Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CLOTH BARRIER 3% CREAM

Facility

$12.42

Hospital Charge Code	270663233
Hospital Revenue Code	270
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$1.86
Rate for Payer: Qualcare PPO/HMO/WC	$1.86

CLOTH BARRIER 3% CREAM

Facility

$12.42

Hospital Charge Code	270663233
Hospital Revenue Code	270
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$6.21
Rate for Payer: Aetna Commercial	$4.72
Rate for Payer: Aetna Medicare Advantage	$3.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.17
Rate for Payer: Cigna Commercial	$6.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.23
Rate for Payer: Oxford Commercial	$2.48
Rate for Payer: Qualcare PPO/HMO/WC	$1.86
Rate for Payer: UnitedHealthcare Commercial	$2.48
Rate for Payer: UnitedHealthcare Community & State	$0.39
Rate for Payer: Wellpoint Medicaid Managed Care	$0.35

CLOT INHIBIT PROT C ACTIVITY

Facility

$390.00

Service Code	HCPCS 85303
Hospital Charge Code	401485303
Hospital Revenue Code	305
Min. Negotiated Rate	$11.07
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$37.64
Rate for Payer: Aetna Medicare Advantage	$44.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.20
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$13.84
Rate for Payer: Clover Medicare Advantage	$13.15
Rate for Payer: EmblemHealth Commercial	$41.52
Rate for Payer: Humana Medicare Advantage	$14.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.84
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	$11.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.84
Rate for Payer: Wellcare Medicare Advantage	$13.84
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

CLOT INHIBIT PROT C ACTIVITY

Facility

$390.00

Service Code	HCPCS 85303
Hospital Charge Code	401485303
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CLOT INHIBIT PROT C ANTIGEN

Facility

$390.00

Service Code	HCPCS 85302
Hospital Charge Code	401485302
Hospital Revenue Code	305
Min. Negotiated Rate	$9.61
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$32.67
Rate for Payer: Aetna Medicare Advantage	$38.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.57
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.01
Rate for Payer: Clover Medicare Advantage	$11.41
Rate for Payer: EmblemHealth Commercial	$36.03
Rate for Payer: Humana Medicare Advantage	$12.37
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.01
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	$9.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.01
Rate for Payer: Wellcare Medicare Advantage	$12.01
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

CLOT INHIBIT PROT C ANTIGEN

Facility

$390.00

Service Code	HCPCS 85302
Hospital Charge Code	401485302
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CLOT INHIBIT PROT S FREE

Facility

$390.00

Service Code	HCPCS 85306
Hospital Charge Code	401485306
Hospital Revenue Code	305
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$41.67
Rate for Payer: Aetna Medicare Advantage	$49.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.57
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$15.32
Rate for Payer: Clover Medicare Advantage	$14.55
Rate for Payer: EmblemHealth Commercial	$45.96
Rate for Payer: Humana Medicare Advantage	$15.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.32
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	$12.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.32
Rate for Payer: Wellcare Medicare Advantage	$15.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

CLOT INHIBIT PROT S FREE

Facility

$390.00

Service Code	HCPCS 85306
Hospital Charge Code	401485306
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CLOT INHIBIT PROT S TOTAL

Facility

$390.00

Service Code	HCPCS 85305
Hospital Charge Code	401485305
Hospital Revenue Code	305
Min. Negotiated Rate	$9.29
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$31.58
Rate for Payer: Aetna Medicare Advantage	$37.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.12
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$11.61
Rate for Payer: Clover Medicare Advantage	$11.03
Rate for Payer: EmblemHealth Commercial	$34.83
Rate for Payer: Humana Medicare Advantage	$11.96
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.61
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	$9.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.61
Rate for Payer: Wellcare Medicare Advantage	$11.61
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

CLOT INHIBIT PROT S TOTAL

Facility

$390.00

Service Code	HCPCS 85305
Hospital Charge Code	401485305
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CLOTRIMAZOLE 10 MG TROCHE

Facility

$9.78

Service Code	NDC 574010714
Hospital Charge Code	60628336
Hospital Revenue Code	250
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$4.89
Rate for Payer: Aetna Commercial	$3.72
Rate for Payer: Aetna Medicare Advantage	$2.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.49
Rate for Payer: Cigna Commercial	$4.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.54
Rate for Payer: Oxford Commercial	$1.96
Rate for Payer: Qualcare PPO/HMO/WC	$1.47
Rate for Payer: UnitedHealthcare Commercial	$1.96
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.28

CLOTRIMAZOLE 10 MG TROCHE

Facility

$9.78

Service Code	NDC 574010714
Hospital Charge Code	60628336
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$1.47
Rate for Payer: Qualcare PPO/HMO/WC	$1.47

CLOTRIMAZOLE 1 % CRE

Facility

$57.55

Service Code	NDC 45802043411
Hospital Charge Code	60628334
Hospital Revenue Code	250
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$28.77
Rate for Payer: Aetna Commercial	$21.87
Rate for Payer: Aetna Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.68
Rate for Payer: Cigna Commercial	$28.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.96
Rate for Payer: Oxford Commercial	$11.51
Rate for Payer: Qualcare PPO/HMO/WC	$8.63
Rate for Payer: UnitedHealthcare Commercial	$11.51
Rate for Payer: UnitedHealthcare Community & State	$1.82
Rate for Payer: Wellpoint Medicaid Managed Care	$1.63

CLOTRIMAZOLE 1 % CRE

Facility

$57.55

Service Code	NDC 45802043411
Hospital Charge Code	60628334
Hospital Revenue Code	250
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$8.63
Rate for Payer: Qualcare PPO/HMO/WC	$8.63

