Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

LEUKOCYTE TRANSFUSION

Facility

$89.00

Service Code	HCPCS 86950
Hospital Charge Code	38477107
Hospital Revenue Code	300
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$734.21
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$734.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$734.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$734.21
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.14
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.35
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$32.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$2.53

LEUKOCYTE TRANSFUSION

Facility

$89.00

Service Code	HCPCS 86950
Hospital Charge Code	38477107
Hospital Revenue Code	300
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$13.35
Rate for Payer: Qualcare PPO/HMO/WC	$13.35

LEUNG BILARY STENT COTTON 7FR

Facility

$279.00

Hospital Charge Code	270331662
Hospital Revenue Code	278
Min. Negotiated Rate	$41.85
Max. Negotiated Rate	$67.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.52
Rate for Payer: Qualcare PPO/HMO/WC	$41.85

LEUNG BILARY STENT COTTON 7FR

Facility

$279.00

Hospital Charge Code	270331662
Hospital Revenue Code	278
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna Commercial	$106.02
Rate for Payer: Aetna Medicare Advantage	$83.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.14
Rate for Payer: Cigna Commercial	$139.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.52
Rate for Payer: Qualcare PPO/HMO/WC	$41.85
Rate for Payer: UnitedHealthcare Community & State	$8.82
Rate for Payer: Wellpoint Medicaid Managed Care	$7.92

LEUPROLIDE ACETATE 3.75 MG

Facility

$4,611.48

Service Code	HCPCS J1950
Hospital Charge Code	60627392
Hospital Revenue Code	636
Min. Negotiated Rate	$130.97
Max. Negotiated Rate	$6,404.61
Rate for Payer: Aetna Commercial	$4,802.35
Rate for Payer: Aetna Medicare Advantage	$5,720.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,404.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,404.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,765.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,871.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,404.61
Rate for Payer: Cigna Medicare Advantage	$1,765.57
Rate for Payer: Clover Medicare Advantage	$1,677.29
Rate for Payer: EmblemHealth Commercial	$5,296.71
Rate for Payer: Humana Medicare Advantage	$1,818.54
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,765.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,115.98
Rate for Payer: Qualcare PPO/HMO/WC	$691.72
Rate for Payer: UnitedHealthcare Community & State	$145.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,765.57
Rate for Payer: Wellcare Medicare Advantage	$1,765.57
Rate for Payer: Wellpoint Medicaid Managed Care	$130.97

LEUPROLIDE ACETATE 3.75 MG

Facility

$4,611.48

Service Code	HCPCS J1950
Hospital Charge Code	60627392
Hospital Revenue Code	636
Min. Negotiated Rate	$691.72
Max. Negotiated Rate	$1,115.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,115.98
Rate for Payer: Qualcare PPO/HMO/WC	$691.72

LEUPROLIDE ACETATE 7.5 MG

Facility

$5,495.41

Service Code	HCPCS J9217
Hospital Charge Code	60627393
Hospital Revenue Code	636
Min. Negotiated Rate	$824.31
Max. Negotiated Rate	$1,329.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,329.89
Rate for Payer: Qualcare PPO/HMO/WC	$824.31

LEUPROLIDE ACETATE 7.5 MG

Facility

$5,495.41

Service Code	HCPCS J9217
Hospital Charge Code	60627393
Hospital Revenue Code	636
Min. Negotiated Rate	$156.07
Max. Negotiated Rate	$1,329.89
Rate for Payer: Aetna Commercial	$479.26
Rate for Payer: Aetna Medicare Advantage	$570.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$639.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$639.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$176.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$186.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$639.17
Rate for Payer: Cigna Medicare Advantage	$176.20
Rate for Payer: Clover Medicare Advantage	$167.39
Rate for Payer: EmblemHealth Commercial	$528.60
Rate for Payer: Humana Medicare Advantage	$181.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$176.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,329.89
Rate for Payer: Qualcare PPO/HMO/WC	$824.31
Rate for Payer: UnitedHealthcare Community & State	$173.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$176.20
Rate for Payer: Wellcare Medicare Advantage	$176.20
Rate for Payer: Wellpoint Medicaid Managed Care	$156.07

