qualcare PPO/HMO/WC	$20.77

OXYCODONE 10 MG IR TAB

Facility

$4.22

Service Code	NDC 10702005601
Hospital Charge Code	60630058
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.11
Rate for Payer: Aetna Commercial	$1.60
Rate for Payer: Aetna Medicare Advantage	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.08
Rate for Payer: Cigna Commercial	$2.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.10
Rate for Payer: Oxford Commercial	$0.84
Rate for Payer: Qualcare PPO/HMO/WC	$0.63
Rate for Payer: UnitedHealthcare Commercial	$0.84
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

OXYCODONE 10 MG IR TAB

Facility

$4.22

Service Code	NDC 10702005601
Hospital Charge Code	60630058
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$0.63
Rate for Payer: Qualcare PPO/HMO/WC	$0.63

OXYCODONE 30 MG TAB

Facility

$24.05

Service Code	NDC 228287911
Hospital Charge Code	60630083
Hospital Revenue Code	250
Min. Negotiated Rate	$3.61
Max. Negotiated Rate	$3.61
Rate for Payer: Qualcare PPO/HMO/WC	$3.61

OXYCODONE 30 MG TAB

Facility

$24.05

Service Code	NDC 228287911
Hospital Charge Code	60630083
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$12.03
Rate for Payer: Aetna Commercial	$9.14
Rate for Payer: Aetna Medicare Advantage	$7.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.13
Rate for Payer: Cigna Commercial	$12.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.25
Rate for Payer: Oxford Commercial	$4.81
Rate for Payer: Qualcare PPO/HMO/WC	$3.61
Rate for Payer: UnitedHealthcare Commercial	$4.81
Rate for Payer: UnitedHealthcare Community & State	$0.76
Rate for Payer: Wellpoint Medicaid Managed Care	$0.68

OXYCODONE 5MG CAPSULE

Facility

$5.16

Service Code	NDC 54868393203
Hospital Charge Code	60629240
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$2.58
Rate for Payer: Aetna Commercial	$1.96
Rate for Payer: Aetna Medicare Advantage	$1.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.32
Rate for Payer: Cigna Commercial	$2.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.34
Rate for Payer: Oxford Commercial	$1.03
Rate for Payer: Qualcare PPO/HMO/WC	$0.77
Rate for Payer: UnitedHealthcare Commercial	$1.03
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

OXYCODONE 5MG CAPSULE

Facility

$5.16

Service Code	NDC 54868393203
Hospital Charge Code	60629240
Hospital Revenue Code	250
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$0.77
Rate for Payer: Qualcare PPO/HMO/WC	$0.77

OXYCODONE APAP 5MG/325MG

Facility

$69.75

Service Code	NDC 63481062370
Hospital Charge Code	6022057
Hospital Revenue Code	251
Min. Negotiated Rate	$10.46
Max. Negotiated Rate	$10.46
Rate for Payer: Qualcare PPO/HMO/WC	$10.46

OXYCODONE APAP 5MG/325MG

Facility

$69.75

Service Code	NDC 63481062370
Hospital Charge Code	6022057
Hospital Revenue Code	251
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$34.88
Rate for Payer: Aetna Commercial	$26.50
Rate for Payer: Aetna Medicare Advantage	$20.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.79
Rate for Payer: Cigna Commercial	$34.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.14
Rate for Payer: Oxford Commercial	$13.95
Rate for Payer: Qualcare PPO/HMO/WC	$10.46
Rate for Payer: UnitedHealthcare Commercial	$13.95
Rate for Payer: UnitedHealthcare Community & State	$2.20
Rate for Payer: Wellpoint Medicaid Managed Care	$1.98

OXYCODONE CONFIRM

Facility

$137.00

Service Code	HCPCS 80361
Hospital Charge Code	38478106
Hospital Revenue Code	301
Min. Negotiated Rate	$20.55
Max. Negotiated Rate	$20.55
Rate for Payer: Qualcare PPO/HMO/WC	$20.55

OXYCODONE CONFIRM

Facility

$137.00

Service Code	HCPCS 80361
Hospital Charge Code	38478106
Hospital Revenue Code	301
Min. Negotiated Rate	$3.89
Max. Negotiated Rate	$156.00
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) 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	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.55
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$22.05
Rate for Payer: Wellpoint Medicaid Managed Care	$3.89

OXYCODONE/METABOLITE QNT URINE

Facility

$390.00

Service Code	HCPCS 80365
Hospital Charge Code	401080365
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

OXYCODONE/METABOLITE QNT URINE

Facility

$390.00

Service Code	HCPCS 80365
Hospital Charge Code	401080365
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$22.05
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

