Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

LEPTOSPIRAL AB

Facility

$390.00

Service Code	HCPCS 86720
Hospital Charge Code	397041287
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LESD BLOOD

Facility

$325.00

Service Code	HCPCS 83655
Hospital Charge Code	38479441
Hospital Revenue Code	301
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$48.75
Rate for Payer: Qualcare PPO/HMO/WC	$48.75

LESD BLOOD

Facility

$325.00

Service Code	HCPCS 83655
Hospital Charge Code	38479441
Hospital Revenue Code	301
Min. Negotiated Rate	$9.23
Max. Negotiated Rate	$162.50
Rate for Payer: Aetna Commercial	$32.94
Rate for Payer: Aetna Medicare Advantage	$39.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.93
Rate for Payer: Cigna Commercial	$162.50
Rate for Payer: Cigna Medicare Advantage	$12.11
Rate for Payer: Clover Medicare Advantage	$11.50
Rate for Payer: EmblemHealth Commercial	$36.33
Rate for Payer: Humana Medicare Advantage	$12.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.50
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.75
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.11
Rate for Payer: Wellcare Medicare Advantage	$12.11
Rate for Payer: Wellpoint Medicaid Managed Care	$9.23

LETS KIT (LIDO,EPI,TETRA)100ML

Facility

$893.18

Service Code	NDC 51552134501
Hospital Charge Code	606390302
Hospital Revenue Code	250
Min. Negotiated Rate	$133.98
Max. Negotiated Rate	$133.98
Rate for Payer: Qualcare PPO/HMO/WC	$133.98

LETS KIT (LIDO,EPI,TETRA)100ML

Facility

$893.18

Service Code	NDC 51552134501
Hospital Charge Code	606390302
Hospital Revenue Code	250
Min. Negotiated Rate	$25.37
Max. Negotiated Rate	$446.59
Rate for Payer: Aetna Commercial	$339.41
Rate for Payer: Aetna Medicare Advantage	$267.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.76
Rate for Payer: Cigna Commercial	$446.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.23
Rate for Payer: Oxford Commercial	$178.64
Rate for Payer: Qualcare PPO/HMO/WC	$133.98
Rate for Payer: UnitedHealthcare Commercial	$178.64
Rate for Payer: UnitedHealthcare Community & State	$28.22
Rate for Payer: Wellpoint Medicaid Managed Care	$25.37

LETZ LOOP WITH SAFE-T

Facility

$75.00

Hospital Charge Code	270658139
Hospital Revenue Code	270
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

LETZ LOOP WITH SAFE-T

Facility

$75.00

Hospital Charge Code	270658139
Hospital Revenue Code	270
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.50
Rate for Payer: Oxford Commercial	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$15.00
Rate for Payer: UnitedHealthcare Community & State	$2.37
Rate for Payer: Wellpoint Medicaid Managed Care	$2.13

LEUCINE AMINOPEPTIDASE (LAP)

Facility

$154.00

Service Code	HCPCS 83670
Hospital Charge Code	38472452
Hospital Revenue Code	301
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$23.10
Rate for Payer: Qualcare PPO/HMO/WC	$23.10

LEUCINE AMINOPEPTIDASE (LAP)

Facility

$154.00

Service Code	HCPCS 83670
Hospital Charge Code	38472452
Hospital Revenue Code	301
Min. Negotiated Rate	$3.81
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$26.68
Rate for Payer: Aetna Medicare Advantage	$31.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.59
Rate for Payer: Cigna Commercial	$77.00
Rate for Payer: Cigna Medicare Advantage	$9.81
Rate for Payer: Clover Medicare Advantage	$9.32
Rate for Payer: EmblemHealth Commercial	$29.43
Rate for Payer: Humana Medicare Advantage	$10.10
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.04
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.10
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$7.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.81
Rate for Payer: Wellcare Medicare Advantage	$9.81
Rate for Payer: Wellpoint Medicaid Managed Care	$4.37

