Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CLNSCPY FLX W REM LESN BY SNA

Facility

$8,878.50

Service Code	HCPCS 45385
Hospital Charge Code	16000274
Hospital Revenue Code	360
Min. Negotiated Rate	$252.15
Max. Negotiated Rate	$5,347.00
Rate for Payer: Aetna Commercial	$3,866.86
Rate for Payer: Aetna Medicare Advantage	$4,606.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,157.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,157.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,421.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,157.00
Rate for Payer: Cigna Commercial	$2,849.67
Rate for Payer: Cigna Medicare Advantage	$1,421.64
Rate for Payer: Clover Medicare Advantage	$1,350.56
Rate for Payer: EmblemHealth Commercial	$4,264.92
Rate for Payer: Humana Medicare Advantage	$1,464.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,421.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,308.41
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,331.78
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$280.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,421.64
Rate for Payer: Wellcare Medicare Advantage	$1,421.64
Rate for Payer: Wellpoint Medicaid Managed Care	$252.15

CLN SURG OV NP COMPLEX

Facility

$1,003.00

Service Code	HCPCS 99205
Hospital Charge Code	75190195
Hospital Revenue Code	510
Min. Negotiated Rate	$28.49
Max. Negotiated Rate	$501.50
Rate for Payer: Aetna Commercial	$381.14
Rate for Payer: Aetna Medicare Advantage	$300.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.76
Rate for Payer: Cigna Commercial	$501.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.78
Rate for Payer: Qualcare PPO/HMO/WC	$150.45
Rate for Payer: UnitedHealthcare Community & State	$31.69
Rate for Payer: Wellpoint Medicaid Managed Care	$28.49

CLN SURG OV NP COMPLEX

Facility

$1,003.00

Service Code	HCPCS 99205
Hospital Charge Code	75190195
Hospital Revenue Code	510
Min. Negotiated Rate	$150.45
Max. Negotiated Rate	$150.45
Rate for Payer: Qualcare PPO/HMO/WC	$150.45

CLN SURG OV NP COMPREHENSIVE

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	75190190
Hospital Revenue Code	510
Min. Negotiated Rate	$160.23
Max. Negotiated Rate	$160.23
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

CLN SURG OV NP COMPREHENSIVE

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	75190190
Hospital Revenue Code	510
Min. Negotiated Rate	$30.34
Max. Negotiated Rate	$534.10
Rate for Payer: Aetna Commercial	$405.92
Rate for Payer: Aetna Medicare Advantage	$320.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.39
Rate for Payer: Cigna Commercial	$534.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$277.73
Rate for Payer: Qualcare PPO/HMO/WC	$160.23
Rate for Payer: UnitedHealthcare Community & State	$33.76
Rate for Payer: Wellpoint Medicaid Managed Care	$30.34

CLN SURG OV NP DETAILED

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	75190185
Hospital Revenue Code	510
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

CLN SURG OV NP DETAILED

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	75190185
Hospital Revenue Code	510
Min. Negotiated Rate	$23.54
Max. Negotiated Rate	$414.40
Rate for Payer: Aetna Commercial	$314.94
Rate for Payer: Aetna Medicare Advantage	$248.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.34
Rate for Payer: Cigna Commercial	$414.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.49
Rate for Payer: Qualcare PPO/HMO/WC	$124.32
Rate for Payer: UnitedHealthcare Community & State	$26.19
Rate for Payer: Wellpoint Medicaid Managed Care	$23.54

CLOBETASOL 0.05% CREAM 30G

Facility

$1,718.28

Service Code	NDC 54569455000
Hospital Charge Code	60629135
Hospital Revenue Code	250
Min. Negotiated Rate	$48.80
Max. Negotiated Rate	$859.14
Rate for Payer: Aetna Commercial	$652.95
Rate for Payer: Aetna Medicare Advantage	$515.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$438.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$438.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$438.16
Rate for Payer: Cigna Commercial	$859.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$446.75
Rate for Payer: Oxford Commercial	$343.66
Rate for Payer: Qualcare PPO/HMO/WC	$257.74
Rate for Payer: UnitedHealthcare Commercial	$343.66
Rate for Payer: UnitedHealthcare Community & State	$54.30
Rate for Payer: Wellpoint Medicaid Managed Care	$48.80

