Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CLOPIDOGREL 75 MG TAB

Facility

$26.80

Service Code	NDC 63653117103
Hospital Charge Code	60629140
Hospital Revenue Code	250
Min. Negotiated Rate	$4.02
Max. Negotiated Rate	$4.02
Rate for Payer: Qualcare PPO/HMO/WC	$4.02

CLORAZEPATE 3.75MG TAB

Facility

$13.60

Service Code	NDC 13107031901
Hospital Charge Code	6063943085
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$6.80
Rate for Payer: Aetna Commercial	$5.17
Rate for Payer: Aetna Medicare Advantage	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.47
Rate for Payer: Cigna Commercial	$6.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.54
Rate for Payer: Oxford Commercial	$2.72
Rate for Payer: Qualcare PPO/HMO/WC	$2.04
Rate for Payer: UnitedHealthcare Commercial	$2.72
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.39

CLORAZEPATE 3.75MG TAB

Facility

$13.60

Service Code	NDC 13107031901
Hospital Charge Code	6063943085
Hospital Revenue Code	250
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$2.04
Rate for Payer: Qualcare PPO/HMO/WC	$2.04

CLORTRIMAZOLE 1% CREAM 15 GM

Facility

$40.13

Service Code	NDC 45802043401
Hospital Charge Code	606351009
Hospital Revenue Code	250
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$20.07
Rate for Payer: Aetna Commercial	$15.25
Rate for Payer: Aetna Medicare Advantage	$12.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.23
Rate for Payer: Cigna Commercial	$20.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.43
Rate for Payer: Oxford Commercial	$8.03
Rate for Payer: Qualcare PPO/HMO/WC	$6.02
Rate for Payer: UnitedHealthcare Commercial	$8.03
Rate for Payer: UnitedHealthcare Community & State	$1.27
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

CLORTRIMAZOLE 1% CREAM 15 GM

Facility

$40.13

Service Code	NDC 45802043401
Hospital Charge Code	606351009
Hospital Revenue Code	250
Min. Negotiated Rate	$6.02
Max. Negotiated Rate	$6.02
Rate for Payer: Qualcare PPO/HMO/WC	$6.02

CLOSED TX KNEE DISLOC W ANESTH

Facility

$12,366.06

Service Code	HCPCS 27552
Hospital Charge Code	323027552
Hospital Revenue Code	450
Min. Negotiated Rate	$1,854.91
Max. Negotiated Rate	$1,854.91
Rate for Payer: Qualcare PPO/HMO/WC	$1,854.91

CLOSED TX KNEE DISLOC W ANESTH

Facility

$12,366.06

Service Code	HCPCS 27552
Hospital Charge Code	323027552
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$6,929.76
Rate for Payer: Aetna Commercial	$5,196.12
Rate for Payer: Aetna Medicare Advantage	$6,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,929.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,929.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,910.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,929.76
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: Cigna Medicare Advantage	$1,910.34
Rate for Payer: Clover Medicare Advantage	$1,814.82
Rate for Payer: EmblemHealth Commercial	$5,731.02
Rate for Payer: Humana Medicare Advantage	$1,967.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,910.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,215.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,854.91
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,910.34
Rate for Payer: Wellcare Medicare Advantage	$1,910.34
Rate for Payer: Wellpoint Medicaid Managed Care	$351.20

CLOSED TX SHOULDER DISLOCATION

Facility

$7,691.80

Service Code	HCPCS 23675
Hospital Charge Code	323023675
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$6,929.76
Rate for Payer: Aetna Commercial	$5,196.12
Rate for Payer: Aetna Medicare Advantage	$6,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,929.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,929.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,910.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$207.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,929.76
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: Cigna Medicare Advantage	$1,910.34
Rate for Payer: Clover Medicare Advantage	$1,814.82
Rate for Payer: EmblemHealth Commercial	$5,731.02
Rate for Payer: Humana Medicare Advantage	$1,967.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,910.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,999.87
Rate for Payer: Qualcare PPO/HMO/WC	$1,153.77
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,910.34
Rate for Payer: Wellcare Medicare Advantage	$1,910.34
Rate for Payer: Wellpoint Medicaid Managed Care	$218.45

CLOSED TX SHOULDER DISLOCATION

Facility

$7,691.80

Service Code	HCPCS 23675
Hospital Charge Code	323023675
Hospital Revenue Code	450
Min. Negotiated Rate	$1,153.77
Max. Negotiated Rate	$1,153.77
Rate for Payer: Qualcare PPO/HMO/WC	$1,153.77

