Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

LISINOPRIL 2.5 MG TAB

Facility

$4.36

Service Code	NDC 68180051201
Hospital Charge Code	60629826
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$0.65
Rate for Payer: Qualcare PPO/HMO/WC	$0.65

LISINOPRIL 2.5 MG TAB

Facility

$4.36

Service Code	NDC 68180051201
Hospital Charge Code	60629826
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.18
Rate for Payer: Aetna Commercial	$1.66
Rate for Payer: Aetna Medicare Advantage	$1.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.11
Rate for Payer: Cigna Commercial	$2.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.13
Rate for Payer: Oxford Commercial	$0.87
Rate for Payer: Qualcare PPO/HMO/WC	$0.65
Rate for Payer: UnitedHealthcare Commercial	$0.87
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

LISINOPRIL 5 MG TAB

Facility

$6.10

Service Code	NDC 51079098120
Hospital Charge Code	60627574
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$0.92
Rate for Payer: Qualcare PPO/HMO/WC	$0.92

LISINOPRIL 5 MG TAB

Facility

$6.10

Service Code	NDC 51079098120
Hospital Charge Code	60627574
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.05
Rate for Payer: Aetna Commercial	$2.32
Rate for Payer: Aetna Medicare Advantage	$1.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.56
Rate for Payer: Cigna Commercial	$3.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.59
Rate for Payer: Oxford Commercial	$1.22
Rate for Payer: Qualcare PPO/HMO/WC	$0.92
Rate for Payer: UnitedHealthcare Commercial	$1.22
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

LISPRO INSULIN 75/25 U-100 INJ

Facility

$1,849.20

Service Code	NDC 2751101
Hospital Charge Code	60629167
Hospital Revenue Code	250
Min. Negotiated Rate	$52.52
Max. Negotiated Rate	$924.60
Rate for Payer: Aetna Commercial	$702.70
Rate for Payer: Aetna Medicare Advantage	$554.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$471.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$471.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$471.55
Rate for Payer: Cigna Commercial	$924.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$480.79
Rate for Payer: Oxford Commercial	$369.84
Rate for Payer: Qualcare PPO/HMO/WC	$277.38
Rate for Payer: UnitedHealthcare Commercial	$369.84
Rate for Payer: UnitedHealthcare Community & State	$58.43
Rate for Payer: Wellpoint Medicaid Managed Care	$52.52

LISPRO INSULIN 75/25 U-100 INJ

Facility

$1,849.20

Service Code	NDC 2751101
Hospital Charge Code	60629167
Hospital Revenue Code	250
Min. Negotiated Rate	$277.38
Max. Negotiated Rate	$277.38
Rate for Payer: Qualcare PPO/HMO/WC	$277.38

LISTERIA AB

Facility

$390.00

Service Code	HCPCS 86609
Hospital Charge Code	39900227
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LISTERIA AB

Facility

$390.00

Service Code	HCPCS 86609
Hospital Charge Code	39900227
Hospital Revenue Code	302
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$35.03
Rate for Payer: Aetna Medicare Advantage	$41.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.72
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.88
Rate for Payer: Clover Medicare Advantage	$12.24
Rate for Payer: EmblemHealth Commercial	$38.64
Rate for Payer: Humana Medicare Advantage	$13.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.88
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	$10.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.88
Rate for Payer: Wellcare Medicare Advantage	$12.88
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

LITHIUM

Facility

$189.00

Service Code	HCPCS 80178
Hospital Charge Code	38472461
Hospital Revenue Code	301
Min. Negotiated Rate	$5.29
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$17.98
Rate for Payer: Aetna Medicare Advantage	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.61
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	$23.98
Rate for Payer: Cigna Commercial	$94.50
Rate for Payer: Cigna Medicare Advantage	$6.61
Rate for Payer: Clover Medicare Advantage	$6.28
Rate for Payer: EmblemHealth Commercial	$19.83
Rate for Payer: Humana Medicare Advantage	$6.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.14
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.35
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$5.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.61
Rate for Payer: Wellcare Medicare Advantage	$6.61
Rate for Payer: Wellpoint Medicaid Managed Care	$5.37

LITHIUM

Facility

$189.00

Service Code	HCPCS 80178
Hospital Charge Code	38472461
Hospital Revenue Code	301
Min. Negotiated Rate	$28.35
Max. Negotiated Rate	$28.35
Rate for Payer: Qualcare PPO/HMO/WC	$28.35

LITHIUM 8 MEQ/5 ML SOL

Facility

$12.06

Service Code	NDC 54352763
Hospital Charge Code	6009773
Hospital Revenue Code	251
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$1.81
Rate for Payer: Qualcare PPO/HMO/WC	$1.81