CLOBETASOL 0.05% CREAM 30G

Facility

$1,718.28

Service Code	NDC 54569455000
Hospital Charge Code	60629135
Hospital Revenue Code	250
Min. Negotiated Rate	$257.74
Max. Negotiated Rate	$257.74
Rate for Payer: Qualcare PPO/HMO/WC	$257.74

CLOBETASOL PROP 0.05% CR 15GM

Facility

$859.14

Service Code	NDC 51672125801
Hospital Charge Code	6023413
Hospital Revenue Code	250
Min. Negotiated Rate	$128.87
Max. Negotiated Rate	$128.87
Rate for Payer: Qualcare PPO/HMO/WC	$128.87

CLOBETASOL PROP 0.05% CR 15GM

Facility

$859.14

Service Code	NDC 51672125801
Hospital Charge Code	6023413
Hospital Revenue Code	250
Min. Negotiated Rate	$24.40
Max. Negotiated Rate	$429.57
Rate for Payer: Aetna Commercial	$326.47
Rate for Payer: Aetna Medicare Advantage	$257.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$219.08
Rate for Payer: Cigna Commercial	$429.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.38
Rate for Payer: Oxford Commercial	$171.83
Rate for Payer: Qualcare PPO/HMO/WC	$128.87
Rate for Payer: UnitedHealthcare Commercial	$171.83
Rate for Payer: UnitedHealthcare Community & State	$27.15
Rate for Payer: Wellpoint Medicaid Managed Care	$24.40

CLOBETASOL PROP CRM .05% 60GM

Facility

$3,075.03

Service Code	NDC 69238153206
Hospital Charge Code	606390496
Hospital Revenue Code	250
Min. Negotiated Rate	$461.25
Max. Negotiated Rate	$461.25
Rate for Payer: Qualcare PPO/HMO/WC	$461.25

CLOBETASOL PROP CRM .05% 60GM

Facility

$3,075.03

Service Code	NDC 69238153206
Hospital Charge Code	606390496
Hospital Revenue Code	250
Min. Negotiated Rate	$87.33
Max. Negotiated Rate	$1,537.52
Rate for Payer: Aetna Commercial	$1,168.51
Rate for Payer: Aetna Medicare Advantage	$922.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$784.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$784.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$784.13
Rate for Payer: Cigna Commercial	$1,537.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$799.51
Rate for Payer: Oxford Commercial	$615.01
Rate for Payer: Qualcare PPO/HMO/WC	$461.25
Rate for Payer: UnitedHealthcare Commercial	$615.01
Rate for Payer: UnitedHealthcare Community & State	$97.17
Rate for Payer: Wellpoint Medicaid Managed Care	$87.33

CLOBETASOL PROPIONATE .05% 30G

Facility

$1,740.33

Service Code	NDC 50383026830
Hospital Charge Code	6008643
Hospital Revenue Code	250
Min. Negotiated Rate	$49.43
Max. Negotiated Rate	$870.16
Rate for Payer: Aetna Commercial	$661.33
Rate for Payer: Aetna Medicare Advantage	$522.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$443.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$443.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$443.78
Rate for Payer: Cigna Commercial	$870.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$452.49
Rate for Payer: Oxford Commercial	$348.07
Rate for Payer: Qualcare PPO/HMO/WC	$261.05
Rate for Payer: UnitedHealthcare Commercial	$348.07
Rate for Payer: UnitedHealthcare Community & State	$54.99
Rate for Payer: Wellpoint Medicaid Managed Care	$49.43

CLOBETASOL PROPIONATE .05% 30G

Facility

$1,740.33

Service Code	NDC 50383026830
Hospital Charge Code	6008643
Hospital Revenue Code	250
Min. Negotiated Rate	$261.05
Max. Negotiated Rate	$261.05
Rate for Payer: Qualcare PPO/HMO/WC	$261.05