CLOTRIMAZOLE 1% TOP SOLN

Facility

$302.37

Service Code	NDC 93024843
Hospital Charge Code	60628335
Hospital Revenue Code	250
Min. Negotiated Rate	$8.59
Max. Negotiated Rate	$151.19
Rate for Payer: Aetna Commercial	$114.90
Rate for Payer: Aetna Medicare Advantage	$90.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.10
Rate for Payer: Cigna Commercial	$151.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.62
Rate for Payer: Oxford Commercial	$60.47
Rate for Payer: Qualcare PPO/HMO/WC	$45.36
Rate for Payer: UnitedHealthcare Commercial	$60.47
Rate for Payer: UnitedHealthcare Community & State	$9.55
Rate for Payer: Wellpoint Medicaid Managed Care	$8.59

CLOTRIMAZOLE 1% TOP SOLN

Facility

$302.37

Service Code	NDC 93024843
Hospital Charge Code	60628335
Hospital Revenue Code	250
Min. Negotiated Rate	$45.36
Max. Negotiated Rate	$45.36
Rate for Payer: Qualcare PPO/HMO/WC	$45.36

CLOTRIMAZOLE 1% VAGINAL CREAM

Facility

$80.40

Service Code	NDC 472022041
Hospital Charge Code	60628963
Hospital Revenue Code	251
Min. Negotiated Rate	$12.06
Max. Negotiated Rate	$12.06
Rate for Payer: Qualcare PPO/HMO/WC	$12.06

CLOTRIMAZOLE 1% VAGINAL CREAM

Facility

$80.40

Service Code	NDC 472022041
Hospital Charge Code	60628963
Hospital Revenue Code	251
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$40.20
Rate for Payer: Aetna Commercial	$30.55
Rate for Payer: Aetna Medicare Advantage	$24.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.50
Rate for Payer: Cigna Commercial	$40.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.90
Rate for Payer: Oxford Commercial	$16.08
Rate for Payer: Qualcare PPO/HMO/WC	$12.06
Rate for Payer: UnitedHealthcare Commercial	$16.08
Rate for Payer: UnitedHealthcare Community & State	$2.54
Rate for Payer: Wellpoint Medicaid Managed Care	$2.28

CLOTRIMAZOLE 30 GM

Facility

$8.40

Hospital Charge Code	60628334W
Hospital Revenue Code	250
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$1.26
Rate for Payer: Qualcare PPO/HMO/WC	$1.26

CLOTRIMAZOLE 30 GM

Facility

$8.40

Hospital Charge Code	60628334W
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$4.20
Rate for Payer: Aetna Commercial	$3.19
Rate for Payer: Aetna Medicare Advantage	$2.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.14
Rate for Payer: Cigna Commercial	$4.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.18
Rate for Payer: Oxford Commercial	$1.68
Rate for Payer: Qualcare PPO/HMO/WC	$1.26
Rate for Payer: UnitedHealthcare Commercial	$1.68
Rate for Payer: UnitedHealthcare Community & State	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

CLOTTIN FACTR VIII VON WILLEBR

Facility

$161.00

Service Code	HCPCS 85247
Hospital Charge Code	38477172
Hospital Revenue Code	305
Min. Negotiated Rate	$24.15
Max. Negotiated Rate	$24.15
Rate for Payer: Qualcare PPO/HMO/WC	$24.15

CLOTTIN FACTR VIII VON WILLEBR

Facility

$161.00

Service Code	HCPCS 85247
Hospital Charge Code	38477172
Hospital Revenue Code	305
Min. Negotiated Rate	$4.57
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$62.40
Rate for Payer: Aetna Medicare Advantage	$74.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.21
Rate for Payer: Cigna Commercial	$80.50
Rate for Payer: Cigna Medicare Advantage	$22.94
Rate for Payer: Clover Medicare Advantage	$21.79
Rate for Payer: EmblemHealth Commercial	$68.82
Rate for Payer: Humana Medicare Advantage	$23.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.86
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.15
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$18.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.94
Rate for Payer: Wellcare Medicare Advantage	$22.94
Rate for Payer: Wellpoint Medicaid Managed Care	$4.57

CLOTTING FACTOR XIII FIBRIN ST

Facility

$66.00

Service Code	HCPCS 85291
Hospital Charge Code	38477056
Hospital Revenue Code	305
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$24.78
Rate for Payer: Aetna Medicare Advantage	$29.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.05
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: Cigna Medicare Advantage	$9.11
Rate for Payer: Clover Medicare Advantage	$8.65
Rate for Payer: EmblemHealth Commercial	$27.33
Rate for Payer: Humana Medicare Advantage	$9.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.16
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$7.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.11
Rate for Payer: Wellcare Medicare Advantage	$9.11
Rate for Payer: Wellpoint Medicaid Managed Care	$1.87

CLOTTING FACTOR XIII FIBRIN ST

Facility

$66.00

Service Code	HCPCS 85291
Hospital Charge Code	38477056
Hospital Revenue Code	305
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

CLOTTING INH/ANTICOAG PROT C

Facility

$97.00

Service Code	HCPCS 85303
Hospital Charge Code	38477120
Hospital Revenue Code	305
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$37.64
Rate for Payer: Aetna Medicare Advantage	$44.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.20
Rate for Payer: Cigna Commercial	$48.50
Rate for Payer: Cigna Medicare Advantage	$13.84
Rate for Payer: Clover Medicare Advantage	$13.15
Rate for Payer: EmblemHealth Commercial	$41.52
Rate for Payer: Humana Medicare Advantage	$14.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.22
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.55
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$11.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.84
Rate for Payer: Wellcare Medicare Advantage	$13.84
Rate for Payer: Wellpoint Medicaid Managed Care	$2.75

Know your out-of-pocket cost for care.

All Charges