LEUCOVORIN CALCIUM 100 MG VIAL

Facility

$160.80

Service Code	HCPCS J0640
Hospital Charge Code	60628530
Hospital Revenue Code	636
Min. Negotiated Rate	$4.57
Max. Negotiated Rate	$80.40
Rate for Payer: Aetna Commercial	$61.10
Rate for Payer: Aetna Medicare Advantage	$48.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.00
Rate for Payer: Cigna Commercial	$80.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.91
Rate for Payer: Qualcare PPO/HMO/WC	$24.12
Rate for Payer: UnitedHealthcare Community & State	$5.08
Rate for Payer: Wellpoint Medicaid Managed Care	$4.57

LEUCOVORIN CALCIUM 100 MG VIAL

Facility

$160.80

Service Code	HCPCS J0640
Hospital Charge Code	60628530
Hospital Revenue Code	636
Min. Negotiated Rate	$24.12
Max. Negotiated Rate	$38.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.91
Rate for Payer: Qualcare PPO/HMO/WC	$24.12

LEUCOVORIN CALCIUM 25MG TAB

Facility

$91.72

Service Code	NDC 51079058205
Hospital Charge Code	60629049
Hospital Revenue Code	250
Min. Negotiated Rate	$13.76
Max. Negotiated Rate	$13.76
Rate for Payer: Qualcare PPO/HMO/WC	$13.76

LEUCOVORIN CALCIUM 25MG TAB

Facility

$91.72

Service Code	NDC 51079058205
Hospital Charge Code	60629049
Hospital Revenue Code	250
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$45.86
Rate for Payer: Aetna Commercial	$34.85
Rate for Payer: Aetna Medicare Advantage	$27.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.39
Rate for Payer: Cigna Commercial	$45.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.85
Rate for Payer: Oxford Commercial	$18.34
Rate for Payer: Qualcare PPO/HMO/WC	$13.76
Rate for Payer: UnitedHealthcare Commercial	$18.34
Rate for Payer: UnitedHealthcare Community & State	$2.90
Rate for Payer: Wellpoint Medicaid Managed Care	$2.60

LEUCOVORIN CALCIUM/350MG

Facility

$152.36

Service Code	HCPCS J0640
Hospital Charge Code	60633279
Hospital Revenue Code	636
Min. Negotiated Rate	$22.85
Max. Negotiated Rate	$36.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.87
Rate for Payer: Qualcare PPO/HMO/WC	$22.85

LEUCOVORIN CALCIUM/350MG

Facility

$152.36

Service Code	HCPCS J0640
Hospital Charge Code	60633279
Hospital Revenue Code	636
Min. Negotiated Rate	$4.33
Max. Negotiated Rate	$76.18
Rate for Payer: Aetna Commercial	$57.90
Rate for Payer: Aetna Medicare Advantage	$45.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.85
Rate for Payer: Cigna Commercial	$76.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.87
Rate for Payer: Qualcare PPO/HMO/WC	$22.85
Rate for Payer: UnitedHealthcare Community & State	$4.81
Rate for Payer: Wellpoint Medicaid Managed Care	$4.33

LEUCOVORIN CALCIUM/50MG

Facility

$52.26

Service Code	HCPCS J0640
Hospital Charge Code	60633275
Hospital Revenue Code	636
Min. Negotiated Rate	$7.84
Max. Negotiated Rate	$12.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.65
Rate for Payer: Qualcare PPO/HMO/WC	$7.84

LEUCOVORIN CALCIUM/50MG

Facility

$52.26

Service Code	HCPCS J0640
Hospital Charge Code	60633275
Hospital Revenue Code	636
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$26.13
Rate for Payer: Aetna Commercial	$19.86
Rate for Payer: Aetna Medicare Advantage	$15.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.33
Rate for Payer: Cigna Commercial	$26.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.65
Rate for Payer: Qualcare PPO/HMO/WC	$7.84
Rate for Payer: UnitedHealthcare Community & State	$1.65
Rate for Payer: Wellpoint Medicaid Managed Care	$1.48

LEUCOVORIN CALCIUM 5 MG TAB

Facility

$21.78

Service Code	NDC 51079058106
Hospital Charge Code	6008668
Hospital Revenue Code	251
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$3.27
Rate for Payer: Qualcare PPO/HMO/WC	$3.27

