Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CHLOROQUINE PHOSPHATE 500 MG TAB

Facility

$36.18

Service Code	NDC 63304046126
Hospital Charge Code	6063943189
Hospital Revenue Code	250
Min. Negotiated Rate	$5.43
Max. Negotiated Rate	$5.43
Rate for Payer: Qualcare PPO/HMO/WC	$5.43

CHLOROQUINE PHOSPHATE 500 MG TAB

Facility

$36.18

Service Code	NDC 63304046126
Hospital Charge Code	6063943189
Hospital Revenue Code	250
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$18.09
Rate for Payer: Aetna Commercial	$13.75
Rate for Payer: Aetna Medicare Advantage	$10.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.23
Rate for Payer: Cigna Commercial	$18.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.41
Rate for Payer: Oxford Commercial	$7.24
Rate for Payer: Qualcare PPO/HMO/WC	$5.43
Rate for Payer: UnitedHealthcare Commercial	$7.24
Rate for Payer: UnitedHealthcare Community & State	$1.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1.03

CHLORPACIN WCS-90 2 GM

Facility

$25.25

Hospital Charge Code	60628353W
Hospital Revenue Code	250
Min. Negotiated Rate	$3.79
Max. Negotiated Rate	$3.79
Rate for Payer: Qualcare PPO/HMO/WC	$3.79

CHLORPACIN WCS-90 2 GM

Facility

$25.25

Hospital Charge Code	60628353W
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$12.62
Rate for Payer: Aetna Commercial	$9.60
Rate for Payer: Aetna Medicare Advantage	$7.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.44
Rate for Payer: Cigna Commercial	$12.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.57
Rate for Payer: Oxford Commercial	$5.05
Rate for Payer: Qualcare PPO/HMO/WC	$3.79
Rate for Payer: UnitedHealthcare Commercial	$5.05
Rate for Payer: UnitedHealthcare Community & State	$0.80
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

CHLORPROMAZINE 100 MG TAB

Facility

$149.01

Service Code	NDC 51079051620
Hospital Charge Code	60627787
Hospital Revenue Code	250
Min. Negotiated Rate	$4.23
Max. Negotiated Rate	$74.50
Rate for Payer: Aetna Commercial	$56.62
Rate for Payer: Aetna Medicare Advantage	$44.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.00
Rate for Payer: Cigna Commercial	$74.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.74
Rate for Payer: Oxford Commercial	$29.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.35
Rate for Payer: UnitedHealthcare Commercial	$29.80
Rate for Payer: UnitedHealthcare Community & State	$4.71
Rate for Payer: Wellpoint Medicaid Managed Care	$4.23

CHLORPROMAZINE 100 MG TAB

Facility

$149.01

Service Code	NDC 51079051620
Hospital Charge Code	60627787
Hospital Revenue Code	250
Min. Negotiated Rate	$22.35
Max. Negotiated Rate	$22.35
Rate for Payer: Qualcare PPO/HMO/WC	$22.35

CHLORPROMAZINE 10 MG TAB

Facility

$44.42

Service Code	HCPCS Q0161
Hospital Charge Code	60627789
Hospital Revenue Code	636
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$22.21
Rate for Payer: Aetna Commercial	$16.88
Rate for Payer: Aetna Medicare Advantage	$13.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.33
Rate for Payer: Cigna Commercial	$22.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.75
Rate for Payer: Qualcare PPO/HMO/WC	$6.66
Rate for Payer: UnitedHealthcare Community & State	$1.40
Rate for Payer: Wellpoint Medicaid Managed Care	$1.26

CHLORPROMAZINE 10 MG TAB

Facility

$44.42

Service Code	HCPCS Q0161
Hospital Charge Code	60627789
Hospital Revenue Code	636
Min. Negotiated Rate	$6.66
Max. Negotiated Rate	$10.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.75
Rate for Payer: Qualcare PPO/HMO/WC	$6.66

CHLORPROMAZINE 200MG TABLET

Facility

$177.68

Service Code	NDC 51079051720
Hospital Charge Code	60631237
Hospital Revenue Code	250
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$88.84
Rate for Payer: Aetna Commercial	$67.52
Rate for Payer: Aetna Medicare Advantage	$53.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.31
Rate for Payer: Cigna Commercial	$88.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.20
Rate for Payer: Oxford Commercial	$35.54
Rate for Payer: Qualcare PPO/HMO/WC	$26.65
Rate for Payer: UnitedHealthcare Commercial	$35.54
Rate for Payer: UnitedHealthcare Community & State	$5.61
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

CHLORPROMAZINE 200MG TABLET

Facility

$177.68

Service Code	NDC 51079051720
Hospital Charge Code	60631237
Hospital Revenue Code	250
Min. Negotiated Rate	$26.65
Max. Negotiated Rate	$26.65
Rate for Payer: Qualcare PPO/HMO/WC	$26.65

CHLORPROMAZINE 25 MG/ML INJ

Facility

$154.37

Service Code	HCPCS J3230
Hospital Charge Code	60627794
Hospital Revenue Code	636
Min. Negotiated Rate	$4.38
Max. Negotiated Rate	$77.19
Rate for Payer: Aetna Commercial	$58.66
Rate for Payer: Aetna Medicare Advantage	$46.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.36
Rate for Payer: Cigna Commercial	$77.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.36
Rate for Payer: Qualcare PPO/HMO/WC	$23.16
Rate for Payer: UnitedHealthcare Community & State	$4.88
Rate for Payer: Wellpoint Medicaid Managed Care	$4.38

CHLORPROMAZINE 25 MG/ML INJ

Facility

$154.37

Service Code	HCPCS J3230
Hospital Charge Code	60627794
Hospital Revenue Code	636
Min. Negotiated Rate	$23.16
Max. Negotiated Rate	$37.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.36
Rate for Payer: Qualcare PPO/HMO/WC	$23.16

