Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

LAMINOTOMY SINGLE LUMBAR-LT

Facility

$63,107.55

Service Code	HCPCS 63042
Hospital Charge Code	16001020
Hospital Revenue Code	360
Min. Negotiated Rate	$9,466.13
Max. Negotiated Rate	$9,466.13
Rate for Payer: Qualcare PPO/HMO/WC	$9,466.13

LAMIVUDINE 150 MG TAB

Facility

$54.74

Service Code	NDC 68084057821
Hospital Charge Code	6016539
Hospital Revenue Code	250
Min. Negotiated Rate	$1.55
Max. Negotiated Rate	$27.37
Rate for Payer: Aetna Commercial	$20.80
Rate for Payer: Aetna Medicare Advantage	$16.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.96
Rate for Payer: Cigna Commercial	$27.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.23
Rate for Payer: Oxford Commercial	$10.95
Rate for Payer: Qualcare PPO/HMO/WC	$8.21
Rate for Payer: UnitedHealthcare Commercial	$10.95
Rate for Payer: UnitedHealthcare Community & State	$1.73
Rate for Payer: Wellpoint Medicaid Managed Care	$1.55

LAMIVUDINE 150 MG TAB

Facility

$54.74

Service Code	NDC 68084057821
Hospital Charge Code	6016539
Hospital Revenue Code	250
Min. Negotiated Rate	$8.21
Max. Negotiated Rate	$8.21
Rate for Payer: Qualcare PPO/HMO/WC	$8.21

LAMIVUDINE ELIX 10MG/ML 240ML

Facility

$34.10

Service Code	NDC 49702020548
Hospital Charge Code	60628772
Hospital Revenue Code	250
Min. Negotiated Rate	$5.12
Max. Negotiated Rate	$5.12
Rate for Payer: Qualcare PPO/HMO/WC	$5.12

LAMIVUDINE ELIX 10MG/ML 240ML

Facility

$34.10

Service Code	NDC 49702020548
Hospital Charge Code	60628772
Hospital Revenue Code	250
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$17.05
Rate for Payer: Aetna Commercial	$12.96
Rate for Payer: Aetna Medicare Advantage	$10.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.70
Rate for Payer: Cigna Commercial	$17.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.87
Rate for Payer: Oxford Commercial	$6.82
Rate for Payer: Qualcare PPO/HMO/WC	$5.12
Rate for Payer: UnitedHealthcare Commercial	$6.82
Rate for Payer: UnitedHealthcare Community & State	$1.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.97

LAMIVUDINE/ZIDOVUDINE 1 TAB

Facility

$104.05

Service Code	NDC 378518091
Hospital Charge Code	60629151
Hospital Revenue Code	250
Min. Negotiated Rate	$15.61
Max. Negotiated Rate	$15.61
Rate for Payer: Qualcare PPO/HMO/WC	$15.61

LAMIVUDINE/ZIDOVUDINE 1 TAB

Facility

$104.05

Service Code	NDC 378518091
Hospital Charge Code	60629151
Hospital Revenue Code	250
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$52.02
Rate for Payer: Aetna Commercial	$39.54
Rate for Payer: Aetna Medicare Advantage	$31.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.53
Rate for Payer: Cigna Commercial	$52.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.05
Rate for Payer: Oxford Commercial	$20.81
Rate for Payer: Qualcare PPO/HMO/WC	$15.61
Rate for Payer: UnitedHealthcare Commercial	$20.81
Rate for Payer: UnitedHealthcare Community & State	$3.29
Rate for Payer: Wellpoint Medicaid Managed Care	$2.96

LAMOTRIGINE

Facility

$75.00

Service Code	HCPCS 80299
Hospital Charge Code	38472309
Hospital Revenue Code	301
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

LAMOTRIGINE

Facility

$667.59

Service Code	HCPCS 80175
Hospital Charge Code	39900318
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

