Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CHLORAPREP ORNG TINT APPL 26ml

Facility

$778.75

Hospital Charge Code	270301990
Hospital Revenue Code	270
Min. Negotiated Rate	$116.81
Max. Negotiated Rate	$116.81
Rate for Payer: Qualcare PPO/HMO/WC	$116.81

CHLORASEPTIC LOZENGE

Facility

$4.00

Service Code	NDC 78112001106
Hospital Charge Code	606390542
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

CHLORASEPTIC LOZENGE

Facility

$4.00

Service Code	NDC 78112001106
Hospital Charge Code	606390542
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

CHLORDIAZEPOXIDE

Facility

$181.65

Service Code	HCPCS 80346
Hospital Charge Code	3031473
Hospital Revenue Code	301
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

CHLORDIAZEPOXIDE

Facility

$181.65

Service Code	HCPCS 80346
Hospital Charge Code	3031473
Hospital Revenue Code	301
Min. Negotiated Rate	$5.16
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$69.03
Rate for Payer: Aetna Medicare Advantage	$54.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.32
Rate for Payer: Cigna Commercial	$90.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.23
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.96
Rate for Payer: Wellpoint Medicaid Managed Care	$5.16

CHLORDIAZEPOXIDE 10 MG CAP

Facility

$4.15

Service Code	NDC 51079037520
Hospital Charge Code	60628590
Hospital Revenue Code	250
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$0.62
Rate for Payer: Qualcare PPO/HMO/WC	$0.62

CHLORDIAZEPOXIDE 10 MG CAP

Facility

$4.15

Service Code	NDC 51079037520
Hospital Charge Code	60628590
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.08
Rate for Payer: Aetna Commercial	$1.58
Rate for Payer: Aetna Medicare Advantage	$1.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.06
Rate for Payer: Cigna Commercial	$2.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.08
Rate for Payer: Oxford Commercial	$0.83
Rate for Payer: Qualcare PPO/HMO/WC	$0.62
Rate for Payer: UnitedHealthcare Commercial	$0.83
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

CHLORDIAZEPOXIDE 25 MG CAP

Facility

$4.49

Service Code	NDC 51079014120
Hospital Charge Code	60627840
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$1.71
Rate for Payer: Aetna Medicare Advantage	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.14
Rate for Payer: Cigna Commercial	$2.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.17
Rate for Payer: Oxford Commercial	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.67
Rate for Payer: UnitedHealthcare Commercial	$0.90
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

CHLORDIAZEPOXIDE 25 MG CAP

Facility

$4.49

Service Code	NDC 51079014120
Hospital Charge Code	60627840
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$0.67
Rate for Payer: Qualcare PPO/HMO/WC	$0.67

CHLORDIAZEPOXIDE 5 MG CAP

Facility

$5.43

Service Code	NDC 51079037420
Hospital Charge Code	60627841
Hospital Revenue Code	250
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$0.81
Rate for Payer: Qualcare PPO/HMO/WC	$0.81

CHLORDIAZEPOXIDE 5 MG CAP

Facility

$5.43

Service Code	NDC 51079037420
Hospital Charge Code	60627841
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$2.71
Rate for Payer: Aetna Commercial	$2.06
Rate for Payer: Aetna Medicare Advantage	$1.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.38
Rate for Payer: Cigna Commercial	$2.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.41
Rate for Payer: Oxford Commercial	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$0.81
Rate for Payer: UnitedHealthcare Commercial	$1.09
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

CHLORDIAZEPOXIDE HYDROCHLORI 1

Facility

$11.99

Service Code	NDC 68682040910
Hospital Charge Code	6063943188
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: Aetna Medicare Advantage	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.06
Rate for Payer: Cigna Commercial	$6.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.12
Rate for Payer: Oxford Commercial	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.80
Rate for Payer: UnitedHealthcare Commercial	$2.40
Rate for Payer: UnitedHealthcare Community & State	$0.38
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

CHLORDIAZEPOXIDE HYDROCHLORI 1

Facility

$11.99

Service Code	NDC 68682040910
Hospital Charge Code	6063943188
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

CHLORDIAZEPOXIDE (LIBRIUM)

Facility

$324.00

Service Code	HCPCS 80346
Hospital Charge Code	38472182
Hospital Revenue Code	301
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$123.12
Rate for Payer: Aetna Medicare Advantage	$97.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.62
Rate for Payer: Cigna Commercial	$162.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.24
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.96
Rate for Payer: Wellpoint Medicaid Managed Care	$9.20

CHLORDIAZEPOXIDE (LIBRIUM)

Facility

$324.00

Service Code	HCPCS 80346
Hospital Charge Code	38472182
Hospital Revenue Code	301
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