LEVALBUTEROL

Facility

$44.96

Service Code	NDC 378968144
Hospital Charge Code	60628899
Hospital Revenue Code	250
Min. Negotiated Rate	$6.74
Max. Negotiated Rate	$6.74
Rate for Payer: Qualcare PPO/HMO/WC	$6.74

LEVALBUTEROL

Facility

$44.96

Service Code	NDC 378968144
Hospital Charge Code	60628899
Hospital Revenue Code	250
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$22.48
Rate for Payer: Aetna Commercial	$17.08
Rate for Payer: Aetna Medicare Advantage	$13.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.46
Rate for Payer: Cigna Commercial	$22.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.69
Rate for Payer: Oxford Commercial	$8.99
Rate for Payer: Qualcare PPO/HMO/WC	$6.74
Rate for Payer: UnitedHealthcare Commercial	$8.99
Rate for Payer: UnitedHealthcare Community & State	$1.42
Rate for Payer: Wellpoint Medicaid Managed Care	$1.28

LEVALBUTEROL1.25 MG/3 ML

Facility

$65.79

Service Code	NDC 54569544500
Hospital Charge Code	60628930
Hospital Revenue Code	250
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$32.90
Rate for Payer: Aetna Commercial	$25.00
Rate for Payer: Aetna Medicare Advantage	$19.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.78
Rate for Payer: Cigna Commercial	$32.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.11
Rate for Payer: Oxford Commercial	$13.16
Rate for Payer: Qualcare PPO/HMO/WC	$9.87
Rate for Payer: UnitedHealthcare Commercial	$13.16
Rate for Payer: UnitedHealthcare Community & State	$2.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1.87

LEVALBUTEROL1.25 MG/3 ML

Facility

$65.79

Service Code	NDC 54569544500
Hospital Charge Code	60628930
Hospital Revenue Code	250
Min. Negotiated Rate	$9.87
Max. Negotiated Rate	$9.87
Rate for Payer: Qualcare PPO/HMO/WC	$9.87

LEVEEN INFLATION SYRINGE 10CC

Facility

$212.00

Hospital Charge Code	270332069
Hospital Revenue Code	272
Min. Negotiated Rate	$6.02
Max. Negotiated Rate	$106.00
Rate for Payer: Aetna Commercial	$80.56
Rate for Payer: Aetna Medicare Advantage	$63.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.06
Rate for Payer: Cigna Commercial	$106.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.12
Rate for Payer: Oxford Commercial	$42.40
Rate for Payer: Qualcare PPO/HMO/WC	$31.80
Rate for Payer: UnitedHealthcare Commercial	$42.40
Rate for Payer: UnitedHealthcare Community & State	$6.70
Rate for Payer: Wellpoint Medicaid Managed Care	$6.02

LEVEEN INFLATION SYRINGE 10CC

Facility

$212.00

Hospital Charge Code	270332069
Hospital Revenue Code	272
Min. Negotiated Rate	$31.80
Max. Negotiated Rate	$31.80
Rate for Payer: Qualcare PPO/HMO/WC	$31.80

LEVEL 1 FOLLOW-UP VISIT

Facility

$575.00

Service Code	HCPCS 99211
Hospital Charge Code	421599211
Hospital Revenue Code	510
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$86.25
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

LEVEL 1 FOLLOW-UP VISIT

Facility

$575.00

Service Code	HCPCS 99211
Hospital Charge Code	421099211
Hospital Revenue Code	510
Min. Negotiated Rate	$16.33
Max. Negotiated Rate	$287.50
Rate for Payer: Aetna Commercial	$218.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.50
Rate for Payer: Qualcare PPO/HMO/WC	$86.25
Rate for Payer: UnitedHealthcare Community & State	$18.17
Rate for Payer: Wellpoint Medicaid Managed Care	$16.33

