Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

QUARRTO LINK ANCHOR 4.5MM SP

Facility

$2,275.00

Service Code	HCPCS C1713
Hospital Charge Code	270683673
Hospital Revenue Code	278
Min. Negotiated Rate	$54.83
Max. Negotiated Rate	$1,137.50
Rate for Payer: Aetna Commercial	$864.50
Rate for Payer: Aetna Medicare Advantage	$682.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$580.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$580.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$455.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$580.12
Rate for Payer: Cigna Commercial	$1,137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$550.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$500.50
Rate for Payer: Qualcare PPO/HMO/WC	$341.25
Rate for Payer: UnitedHealthcare Community & State	$54.83
Rate for Payer: Wellpoint Medicaid Managed Care	$60.29

QUATTRO SPIKE MEDIUM 6143.2517

Facility

$7,425.00

Service Code	HCPCS C1889
Hospital Charge Code	270696763
Hospital Revenue Code	278
Min. Negotiated Rate	$178.94
Max. Negotiated Rate	$3,712.50
Rate for Payer: Aetna Commercial	$2,821.50
Rate for Payer: Aetna Medicare Advantage	$2,227.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,893.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,893.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,485.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,893.38
Rate for Payer: Cigna Commercial	$3,712.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,796.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,113.75
Rate for Payer: UnitedHealthcare Community & State	$178.94
Rate for Payer: Wellpoint Medicaid Managed Care	$196.76

QUATTRO SPIKE MEDIUM 6143.2517

Facility

$7,425.00

Service Code	HCPCS C1889
Hospital Charge Code	270696763
Hospital Revenue Code	278
Min. Negotiated Rate	$1,113.75
Max. Negotiated Rate	$1,796.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,485.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,796.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,113.75

QUATTRO SPIKE SHORT

Facility

$7,425.00

Service Code	HCPCS C1889
Hospital Charge Code	270697446
Hospital Revenue Code	278
Min. Negotiated Rate	$178.94
Max. Negotiated Rate	$3,712.50
Rate for Payer: Aetna Commercial	$2,821.50
Rate for Payer: Aetna Medicare Advantage	$2,227.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,893.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,893.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,485.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,893.38
Rate for Payer: Cigna Commercial	$3,712.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,796.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,113.75
Rate for Payer: UnitedHealthcare Community & State	$178.94
Rate for Payer: Wellpoint Medicaid Managed Care	$196.76

QUATTRO SPIKE SHORT

Facility

$7,425.00

Service Code	HCPCS C1889
Hospital Charge Code	270697446
Hospital Revenue Code	278
Min. Negotiated Rate	$1,113.75
Max. Negotiated Rate	$1,796.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,485.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,796.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,113.75

QUELICIN/20MG/1ML

Facility

$76.18

Service Code	NDC 61553036465
Hospital Charge Code	60633794
Hospital Revenue Code	250
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$38.09
Rate for Payer: Aetna Commercial	$28.95
Rate for Payer: Aetna Medicare Advantage	$22.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.43
Rate for Payer: Cigna Commercial	$38.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.85
Rate for Payer: Oxford Commercial	$15.24
Rate for Payer: Qualcare PPO/HMO/WC	$11.43
Rate for Payer: UnitedHealthcare Commercial	$15.24
Rate for Payer: UnitedHealthcare Community & State	$1.84
Rate for Payer: Wellpoint Medicaid Managed Care	$2.02

QUELICIN/20MG/1ML

Facility

$76.18

Service Code	NDC 61553036465
Hospital Charge Code	60633794
Hospital Revenue Code	250
Min. Negotiated Rate	$11.43
Max. Negotiated Rate	$11.43
Rate for Payer: Qualcare PPO/HMO/WC	$11.43

QUESTRAN/EACH

Facility

$7.00

Hospital Charge Code	60633795
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

QUESTRAN/EACH

Facility

$7.00

Hospital Charge Code	60633795
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

QUESTRAN LIGHT

Facility

$5.00

Hospital Charge Code	60635017
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

QUESTRAN LIGHT

Facility

$5.00

Hospital Charge Code	60635017
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

QUEST SPECIMEN PROCESSING FEE

Facility

$6.85

Hospital Charge Code	3000974
Hospital Revenue Code	300
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$1.03
Rate for Payer: Qualcare PPO/HMO/WC	$1.03