LAMOTRIGINE

Facility

$667.59

Service Code	HCPCS 80175
Hospital Charge Code	39900318
Hospital Revenue Code	301
Min. Negotiated Rate	$10.60
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$36.04
Rate for Payer: Aetna Medicare Advantage	$42.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.06
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$13.25
Rate for Payer: Clover Medicare Advantage	$12.59
Rate for Payer: EmblemHealth Commercial	$39.75
Rate for Payer: Humana Medicare Advantage	$13.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.57
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.25
Rate for Payer: Wellcare Medicare Advantage	$13.25
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

LAMOTRIGINE

Facility

$75.00

Service Code	HCPCS 80299
Hospital Charge Code	38472309
Hospital Revenue Code	301
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.62
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.50
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$2.13

LAMOTRIGINE 100 MG TAB

Facility

$26.80

Service Code	NDC 173064255
Hospital Charge Code	60628826
Hospital Revenue Code	250
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$13.40
Rate for Payer: Aetna Commercial	$10.18
Rate for Payer: Aetna Medicare Advantage	$8.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.83
Rate for Payer: Cigna Commercial	$13.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.97
Rate for Payer: Oxford Commercial	$5.36
Rate for Payer: Qualcare PPO/HMO/WC	$4.02
Rate for Payer: UnitedHealthcare Commercial	$5.36
Rate for Payer: UnitedHealthcare Community & State	$0.85
Rate for Payer: Wellpoint Medicaid Managed Care	$0.76

LAMOTRIGINE 100 MG TAB

Facility

$26.80

Service Code	NDC 173064255
Hospital Charge Code	60628826
Hospital Revenue Code	250
Min. Negotiated Rate	$4.02
Max. Negotiated Rate	$4.02
Rate for Payer: Qualcare PPO/HMO/WC	$4.02

LAMOTRIGINE 25 MG TAB

Facility

$26.80

Service Code	NDC 173063302
Hospital Charge Code	60628827
Hospital Revenue Code	250
Min. Negotiated Rate	$4.02
Max. Negotiated Rate	$4.02
Rate for Payer: Qualcare PPO/HMO/WC	$4.02

LAMOTRIGINE 25 MG TAB

Facility

$26.80

Service Code	NDC 173063302
Hospital Charge Code	60628827
Hospital Revenue Code	250
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$13.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.02
Rate for Payer: UnitedHealthcare Commercial	$5.36
Rate for Payer: UnitedHealthcare Community & State	$0.85
Rate for Payer: Wellpoint Medicaid Managed Care	$0.76
Rate for Payer: Aetna Commercial	$10.18
Rate for Payer: Aetna Medicare Advantage	$8.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.83
Rate for Payer: Cigna Commercial	$13.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.97
Rate for Payer: Oxford Commercial	$5.36

LANG COMP CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G9159GN
Hospital Charge Code	84201162
Hospital Revenue Code	449
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

LANG COMP CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G9159GN
Hospital Charge Code	84201162
Hospital Revenue Code	449
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

LANG COMP CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G9159GN
Hospital Charge Code	84201020
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

LANG COMP CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G9159GN
Hospital Charge Code	84201020
Hospital Revenue Code	440
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

LANG COMP D/C STATUS

Facility

$0.01

Service Code	HCPCS G9161GN
Hospital Charge Code	84201164
Hospital Revenue Code	449
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

LANG COMP D/C STATUS

Facility

$0.01

Service Code	HCPCS G9161GN
Hospital Charge Code	84201030
Hospital Revenue Code	440
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

LANG COMP D/C STATUS

Facility

$0.01

Service Code	HCPCS G9161GN
Hospital Charge Code	84201164
Hospital Revenue Code	449
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

LANG COMP D/C STATUS

Facility

$0.01

Service Code	HCPCS G9161GN
Hospital Charge Code	84201030
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

LANG COMP GOAL STATUS

Facility

$0.01

Service Code	HCPCS G9160GN
Hospital Charge Code	84201163
Hospital Revenue Code	449
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

LANG COMP GOAL STATUS

Facility

$0.01

Service Code	HCPCS G9160GN
Hospital Charge Code	84201025
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

Know your out-of-pocket cost for care.

All Charges