LITHIUM 8 MEQ/5 ML SOL

Facility

$12.06

Service Code	NDC 54352763
Hospital Charge Code	6009773
Hospital Revenue Code	251
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$6.03
Rate for Payer: Aetna Commercial	$4.58
Rate for Payer: Aetna Medicare Advantage	$3.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.08
Rate for Payer: Cigna Commercial	$6.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.14
Rate for Payer: Oxford Commercial	$2.41
Rate for Payer: Qualcare PPO/HMO/WC	$1.81
Rate for Payer: UnitedHealthcare Commercial	$2.41
Rate for Payer: UnitedHealthcare Community & State	$0.38
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

LITHIUM CARB 150MG CAP

Facility

$4.00

Service Code	NDC 54852625
Hospital Charge Code	6063943128
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

LITHIUM CARB 150MG CAP

Facility

$4.00

Service Code	NDC 54852625
Hospital Charge Code	6063943128
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

LITHIUM CARBONATE 300 MG CAP

Facility

$4.00

Service Code	NDC 54852725
Hospital Charge Code	60627863
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

LITHIUM CARBONATE 300 MG CAP

Facility

$4.00

Service Code	NDC 54852725
Hospital Charge Code	60627863
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

LITHIUM CARBONATE 450 MG TER

Facility

$4.00

Service Code	NDC 54002025
Hospital Charge Code	60627862
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

LITHIUM CARBONATE 450 MG TER

Facility

$4.00

Service Code	NDC 54002025
Hospital Charge Code	60627862
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

LITHIUM, SERUM

Facility

$667.59

Service Code	HCPCS 80178
Hospital Charge Code	3001856
Hospital Revenue Code	301
Min. Negotiated Rate	$5.29
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$17.98
Rate for Payer: Aetna Medicare Advantage	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.61
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	$23.98
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$6.61
Rate for Payer: Clover Medicare Advantage	$6.28
Rate for Payer: EmblemHealth Commercial	$19.83
Rate for Payer: Humana Medicare Advantage	$6.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.61
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	$5.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.61
Rate for Payer: Wellcare Medicare Advantage	$6.61
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

LITHIUM, SERUM

Facility

$667.59

Service Code	HCPCS 80178
Hospital Charge Code	3001856
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

LITHLPXY,IN BLAD&REM FRAG,<2.5

Facility

$23,841.70

Service Code	HCPCS 52317
Hospital Charge Code	160000190
Hospital Revenue Code	360
Min. Negotiated Rate	$677.10
Max. Negotiated Rate	$15,191.14
Rate for Payer: Aetna Commercial	$11,390.73
Rate for Payer: Aetna Medicare Advantage	$13,568.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,191.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,191.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,187.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,191.14
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: Cigna Medicare Advantage	$4,187.77
Rate for Payer: Clover Medicare Advantage	$3,978.38
Rate for Payer: EmblemHealth Commercial	$12,563.31
Rate for Payer: Humana Medicare Advantage	$4,313.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,187.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,198.84
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,576.26
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$753.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,187.77
Rate for Payer: Wellcare Medicare Advantage	$4,187.77
Rate for Payer: Wellpoint Medicaid Managed Care	$677.10

LITHLPXY,IN BLAD&REM FRAG,<2.5

Facility

$23,841.70

Service Code	HCPCS 52317
Hospital Charge Code	160000190
Hospital Revenue Code	360
Min. Negotiated Rate	$3,576.26
Max. Negotiated Rate	$3,576.26
Rate for Payer: Qualcare PPO/HMO/WC	$3,576.26

LITHOLAPAXY,IN BLAD&REM F>2.5

Facility

$24,549.79

Service Code	HCPCS 52318
Hospital Charge Code	1600000270
Hospital Revenue Code	360
Min. Negotiated Rate	$697.21
Max. Negotiated Rate	$15,191.14
Rate for Payer: Aetna Commercial	$11,390.73
Rate for Payer: Aetna Medicare Advantage	$13,568.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,191.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,191.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,187.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,191.14
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: Cigna Medicare Advantage	$4,187.77
Rate for Payer: Clover Medicare Advantage	$3,978.38
Rate for Payer: EmblemHealth Commercial	$12,563.31
Rate for Payer: Humana Medicare Advantage	$4,313.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,187.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,382.95
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,682.47
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$775.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,187.77
Rate for Payer: Wellcare Medicare Advantage	$4,187.77
Rate for Payer: Wellpoint Medicaid Managed Care	$697.21

LITHOLAPAXY,IN BLAD&REM F>2.5

Facility

$24,549.79

Service Code	HCPCS 52318
Hospital Charge Code	1600000270
Hospital Revenue Code	360
Min. Negotiated Rate	$3,682.47
Max. Negotiated Rate	$3,682.47
Rate for Payer: Qualcare PPO/HMO/WC	$3,682.47

LITHOPLASTY BDC 7MM X 40CM

Facility

$16,500.00

Hospital Charge Code	270690506
Hospital Revenue Code	272
Min. Negotiated Rate	$2,475.00
Max. Negotiated Rate	$2,475.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00

Know your out-of-pocket cost for care.

All Charges