CHLORIDE,CSF

Facility

$120.00

Service Code	HCPCS 82438
Hospital Charge Code	38472191
Hospital Revenue Code	301
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.00

CHLORIDE,CSF

Facility

$120.00

Service Code	HCPCS 82438
Hospital Charge Code	38472191
Hospital Revenue Code	301
Min. Negotiated Rate	$3.41
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$13.60
Rate for Payer: Aetna Medicare Advantage	$16.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.14
Rate for Payer: Cigna Commercial	$60.00
Rate for Payer: Cigna Medicare Advantage	$5.00
Rate for Payer: Clover Medicare Advantage	$4.75
Rate for Payer: EmblemHealth Commercial	$15.00
Rate for Payer: Humana Medicare Advantage	$5.15
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.20
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.00
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.00
Rate for Payer: Wellcare Medicare Advantage	$5.00
Rate for Payer: Wellpoint Medicaid Managed Care	$3.41

CHLORIDE, SERUM

Facility

$390.00

Service Code	HCPCS 82435
Hospital Charge Code	3000742
Hospital Revenue Code	301
Min. Negotiated Rate	$3.68
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$12.51
Rate for Payer: Aetna Medicare Advantage	$14.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.69
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$4.60
Rate for Payer: Clover Medicare Advantage	$4.37
Rate for Payer: EmblemHealth Commercial	$13.80
Rate for Payer: Humana Medicare Advantage	$4.74
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.60
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	$3.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.60
Rate for Payer: Wellcare Medicare Advantage	$4.60
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

CHLORIDE, SERUM

Facility

$390.00

Service Code	HCPCS 82435
Hospital Charge Code	3000742
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CHLORIDE,SERUM

Facility

$119.00

Service Code	HCPCS 82435
Hospital Charge Code	38472185
Hospital Revenue Code	301
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$17.85
Rate for Payer: Qualcare PPO/HMO/WC	$17.85

CHLORIDE,SERUM

Facility

$119.00

Service Code	HCPCS 82435
Hospital Charge Code	38472185
Hospital Revenue Code	301
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$12.51
Rate for Payer: Aetna Medicare Advantage	$14.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.69
Rate for Payer: Cigna Commercial	$59.50
Rate for Payer: Cigna Medicare Advantage	$4.60
Rate for Payer: Clover Medicare Advantage	$4.37
Rate for Payer: EmblemHealth Commercial	$13.80
Rate for Payer: Humana Medicare Advantage	$4.74
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.94
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.85
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.60
Rate for Payer: Wellcare Medicare Advantage	$4.60
Rate for Payer: Wellpoint Medicaid Managed Care	$3.38

CHLORIDE,URINE

Facility

$107.00

Service Code	HCPCS 82436
Hospital Charge Code	38472188
Hospital Revenue Code	301
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$15.64
Rate for Payer: Aetna Medicare Advantage	$18.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.86
Rate for Payer: Cigna Commercial	$53.50
Rate for Payer: Cigna Medicare Advantage	$5.75
Rate for Payer: Clover Medicare Advantage	$5.46
Rate for Payer: EmblemHealth Commercial	$17.25
Rate for Payer: Humana Medicare Advantage	$5.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.82
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.05
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.75
Rate for Payer: Wellcare Medicare Advantage	$5.75
Rate for Payer: Wellpoint Medicaid Managed Care	$3.04

CHLORIDE,URINE

Facility

$107.00

Service Code	HCPCS 82436
Hospital Charge Code	38472188
Hospital Revenue Code	301
Min. Negotiated Rate	$16.05
Max. Negotiated Rate	$16.05
Rate for Payer: Qualcare PPO/HMO/WC	$16.05

CHLOROQUINE 500MG TAB

Facility

$116.25

Hospital Charge Code	6063943079
Hospital Revenue Code	250
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$58.12
Rate for Payer: Aetna Commercial	$44.17
Rate for Payer: Aetna Medicare Advantage	$34.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.64
Rate for Payer: Cigna Commercial	$58.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.23
Rate for Payer: Oxford Commercial	$23.25
Rate for Payer: Qualcare PPO/HMO/WC	$17.44
Rate for Payer: UnitedHealthcare Commercial	$23.25
Rate for Payer: UnitedHealthcare Community & State	$3.67
Rate for Payer: Wellpoint Medicaid Managed Care	$3.30

CHLOROQUINE 500MG TAB

Facility

$116.25

Hospital Charge Code	6063943079
Hospital Revenue Code	250
Min. Negotiated Rate	$17.44
Max. Negotiated Rate	$17.44
Rate for Payer: Qualcare PPO/HMO/WC	$17.44

Know your out-of-pocket cost for care.

All Charges