LEUCOVORIN CALCIUM 5 MG TAB

Facility

$21.78

Service Code	NDC 51079058106
Hospital Charge Code	6008668
Hospital Revenue Code	251
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$10.89
Rate for Payer: Aetna Commercial	$8.28
Rate for Payer: Aetna Medicare Advantage	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.55
Rate for Payer: Cigna Commercial	$10.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.66
Rate for Payer: Oxford Commercial	$4.36
Rate for Payer: Qualcare PPO/HMO/WC	$3.27
Rate for Payer: UnitedHealthcare Commercial	$4.36
Rate for Payer: UnitedHealthcare Community & State	$0.69
Rate for Payer: Wellpoint Medicaid Managed Care	$0.62

LEUKEMIA/LYMPHOMA PANEL

Facility

$393.00

Service Code	HCPCS 88182
Hospital Charge Code	38472439
Hospital Revenue Code	311
Min. Negotiated Rate	$11.16
Max. Negotiated Rate	$224.58
Rate for Payer: Aetna Commercial	$168.40
Rate for Payer: Aetna Medicare Advantage	$200.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$224.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$224.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$61.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$224.58
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$61.91
Rate for Payer: Clover Medicare Advantage	$58.81
Rate for Payer: EmblemHealth Commercial	$185.73
Rate for Payer: Humana Medicare Advantage	$63.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$61.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.18
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.95
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$136.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.91
Rate for Payer: Wellcare Medicare Advantage	$61.91
Rate for Payer: Wellpoint Medicaid Managed Care	$11.16

LEUKEMIA/LYMPHOMA PANEL

Facility

$393.00

Service Code	HCPCS 88182
Hospital Charge Code	38472439
Hospital Revenue Code	311
Min. Negotiated Rate	$58.95
Max. Negotiated Rate	$58.95
Rate for Payer: Qualcare PPO/HMO/WC	$58.95

LEUKOCYTE ALKALINE PHOSPHATASE

Facility

$168.00

Service Code	HCPCS 85540
Hospital Charge Code	38473024
Hospital Revenue Code	305
Min. Negotiated Rate	$4.77
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$23.39
Rate for Payer: Aetna Medicare Advantage	$27.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.20
Rate for Payer: Cigna Commercial	$84.00
Rate for Payer: Cigna Medicare Advantage	$8.60
Rate for Payer: Clover Medicare Advantage	$8.17
Rate for Payer: EmblemHealth Commercial	$25.80
Rate for Payer: Humana Medicare Advantage	$8.86
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.68
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.20
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$6.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.60
Rate for Payer: Wellcare Medicare Advantage	$8.60
Rate for Payer: Wellpoint Medicaid Managed Care	$4.77

LEUKOCYTE ALKALINE PHOSPHATASE

Facility

$168.00

Service Code	HCPCS 85540
Hospital Charge Code	38473024
Hospital Revenue Code	305
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$25.20
Rate for Payer: Qualcare PPO/HMO/WC	$25.20

LEUKOCYTE HISTMINE RELEASE TST

Facility

$88.00

Service Code	HCPCS 86343
Hospital Charge Code	38477106
Hospital Revenue Code	302
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$33.89
Rate for Payer: Aetna Medicare Advantage	$40.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.20
Rate for Payer: Cigna Commercial	$44.00
Rate for Payer: Cigna Medicare Advantage	$12.46
Rate for Payer: Clover Medicare Advantage	$11.84
Rate for Payer: EmblemHealth Commercial	$37.38
Rate for Payer: Humana Medicare Advantage	$12.83
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.88
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.20
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.46
Rate for Payer: Wellcare Medicare Advantage	$12.46
Rate for Payer: Wellpoint Medicaid Managed Care	$2.50

LEUKOCYTE HISTMINE RELEASE TST

Facility

$88.00

Service Code	HCPCS 86343
Hospital Charge Code	38477106
Hospital Revenue Code	302
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$13.20

Know your out-of-pocket cost for care.

All Charges