LEVEL 1 FOLLOW-UP VISIT

Facility

$311.00

Service Code	HCPCS 99211
Hospital Charge Code	485099211
Hospital Revenue Code	510
Min. Negotiated Rate	$8.83
Max. Negotiated Rate	$155.50
Rate for Payer: Aetna Commercial	$118.18
Rate for Payer: Aetna Medicare Advantage	$93.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.31
Rate for Payer: Cigna Commercial	$155.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.86
Rate for Payer: Qualcare PPO/HMO/WC	$46.65
Rate for Payer: UnitedHealthcare Community & State	$9.83
Rate for Payer: Wellpoint Medicaid Managed Care	$8.83

LEVEL 1 FOLLOW-UP VISIT

Facility

$311.00

Service Code	HCPCS 99211
Hospital Charge Code	485599211
Hospital Revenue Code	510
Min. Negotiated Rate	$46.65
Max. Negotiated Rate	$46.65
Rate for Payer: Qualcare PPO/HMO/WC	$46.65

LEVEL 1 FOLLOW-UP VISIT

Facility

$575.00

Service Code	HCPCS 99211
Hospital Charge Code	421099211
Hospital Revenue Code	510
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$86.25
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

LEVEL 1 FOLLOW-UP VISIT

Facility

$311.00

Service Code	HCPCS 99211
Hospital Charge Code	485099211
Hospital Revenue Code	510
Min. Negotiated Rate	$46.65
Max. Negotiated Rate	$46.65
Rate for Payer: Qualcare PPO/HMO/WC	$46.65

LEVEL 1 FOLLOW-UP VISIT

Facility

$311.00

Service Code	HCPCS 99211
Hospital Charge Code	485599211
Hospital Revenue Code	510
Min. Negotiated Rate	$8.83
Max. Negotiated Rate	$155.50
Rate for Payer: Aetna Commercial	$118.18
Rate for Payer: Aetna Medicare Advantage	$93.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.31
Rate for Payer: Cigna Commercial	$155.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.86
Rate for Payer: Qualcare PPO/HMO/WC	$46.65
Rate for Payer: UnitedHealthcare Community & State	$9.83
Rate for Payer: Wellpoint Medicaid Managed Care	$8.83

LEVEL 1 FOLLOW-UP VISIT

Facility

$575.00

Service Code	HCPCS 99211
Hospital Charge Code	421599211
Hospital Revenue Code	510
Min. Negotiated Rate	$16.33
Max. Negotiated Rate	$287.50
Rate for Payer: Aetna Commercial	$218.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.50
Rate for Payer: Qualcare PPO/HMO/WC	$86.25
Rate for Payer: UnitedHealthcare Community & State	$18.17
Rate for Payer: Wellpoint Medicaid Managed Care	$16.33

LEVEL 1 OUTPATIENT CONSULT

Facility

$575.00

Service Code	HCPCS 99241
Hospital Charge Code	421599241
Hospital Revenue Code	510
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$86.25
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

LEVEL 1 OUTPATIENT CONSULT

Facility

$575.00

Service Code	HCPCS 99241
Hospital Charge Code	421599241
Hospital Revenue Code	510
Min. Negotiated Rate	$16.33
Max. Negotiated Rate	$287.50
Rate for Payer: Aetna Commercial	$218.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.50
Rate for Payer: Qualcare PPO/HMO/WC	$86.25
Rate for Payer: UnitedHealthcare Community & State	$18.17
Rate for Payer: Wellpoint Medicaid Managed Care	$16.33

LEVEL 1 OUTPATIENT CONSULT

Facility

$575.00

Service Code	HCPCS 99241
Hospital Charge Code	485599241
Hospital Revenue Code	510
Min. Negotiated Rate	$16.33
Max. Negotiated Rate	$287.50
Rate for Payer: Aetna Commercial	$218.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.50
Rate for Payer: Qualcare PPO/HMO/WC	$86.25
Rate for Payer: UnitedHealthcare Community & State	$18.17
Rate for Payer: Wellpoint Medicaid Managed Care	$16.33

Know your out-of-pocket cost for care.

All Charges