Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

LOPINAVIR/RITONAVIR 400-100/5M

Facility

$102.31

Service Code	NDC 74395646
Hospital Charge Code	60632263
Hospital Revenue Code	250
Min. Negotiated Rate	$2.91
Max. Negotiated Rate	$51.16
Rate for Payer: Aetna Commercial	$38.88
Rate for Payer: Aetna Medicare Advantage	$30.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.09
Rate for Payer: Cigna Commercial	$51.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.60
Rate for Payer: Oxford Commercial	$20.46
Rate for Payer: Qualcare PPO/HMO/WC	$15.35
Rate for Payer: UnitedHealthcare Commercial	$20.46
Rate for Payer: UnitedHealthcare Community & State	$3.23
Rate for Payer: Wellpoint Medicaid Managed Care	$2.91

LOPRESSOR/100MG/TAB

Facility

$4.00

Service Code	NDC 62584026701
Hospital Charge Code	60633323
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

LOPRESSOR/100MG/TAB

Facility

$4.00

Service Code	NDC 62584026701
Hospital Charge Code	60633323
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

LOPRESSOR 25 U/D

Facility

$4.00

Service Code	NDC 50742010701
Hospital Charge Code	60635145
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

LOPRESSOR 25 U/D

Facility

$4.00

Service Code	NDC 50742010701
Hospital Charge Code	60635145
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

LO-PROFILE LAPIDUS PLATE

Facility

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	270676947
Hospital Revenue Code	278
Min. Negotiated Rate	$8.52
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$114.00
Rate for Payer: Aetna Medicare Advantage	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.50
Rate for Payer: Cigna Commercial	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$45.00
Rate for Payer: UnitedHealthcare Community & State	$9.48
Rate for Payer: Wellpoint Medicaid Managed Care	$8.52

LO-PROFILE LAPIDUS PLATE

Facility

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	270676947
Hospital Revenue Code	278
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$72.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

LO PRO MTP PLT STD TI

Facility

$4,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270692422
Hospital Revenue Code	278
Min. Negotiated Rate	$127.09
Max. Negotiated Rate	$2,237.50
Rate for Payer: Aetna Commercial	$1,700.50
Rate for Payer: Aetna Medicare Advantage	$1,342.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,141.12
Rate for Payer: Cigna Commercial	$2,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: Qualcare PPO/HMO/WC	$671.25
Rate for Payer: UnitedHealthcare Community & State	$141.41
Rate for Payer: Wellpoint Medicaid Managed Care	$127.09

LO PRO MTP PLT STD TI

Facility

$4,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270692422
Hospital Revenue Code	278
Min. Negotiated Rate	$671.25
Max. Negotiated Rate	$1,082.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: Qualcare PPO/HMO/WC	$671.25

LOPROSCRW TM SS 2.7X22MMCORTEX

Facility

$225.00

Service Code	HCPCS C1713
Hospital Charge Code	270671911
Hospital Revenue Code	278
Min. Negotiated Rate	$6.39
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna Commercial	$85.50
Rate for Payer: Aetna Medicare Advantage	$67.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.38
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.45
Rate for Payer: Qualcare PPO/HMO/WC	$33.75
Rate for Payer: UnitedHealthcare Community & State	$7.11
Rate for Payer: Wellpoint Medicaid Managed Care	$6.39

LOPROSCRW TM SS 2.7X22MMCORTEX

Facility

$225.00

Service Code	HCPCS C1713
Hospital Charge Code	270671911
Hospital Revenue Code	278
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$54.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.45
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

LOPROSCRW TM SS 2.7X28MMCORTEX

Facility

$225.00

Service Code	HCPCS C1713
Hospital Charge Code	270671914
Hospital Revenue Code	278
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$54.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.45
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

LOPROSCRW TM SS 2.7X28MMCORTEX

Facility

$225.00

Service Code	HCPCS C1713
Hospital Charge Code	270671914
Hospital Revenue Code	278
Min. Negotiated Rate	$6.39
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna Commercial	$85.50
Rate for Payer: Aetna Medicare Advantage	$67.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.38
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.45
Rate for Payer: Qualcare PPO/HMO/WC	$33.75
Rate for Payer: UnitedHealthcare Community & State	$7.11
Rate for Payer: Wellpoint Medicaid Managed Care	$6.39

LORATADINE 10 MG TAB UD

Facility

$5.76

Service Code	NDC 51079024620
Hospital Charge Code	6017792
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$0.86
Rate for Payer: Qualcare PPO/HMO/WC	$0.86

LORATADINE 10 MG TAB UD

Facility

$5.76

Service Code	NDC 51079024620
Hospital Charge Code	6017792
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$2.88
Rate for Payer: Aetna Commercial	$2.19
Rate for Payer: Aetna Medicare Advantage	$1.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.47
Rate for Payer: Cigna Commercial	$2.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.86
Rate for Payer: UnitedHealthcare Commercial	$1.15
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

LORAZAPAM

Facility

$390.00

Service Code	HCPCS 80346
Hospital Charge Code	39900442
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LORAZAPAM

Facility

$390.00

Service Code	HCPCS 80346
Hospital Charge Code	39900442
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$20.96
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

LORAZEPAM 0.5 MG TAB

Facility

$4.69

Service Code	NDC 51079041721
Hospital Charge Code	60629823
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.35
Rate for Payer: Aetna Commercial	$1.78
Rate for Payer: Aetna Medicare Advantage	$1.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.20
Rate for Payer: Cigna Commercial	$2.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.22
Rate for Payer: Oxford Commercial	$0.94
Rate for Payer: Qualcare PPO/HMO/WC	$0.70
Rate for Payer: UnitedHealthcare Commercial	$0.94
Rate for Payer: UnitedHealthcare Community & State	$0.15
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

LORAZEPAM 0.5 MG TAB

Facility

$4.69

Service Code	NDC 51079041721
Hospital Charge Code	60629823
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$0.70
Rate for Payer: Qualcare PPO/HMO/WC	$0.70

LORAZEPAM 1 MG TAB

Facility

$6.10

Service Code	NDC 51079038620
Hospital Charge Code	6021125
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$0.92
Rate for Payer: Qualcare PPO/HMO/WC	$0.92

LORAZEPAM 1 MG TAB

Facility

$6.10

Service Code	NDC 51079038620
Hospital Charge Code	6021125
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

LORAZEPAM 2MG/ML 10 ML VIAL

Facility

$6.03

Service Code	HCPCS J2060
Hospital Charge Code	60630218
Hospital Revenue Code	636
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$1.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.46
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

LORAZEPAM 2MG/ML 10 ML VIAL

Facility

$6.03

Service Code	HCPCS J2060
Hospital Charge Code	60630218
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.02
Rate for Payer: Aetna Commercial	$2.29
Rate for Payer: Aetna Medicare Advantage	$1.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.54
Rate for Payer: Cigna Commercial	$3.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.46
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

LORAZEPAM 2 MG/ML SOL

Facility

$40.00

Service Code	HCPCS J2060
Hospital Charge Code	60627845
Hospital Revenue Code	636
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna Commercial	$15.20
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.20
Rate for Payer: Cigna Commercial	$20.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.68
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Community & State	$1.26
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

LORAZEPAM 2 MG/ML SOL

Facility

$40.00

Service Code	HCPCS J2060
Hospital Charge Code	60627845
Hospital Revenue Code	636
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$9.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.68
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

Know your out-of-pocket cost for care.

All Charges