CLOSED TX STERNUM W/O MANIP

Facility

$645.00

Service Code	HCPCS 21820
Hospital Charge Code	5700728
Hospital Revenue Code	450
Min. Negotiated Rate	$96.75
Max. Negotiated Rate	$96.75
Rate for Payer: Qualcare PPO/HMO/WC	$96.75

CLOSED TX STERNUM W/O MANIP

Facility

$645.00

Service Code	HCPCS 21820
Hospital Charge Code	5700728
Hospital Revenue Code	450
Min. Negotiated Rate	$18.32
Max. Negotiated Rate	$1,063.04
Rate for Payer: Aetna Commercial	$797.10
Rate for Payer: Aetna Medicare Advantage	$949.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,063.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,063.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$293.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,063.04
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: Cigna Medicare Advantage	$293.05
Rate for Payer: Clover Medicare Advantage	$278.40
Rate for Payer: EmblemHealth Commercial	$879.15
Rate for Payer: Humana Medicare Advantage	$301.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$293.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.70
Rate for Payer: Qualcare PPO/HMO/WC	$96.75
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$293.05
Rate for Payer: Wellcare Medicare Advantage	$293.05
Rate for Payer: Wellpoint Medicaid Managed Care	$18.32

CLOSESURE SYSTEM CARTER THOMAS

Facility

$675.00

Hospital Charge Code	270674140
Hospital Revenue Code	272
Min. Negotiated Rate	$19.17
Max. Negotiated Rate	$337.50
Rate for Payer: Aetna Commercial	$256.50
Rate for Payer: Aetna Medicare Advantage	$202.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$172.12
Rate for Payer: Cigna Commercial	$337.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.50
Rate for Payer: Oxford Commercial	$135.00
Rate for Payer: Qualcare PPO/HMO/WC	$101.25
Rate for Payer: UnitedHealthcare Commercial	$135.00
Rate for Payer: UnitedHealthcare Community & State	$21.33
Rate for Payer: Wellpoint Medicaid Managed Care	$19.17

CLOSESURE SYSTEM CARTER THOMAS

Facility

$675.00

Hospital Charge Code	270674140
Hospital Revenue Code	272
Min. Negotiated Rate	$101.25
Max. Negotiated Rate	$101.25
Rate for Payer: Qualcare PPO/HMO/WC	$101.25

CLOSEUREFAST 6F CATHETER

Facility

$5,775.00

Hospital Charge Code	270703632
Hospital Revenue Code	272
Min. Negotiated Rate	$164.01
Max. Negotiated Rate	$2,887.50
Rate for Payer: Aetna Commercial	$2,194.50
Rate for Payer: Aetna Medicare Advantage	$1,732.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,472.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,472.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,472.62
Rate for Payer: Cigna Commercial	$2,887.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,501.50
Rate for Payer: Oxford Commercial	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$866.25
Rate for Payer: UnitedHealthcare Commercial	$1,155.00
Rate for Payer: UnitedHealthcare Community & State	$182.49
Rate for Payer: Wellpoint Medicaid Managed Care	$164.01

CLOSEUREFAST 6F CATHETER

Facility

$5,775.00

Hospital Charge Code	270703632
Hospital Revenue Code	272
Min. Negotiated Rate	$866.25
Max. Negotiated Rate	$866.25
Rate for Payer: Qualcare PPO/HMO/WC	$866.25

CLOS SYS PORT ENDO CART THOM I

Facility

$976.50

Hospital Charge Code	270675138
Hospital Revenue Code	272
Min. Negotiated Rate	$27.73
Max. Negotiated Rate	$488.25
Rate for Payer: Aetna Commercial	$371.07
Rate for Payer: Aetna Medicare Advantage	$292.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$249.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$249.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$249.01
Rate for Payer: Cigna Commercial	$488.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.89
Rate for Payer: Oxford Commercial	$195.30
Rate for Payer: Qualcare PPO/HMO/WC	$146.47
Rate for Payer: UnitedHealthcare Commercial	$195.30
Rate for Payer: UnitedHealthcare Community & State	$30.86
Rate for Payer: Wellpoint Medicaid Managed Care	$27.73