CHLORPROMAZINE 25 MG TAB

Facility

$64.05

Service Code	HCPCS Q0161
Hospital Charge Code	60627791
Hospital Revenue Code	636
Min. Negotiated Rate	$9.61
Max. Negotiated Rate	$15.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.50
Rate for Payer: Qualcare PPO/HMO/WC	$9.61

CHLORPROMAZINE 25 MG TAB

Facility

$64.05

Service Code	HCPCS Q0161
Hospital Charge Code	60627791
Hospital Revenue Code	636
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$32.02
Rate for Payer: Aetna Commercial	$24.34
Rate for Payer: Aetna Medicare Advantage	$19.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.33
Rate for Payer: Cigna Commercial	$32.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.50
Rate for Payer: Qualcare PPO/HMO/WC	$9.61
Rate for Payer: UnitedHealthcare Community & State	$2.02
Rate for Payer: Wellpoint Medicaid Managed Care	$1.82

CHLORPROMAZINE 50 MG TAB

Facility

$92.66

Service Code	HCPCS Q0161
Hospital Charge Code	60627793
Hospital Revenue Code	636
Min. Negotiated Rate	$2.63
Max. Negotiated Rate	$46.33
Rate for Payer: Aetna Commercial	$35.21
Rate for Payer: Aetna Medicare Advantage	$27.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.63
Rate for Payer: Cigna Commercial	$46.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.42
Rate for Payer: Qualcare PPO/HMO/WC	$13.90
Rate for Payer: UnitedHealthcare Community & State	$2.93
Rate for Payer: Wellpoint Medicaid Managed Care	$2.63

CHLORPROMAZINE 50 MG TAB

Facility

$92.66

Service Code	HCPCS Q0161
Hospital Charge Code	60627793
Hospital Revenue Code	636
Min. Negotiated Rate	$13.90
Max. Negotiated Rate	$22.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.42
Rate for Payer: Qualcare PPO/HMO/WC	$13.90

CHLORPROMAZINE LEVEL

Facility

$67.25

Service Code	HCPCS 80342
Hospital Charge Code	3000776
Hospital Revenue Code	301
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$10.09
Rate for Payer: Qualcare PPO/HMO/WC	$10.09

CHLORPROMAZINE LEVEL

Facility

$67.25

Service Code	HCPCS 80342
Hospital Charge Code	3000776
Hospital Revenue Code	301
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$25.55
Rate for Payer: Aetna Medicare Advantage	$20.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.15
Rate for Payer: Cigna Commercial	$33.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.48
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.09
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$1.91

Chlorpronazine 50mg/2ml Inj

Facility

$176.88

Service Code	HCPCS J3230
Hospital Charge Code	60632688
Hospital Revenue Code	636
Min. Negotiated Rate	$26.53
Max. Negotiated Rate	$42.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.80
Rate for Payer: Qualcare PPO/HMO/WC	$26.53

Chlorpronazine 50mg/2ml Inj

Facility

$176.88

Service Code	HCPCS J3230
Hospital Charge Code	60632688
Hospital Revenue Code	636
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$88.44
Rate for Payer: Aetna Commercial	$67.21
Rate for Payer: Aetna Medicare Advantage	$53.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.10
Rate for Payer: Cigna Commercial	$88.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.80
Rate for Payer: Qualcare PPO/HMO/WC	$26.53
Rate for Payer: UnitedHealthcare Community & State	$5.59
Rate for Payer: Wellpoint Medicaid Managed Care	$5.02

CHLORTHALIDONE 25 MG TAB

Facility

$15.41

Service Code	NDC 51079005820
Hospital Charge Code	60627962
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.31

CHLORTHALIDONE 25 MG TAB

Facility

$15.41

Service Code	NDC 51079005820
Hospital Charge Code	60627962
Hospital Revenue Code	250
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$7.71
Rate for Payer: Aetna Commercial	$5.86
Rate for Payer: Aetna Medicare Advantage	$4.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.93
Rate for Payer: Cigna Commercial	$7.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.01
Rate for Payer: Oxford Commercial	$3.08
Rate for Payer: Qualcare PPO/HMO/WC	$2.31
Rate for Payer: UnitedHealthcare Commercial	$3.08
Rate for Payer: UnitedHealthcare Community & State	$0.49
Rate for Payer: Wellpoint Medicaid Managed Care	$0.44

CHLORTHALIDONE 50 MG TAB

Facility

$9.98

Service Code	NDC 378021301
Hospital Charge Code	60627963
Hospital Revenue Code	250
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$4.99
Rate for Payer: Aetna Commercial	$3.79
Rate for Payer: Aetna Medicare Advantage	$2.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.54
Rate for Payer: Cigna Commercial	$4.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.59
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.50
Rate for Payer: UnitedHealthcare Commercial	$2.00
Rate for Payer: UnitedHealthcare Community & State	$0.32
Rate for Payer: Wellpoint Medicaid Managed Care	$0.28

CHLORTHALIDONE 50 MG TAB

Facility

$9.98

Service Code	NDC 378021301
Hospital Charge Code	60627963
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.50

CH LUTEINIZING HORMONE

Facility

$390.00

Service Code	HCPCS 83002
Hospital Charge Code	397071055
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$50.37
Rate for Payer: Aetna Medicare Advantage	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.18
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$18.52
Rate for Payer: Clover Medicare Advantage	$17.59
Rate for Payer: EmblemHealth Commercial	$55.56
Rate for Payer: Humana Medicare Advantage	$19.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.52
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	$14.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.52
Rate for Payer: Wellcare Medicare Advantage	$18.52
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

Know your out-of-pocket cost for care.

All Charges