Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

OXYCODONE URINE

Facility

$137.00

Service Code	HCPCS 80361
Hospital Charge Code	38478098
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 URINE

Facility

$137.00

Service Code	HCPCS 80361
Hospital Charge Code	38478098
Hospital Revenue Code	301
Min. Negotiated Rate	$20.55
Max. Negotiated Rate	$20.55
Rate for Payer: Qualcare PPO/HMO/WC	$20.55

OXYCONTIN 40 MG TAB U/D

Facility

$70.89

Service Code	NDC 59011044020
Hospital Charge Code	60635312
Hospital Revenue Code	250
Min. Negotiated Rate	$10.63
Max. Negotiated Rate	$10.63
Rate for Payer: Qualcare PPO/HMO/WC	$10.63

OXYCONTIN 40 MG TAB U/D

Facility

$70.89

Service Code	NDC 59011044020
Hospital Charge Code	60635312
Hospital Revenue Code	250
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$35.45
Rate for Payer: Aetna Commercial	$26.94
Rate for Payer: Aetna Medicare Advantage	$21.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.08
Rate for Payer: Cigna Commercial	$35.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.43
Rate for Payer: Oxford Commercial	$14.18
Rate for Payer: Qualcare PPO/HMO/WC	$10.63
Rate for Payer: UnitedHealthcare Commercial	$14.18
Rate for Payer: UnitedHealthcare Community & State	$2.24
Rate for Payer: Wellpoint Medicaid Managed Care	$2.01

OXYGEN SUPPLY

Facility

$450.00

Hospital Charge Code	270339090
Hospital Revenue Code	272
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

OXYGEN SUPPLY

Facility

$450.00

Hospital Charge Code	270339090
Hospital Revenue Code	272
Min. Negotiated Rate	$12.78
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$171.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Commercial	$90.00
Rate for Payer: UnitedHealthcare Community & State	$14.22
Rate for Payer: Wellpoint Medicaid Managed Care	$12.78

OXYGEN U.S.P.

Facility

$3,429.11

Hospital Charge Code	270616668
Hospital Revenue Code	270
Min. Negotiated Rate	$514.37
Max. Negotiated Rate	$514.37
Rate for Payer: Qualcare PPO/HMO/WC	$514.37

OXYGEN U.S.P.

Facility

$3,429.11

Hospital Charge Code	270616668
Hospital Revenue Code	270
Min. Negotiated Rate	$97.39
Max. Negotiated Rate	$1,714.56
Rate for Payer: Aetna Commercial	$1,303.06
Rate for Payer: Aetna Medicare Advantage	$1,028.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$874.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$874.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$874.42
Rate for Payer: Cigna Commercial	$1,714.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$891.57
Rate for Payer: Oxford Commercial	$685.82
Rate for Payer: Qualcare PPO/HMO/WC	$514.37
Rate for Payer: UnitedHealthcare Commercial	$685.82
Rate for Payer: UnitedHealthcare Community & State	$108.36
Rate for Payer: Wellpoint Medicaid Managed Care	$97.39

OXYMETAZOLINE NSL SPR 0.05%

Facility

$26.73

Service Code	NDC 45802041059
Hospital Charge Code	60628076
Hospital Revenue Code	250
Min. Negotiated Rate	$4.01
Max. Negotiated Rate	$4.01
Rate for Payer: Qualcare PPO/HMO/WC	$4.01

OXYMETAZOLINE NSL SPR 0.05%

Facility

$26.73

Service Code	NDC 45802041059
Hospital Charge Code	60628076
Hospital Revenue Code	250
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$13.37
Rate for Payer: Aetna Commercial	$10.16
Rate for Payer: Aetna Medicare Advantage	$8.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.82
Rate for Payer: Cigna Commercial	$13.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.95
Rate for Payer: Oxford Commercial	$5.35
Rate for Payer: Qualcare PPO/HMO/WC	$4.01
Rate for Payer: UnitedHealthcare Commercial	$5.35
Rate for Payer: UnitedHealthcare Community & State	$0.84
Rate for Payer: Wellpoint Medicaid Managed Care	$0.76

OXYTOCIN 10 UNITS/ML INJ

Facility

$7.24

Service Code	HCPCS J2590
Hospital Charge Code	60628284
Hospital Revenue Code	636
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.75
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

OXYTOCIN 10 UNITS/ML INJ

Facility

$7.24

Service Code	HCPCS J2590
Hospital Charge Code	60628284
Hospital Revenue Code	636
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$3.62
Rate for Payer: Aetna Commercial	$2.75
Rate for Payer: Aetna Medicare Advantage	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.85
Rate for Payer: Cigna Commercial	$3.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.75
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

OXYTOCIN 30 U 0.9 SOD CHL NS

Facility

$72.29

Service Code	HCPCS J2590
Hospital Charge Code	606350996
Hospital Revenue Code	636
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$36.15
Rate for Payer: Aetna Commercial	$27.47
Rate for Payer: Aetna Medicare Advantage	$21.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.43
Rate for Payer: Cigna Commercial	$36.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.49
Rate for Payer: Qualcare PPO/HMO/WC	$10.84
Rate for Payer: UnitedHealthcare Community & State	$2.28
Rate for Payer: Wellpoint Medicaid Managed Care	$2.05