CLOS SYS PORT ENDO CART THOM I

Facility

$976.50

Hospital Charge Code	270675138
Hospital Revenue Code	272
Min. Negotiated Rate	$146.47
Max. Negotiated Rate	$146.47
Rate for Payer: Qualcare PPO/HMO/WC	$146.47

CLOSTRIDIUM DIFFERICILE TOXIN

Facility

$292.37

Service Code	HCPCS 87449
Hospital Charge Code	399900537
Hospital Revenue Code	302
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$32.59
Rate for Payer: Aetna Medicare Advantage	$38.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.46
Rate for Payer: Cigna Commercial	$146.19
Rate for Payer: Cigna Medicare Advantage	$11.98
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.02
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.86
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Medicare Advantage	$11.98
Rate for Payer: Wellpoint Medicaid Managed Care	$8.30

CLOSTRIDIUM DIFFERICILE TOXIN

Facility

$292.37

Service Code	HCPCS 87449
Hospital Charge Code	399900537
Hospital Revenue Code	302
Min. Negotiated Rate	$43.86
Max. Negotiated Rate	$43.86
Rate for Payer: Qualcare PPO/HMO/WC	$43.86

CLOSTRIDIUM DIFFICILE TOXIN DE

Facility

$142.00

Service Code	HCPCS 87230
Hospital Charge Code	38475035
Hospital Revenue Code	309
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$21.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.30

CLOSTRIDIUM DIFFICILE TOXIN DE

Facility

$142.00

Service Code	HCPCS 87230
Hospital Charge Code	38475035
Hospital Revenue Code	309
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$53.69
Rate for Payer: Aetna Medicare Advantage	$63.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.61
Rate for Payer: Cigna Commercial	$71.00
Rate for Payer: Cigna Medicare Advantage	$19.74
Rate for Payer: Clover Medicare Advantage	$18.75
Rate for Payer: EmblemHealth Commercial	$59.22
Rate for Payer: Humana Medicare Advantage	$20.33
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.92
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.30
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$15.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.74
Rate for Payer: Wellcare Medicare Advantage	$19.74
Rate for Payer: Wellpoint Medicaid Managed Care	$4.03

CLOSTRIDIUM DIF TOXIN B,Q

Facility

$241.20

Service Code	HCPCS 87493
Hospital Charge Code	39900292
Hospital Revenue Code	306
Min. Negotiated Rate	$6.85
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$101.37
Rate for Payer: Aetna Medicare Advantage	$120.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$135.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$135.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$37.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$135.20
Rate for Payer: Cigna Commercial	$120.60
Rate for Payer: Cigna Medicare Advantage	$37.27
Rate for Payer: Clover Medicare Advantage	$35.41
Rate for Payer: EmblemHealth Commercial	$111.81
Rate for Payer: Humana Medicare Advantage	$38.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$37.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.71
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.18
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$29.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$37.27
Rate for Payer: Wellcare Medicare Advantage	$37.27
Rate for Payer: Wellpoint Medicaid Managed Care	$6.85

CLOSTRIDIUM DIF TOXIN B,Q

Facility

$241.20

Service Code	HCPCS 87493
Hospital Charge Code	39900292
Hospital Revenue Code	306
Min. Negotiated Rate	$36.18
Max. Negotiated Rate	$36.18
Rate for Payer: Qualcare PPO/HMO/WC	$36.18

CLOSURE DEVICE MYNX CON 5F

Facility

$1,025.00

Service Code	HCPCS C1750
Hospital Charge Code	270695678S
Hospital Revenue Code	278
Min. Negotiated Rate	$29.11
Max. Negotiated Rate	$512.50
Rate for Payer: Aetna Commercial	$389.50
Rate for Payer: Aetna Medicare Advantage	$307.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$261.38
Rate for Payer: Cigna Commercial	$512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.05
Rate for Payer: Qualcare PPO/HMO/WC	$153.75
Rate for Payer: UnitedHealthcare Community & State	$32.39
Rate for Payer: Wellpoint Medicaid Managed Care	$29.11

CLOSURE DEVICE MYNX CON 5F

Facility

$1,025.00

Service Code	HCPCS C1750
Hospital Charge Code	270695678S
Hospital Revenue Code	278
Min. Negotiated Rate	$153.75
Max. Negotiated Rate	$248.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.05
Rate for Payer: Qualcare PPO/HMO/WC	$153.75

Know your out-of-pocket cost for care.

All Charges