CLOMIPRAMINE 25 MG CAP

Facility

$75.31

Service Code	NDC 51672401106
Hospital Charge Code	60628595
Hospital Revenue Code	250
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$37.66
Rate for Payer: Aetna Commercial	$28.62
Rate for Payer: Aetna Medicare Advantage	$22.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.20
Rate for Payer: Cigna Commercial	$37.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.58
Rate for Payer: Oxford Commercial	$15.06
Rate for Payer: Qualcare PPO/HMO/WC	$11.30
Rate for Payer: UnitedHealthcare Commercial	$15.06
Rate for Payer: UnitedHealthcare Community & State	$2.38
Rate for Payer: Wellpoint Medicaid Managed Care	$2.14

CLOMIPRAMINE 25 MG CAP

Facility

$75.31

Service Code	NDC 51672401106
Hospital Charge Code	60628595
Hospital Revenue Code	250
Min. Negotiated Rate	$11.30
Max. Negotiated Rate	$11.30
Rate for Payer: Qualcare PPO/HMO/WC	$11.30

CLOMIPRAMINE 50MG CAPSULE

Facility

$75.31

Service Code	NDC 51672401206
Hospital Charge Code	606390170
Hospital Revenue Code	250
Min. Negotiated Rate	$11.30
Max. Negotiated Rate	$11.30
Rate for Payer: Qualcare PPO/HMO/WC	$11.30

CLOMIPRAMINE 50MG CAPSULE

Facility

$75.31

Service Code	NDC 51672401206
Hospital Charge Code	606390170
Hospital Revenue Code	250
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$37.66
Rate for Payer: Aetna Commercial	$28.62
Rate for Payer: Aetna Medicare Advantage	$22.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.20
Rate for Payer: Cigna Commercial	$37.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.58
Rate for Payer: Oxford Commercial	$15.06
Rate for Payer: Qualcare PPO/HMO/WC	$11.30
Rate for Payer: UnitedHealthcare Commercial	$15.06
Rate for Payer: UnitedHealthcare Community & State	$2.38
Rate for Payer: Wellpoint Medicaid Managed Care	$2.14

CLOMIPRAMINE & NORCLOM

Facility

$245.00

Service Code	HCPCS 83789
Hospital Charge Code	38472934
Hospital Revenue Code	301
Min. Negotiated Rate	$6.96
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	$122.50
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	$63.70
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.75
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	$6.96

CLOMIPRAMINE & NORCLOM

Facility

$245.00

Service Code	HCPCS 83789
Hospital Charge Code	38472934
Hospital Revenue Code	301
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$36.75
Rate for Payer: Qualcare PPO/HMO/WC	$36.75

CLONAZEPAM

Facility

$572.15

Service Code	HCPCS 80346
Hospital Charge Code	3038541
Hospital Revenue Code	301
Min. Negotiated Rate	$16.25
Max. Negotiated Rate	$286.07
Rate for Payer: Aetna Commercial	$217.42
Rate for Payer: Aetna Medicare Advantage	$171.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$145.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$145.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$145.90
Rate for Payer: Cigna Commercial	$286.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$148.76
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$85.82
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.96
Rate for Payer: Wellpoint Medicaid Managed Care	$16.25

CLONAZEPAM

Facility

$572.15

Service Code	HCPCS 80346
Hospital Charge Code	3038541
Hospital Revenue Code	301
Min. Negotiated Rate	$85.82
Max. Negotiated Rate	$85.82
Rate for Payer: Qualcare PPO/HMO/WC	$85.82

CLONAZEPAM 0.25MG TABRAPIDDSLV

Facility

$8.71

Service Code	NDC 49884030702
Hospital Charge Code	606390376
Hospital Revenue Code	250
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$1.31
Rate for Payer: Qualcare PPO/HMO/WC	$1.31

CLONAZEPAM 0.25MG TABRAPIDDSLV

Facility

$8.71

Service Code	NDC 49884030702
Hospital Charge Code	606390376
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$4.36
Rate for Payer: Aetna Commercial	$3.31
Rate for Payer: Aetna Medicare Advantage	$2.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.22
Rate for Payer: Cigna Commercial	$4.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.26
Rate for Payer: Oxford Commercial	$1.74
Rate for Payer: Qualcare PPO/HMO/WC	$1.31
Rate for Payer: UnitedHealthcare Commercial	$1.74
Rate for Payer: UnitedHealthcare Community & State	$0.28
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

Know your out-of-pocket cost for care.

All Charges