OXYTOCIN 30 U 0.9 SOD CHL NS

Facility

$72.29

Service Code	HCPCS J2590
Hospital Charge Code	606350996
Hospital Revenue Code	636
Min. Negotiated Rate	$10.84
Max. Negotiated Rate	$17.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.49
Rate for Payer: Qualcare PPO/HMO/WC	$10.84

OXYTOCIN 30U IN 500ML OF LR

Facility

$115.51

Service Code	HCPCS J2590
Hospital Charge Code	606361022
Hospital Revenue Code	636
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$57.76
Rate for Payer: Aetna Commercial	$43.89
Rate for Payer: Aetna Medicare Advantage	$34.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.46
Rate for Payer: Cigna Commercial	$57.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.95
Rate for Payer: Qualcare PPO/HMO/WC	$17.33
Rate for Payer: UnitedHealthcare Community & State	$3.65
Rate for Payer: Wellpoint Medicaid Managed Care	$3.28

OXYTOCIN 30U IN 500ML OF LR

Facility

$115.51

Service Code	HCPCS J2590
Hospital Charge Code	606361022
Hospital Revenue Code	636
Min. Negotiated Rate	$17.33
Max. Negotiated Rate	$27.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.95
Rate for Payer: Qualcare PPO/HMO/WC	$17.33

OXYTOCIN CHALLENGE TEST

Facility

$669.00

Service Code	HCPCS 59020
Hospital Charge Code	83653010
Hospital Revenue Code	720
Min. Negotiated Rate	$100.35
Max. Negotiated Rate	$100.35
Rate for Payer: Qualcare PPO/HMO/WC	$100.35

OXYTOCIN CHALLENGE TEST

Facility

$669.00

Service Code	HCPCS 59020
Hospital Charge Code	83653010
Hospital Revenue Code	720
Min. Negotiated Rate	$19.00
Max. Negotiated Rate	$4,601.00
Rate for Payer: Aetna Commercial	$653.29
Rate for Payer: Aetna Medicare Advantage	$778.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$871.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$871.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$240.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$43.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$871.25
Rate for Payer: Cigna Commercial	$481.45
Rate for Payer: Cigna Medicare Advantage	$240.18
Rate for Payer: Clover Medicare Advantage	$228.17
Rate for Payer: EmblemHealth Commercial	$720.54
Rate for Payer: Humana Medicare Advantage	$247.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$240.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.94
Rate for Payer: Oxford Commercial	$4,053.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.35
Rate for Payer: UnitedHealthcare Commercial	$4,601.00
Rate for Payer: UnitedHealthcare Community & State	$21.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$240.18
Rate for Payer: Wellcare Medicare Advantage	$240.18
Rate for Payer: Wellpoint Medicaid Managed Care	$19.00

OYSTER IGE

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	401186003I
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

OYSTER IGE

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	401186003I
Hospital Revenue Code	302
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$14.20
Rate for Payer: Aetna Medicare Advantage	$16.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.94
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.22
Rate for Payer: Clover Medicare Advantage	$4.96
Rate for Payer: EmblemHealth Commercial	$15.66
Rate for Payer: Humana Medicare Advantage	$5.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.22
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	$4.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.22
Rate for Payer: Wellcare Medicare Advantage	$5.22
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

P16 IHC

Facility

$2,164.00

Service Code	HCPCS 88342
Hospital Charge Code	4016883429
Hospital Revenue Code	310
Min. Negotiated Rate	$324.60
Max. Negotiated Rate	$324.60
Rate for Payer: Qualcare PPO/HMO/WC	$324.60

P16 IHC

Facility

$2,164.00

Service Code	HCPCS 88342
Hospital Charge Code	4016883429
Hospital Revenue Code	310
Min. Negotiated Rate	$61.46
Max. Negotiated Rate	$734.21
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$734.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$734.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$734.21
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$562.64
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$324.60
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$86.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$61.46

P2Y12 PLATELET FUNCTION

Facility

$390.00

Service Code	HCPCS 85576
Hospital Charge Code	5100833
Hospital Revenue Code	305
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$67.76
Rate for Payer: Aetna Medicare Advantage	$80.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$90.36
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$24.91
Rate for Payer: Clover Medicare Advantage	$23.66
Rate for Payer: EmblemHealth Commercial	$74.73
Rate for Payer: Humana Medicare Advantage	$25.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.91
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	$19.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.91
Rate for Payer: Wellcare Medicare Advantage	$24.91
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

P2Y12 PLATELET FUNCTION

Facility

$390.00

Service Code	HCPCS 85576
Hospital Charge Code	411085576
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

P2Y12 PLATELET FUNCTION

Facility

$390.00

Service Code	HCPCS 85576
Hospital Charge Code	411085576
Hospital Revenue Code	305
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$67.76
Rate for Payer: Aetna Medicare Advantage	$80.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$90.36
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$24.91
Rate for Payer: Clover Medicare Advantage	$23.66
Rate for Payer: EmblemHealth Commercial	$74.73
Rate for Payer: Humana Medicare Advantage	$25.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.91
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	$19.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.91
Rate for Payer: Wellcare Medicare Advantage	$24.91
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

Know your out-of-pocket cost for care.

All Charges