OXYCODONE SCR AND CONF,UR

Facility

$499.75

Service Code	HCPCS 80301
Hospital Charge Code	39900314
Hospital Revenue Code	301
Min. Negotiated Rate	$74.96
Max. Negotiated Rate	$74.96
Rate for Payer: Qualcare PPO/HMO/WC	$74.96

OXYCODONE SCR AND CONF,UR

Facility

$499.75

Service Code	HCPCS 80301
Hospital Charge Code	39900314
Hospital Revenue Code	301
Min. Negotiated Rate	$14.19
Max. Negotiated Rate	$249.88
Rate for Payer: Aetna Commercial	$189.91
Rate for Payer: Aetna Medicare Advantage	$149.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.44
Rate for Payer: Cigna Commercial	$249.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.94
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$74.96
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$15.79
Rate for Payer: Wellpoint Medicaid Managed Care	$14.19

OXYCOD ONE SERUM (PERCODAN)

Facility

$291.00

Service Code	HCPCS 83295
Hospital Charge Code	38473114
Hospital Revenue Code	301
Min. Negotiated Rate	$43.65
Max. Negotiated Rate	$43.65
Rate for Payer: Qualcare PPO/HMO/WC	$43.65

OXYCOD ONE SERUM (PERCODAN)

Facility

$291.00

Service Code	HCPCS 83295
Hospital Charge Code	38473114
Hospital Revenue Code	301
Min. Negotiated Rate	$8.26
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$110.58
Rate for Payer: Aetna Medicare Advantage	$87.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.20
Rate for Payer: Cigna Commercial	$145.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.66
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.65
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.20
Rate for Payer: Wellpoint Medicaid Managed Care	$8.26

OXYCODONE TAB 80MG CR

Facility

$75.84

Service Code	NDC 59011048020
Hospital Charge Code	60629133
Hospital Revenue Code	250
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$37.92
Rate for Payer: Aetna Commercial	$28.82
Rate for Payer: Aetna Medicare Advantage	$22.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.34
Rate for Payer: Cigna Commercial	$37.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.72
Rate for Payer: Oxford Commercial	$15.17
Rate for Payer: Qualcare PPO/HMO/WC	$11.38
Rate for Payer: UnitedHealthcare Commercial	$15.17
Rate for Payer: UnitedHealthcare Community & State	$2.40
Rate for Payer: Wellpoint Medicaid Managed Care	$2.15

OXYCODONE TAB 80MG CR

Facility

$75.84

Service Code	NDC 59011048020
Hospital Charge Code	60629133
Hospital Revenue Code	250
Min. Negotiated Rate	$11.38
Max. Negotiated Rate	$11.38
Rate for Payer: Qualcare PPO/HMO/WC	$11.38

OXYCODONE TAB CR 10MG

Facility

$21.64

Service Code	NDC 59011041010
Hospital Charge Code	60628672
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$10.82
Rate for Payer: Aetna Commercial	$8.22
Rate for Payer: Aetna Medicare Advantage	$6.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.52
Rate for Payer: Cigna Commercial	$10.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.63
Rate for Payer: Oxford Commercial	$4.33
Rate for Payer: Qualcare PPO/HMO/WC	$3.25
Rate for Payer: UnitedHealthcare Commercial	$4.33
Rate for Payer: UnitedHealthcare Community & State	$0.68
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

OXYCODONE TAB CR 10MG

Facility

$21.64

Service Code	NDC 59011041010
Hospital Charge Code	60628672
Hospital Revenue Code	250
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$3.25
Rate for Payer: Qualcare PPO/HMO/WC	$3.25

OXYCODONE TAB CR 20MG

Facility

$40.33

Service Code	NDC 59011042010
Hospital Charge Code	60628673
Hospital Revenue Code	250
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$6.05
Rate for Payer: Qualcare PPO/HMO/WC	$6.05

OXYCODONE TAB CR 20MG

Facility

$40.33

Service Code	NDC 59011042010
Hospital Charge Code	60628673
Hospital Revenue Code	250
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$20.16
Rate for Payer: Aetna Commercial	$15.33
Rate for Payer: Aetna Medicare Advantage	$12.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.28
Rate for Payer: Cigna Commercial	$20.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.49
Rate for Payer: Oxford Commercial	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$6.05
Rate for Payer: UnitedHealthcare Commercial	$8.07
Rate for Payer: UnitedHealthcare Community & State	$1.27
Rate for Payer: Wellpoint Medicaid Managed Care	$1.15

Know your out-of-pocket cost for care.

All Charges