QUEST SPECIMEN PROCESSING FEE

Facility

$6.85

Hospital Charge Code	3000974
Hospital Revenue Code	300
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$2.60
Rate for Payer: Aetna Medicare Advantage	$2.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.75
Rate for Payer: Cigna Commercial	$3.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.06
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.03
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.18

QUEST TEST # 93882 VGKC

Facility

$2,002.18

Service Code	HCPCS 83519
Hospital Charge Code	3035450A
Hospital Revenue Code	301
Min. Negotiated Rate	$300.33
Max. Negotiated Rate	$300.33
Rate for Payer: Qualcare PPO/HMO/WC	$300.33

QUEST TEST # 93882 VGKC

Facility

$2,002.18

Service Code	HCPCS 83519
Hospital Charge Code	3035450A
Hospital Revenue Code	301
Min. Negotiated Rate	$14.72
Max. Negotiated Rate	$1,001.09
Rate for Payer: Aetna Commercial	$50.05
Rate for Payer: Aetna Medicare Advantage	$59.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.42
Rate for Payer: Cigna Commercial	$1,001.09
Rate for Payer: Cigna Medicare Advantage	$18.40
Rate for Payer: Clover Medicare Advantage	$17.48
Rate for Payer: EmblemHealth Commercial	$55.20
Rate for Payer: Humana Medicare Advantage	$18.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$600.65
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.33
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.40
Rate for Payer: Wellcare Medicare Advantage	$18.40
Rate for Payer: Wellpoint Medicaid Managed Care	$53.06

QUEST TEST # 93883 VGKC

Facility

$2,002.17

Service Code	HCPCS 83519XU
Hospital Charge Code	3035450B
Hospital Revenue Code	301
Min. Negotiated Rate	$48.25
Max. Negotiated Rate	$1,001.09
Rate for Payer: Aetna Commercial	$760.82
Rate for Payer: Aetna Medicare Advantage	$600.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.55
Rate for Payer: Cigna Commercial	$1,001.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$600.65
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.33
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$48.25
Rate for Payer: Wellpoint Medicaid Managed Care	$53.06

QUEST TEST # 93883 VGKC

Facility

$2,002.17

Service Code	HCPCS 83519XU
Hospital Charge Code	3035450B
Hospital Revenue Code	301
Min. Negotiated Rate	$300.33
Max. Negotiated Rate	$300.33
Rate for Payer: Qualcare PPO/HMO/WC	$300.33

QUETIAPINE 100 MG TAB

Facility

$45.96

Service Code	NDC 54022125
Hospital Charge Code	60628749
Hospital Revenue Code	250
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$22.98
Rate for Payer: Aetna Commercial	$17.46
Rate for Payer: Aetna Medicare Advantage	$13.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.72
Rate for Payer: Cigna Commercial	$22.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.79
Rate for Payer: Oxford Commercial	$9.19
Rate for Payer: Qualcare PPO/HMO/WC	$6.89
Rate for Payer: UnitedHealthcare Commercial	$9.19
Rate for Payer: UnitedHealthcare Community & State	$1.11
Rate for Payer: Wellpoint Medicaid Managed Care	$1.22

QUETIAPINE 100 MG TAB

Facility

$45.96

Service Code	NDC 54022125
Hospital Charge Code	60628749
Hospital Revenue Code	250
Min. Negotiated Rate	$6.89
Max. Negotiated Rate	$6.89
Rate for Payer: Qualcare PPO/HMO/WC	$6.89

QUETIAPINE 25 MG TAB

Facility

$26.80

Service Code	NDC 54022025
Hospital Charge Code	60628748
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
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	$8.04
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	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.71

QUETIAPINE 25 MG TAB

Facility

$26.80

Service Code	NDC 54022025
Hospital Charge Code	60628748
Hospital Revenue Code	250
Min. Negotiated Rate	$4.02
Max. Negotiated Rate	$4.02
Rate for Payer: Qualcare PPO/HMO/WC	$4.02

QUETIAPINE 300MG TAB

Facility

$107.33

Service Code	NDC 68084053401
Hospital Charge Code	6063943168
Hospital Revenue Code	250
Min. Negotiated Rate	$16.10
Max. Negotiated Rate	$16.10
Rate for Payer: Qualcare PPO/HMO/WC	$16.10

QUETIAPINE 300MG TAB

Facility

$107.33

Service Code	NDC 68084053401
Hospital Charge Code	6063943168
Hospital Revenue Code	250
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$53.66
Rate for Payer: Aetna Commercial	$40.79
Rate for Payer: Aetna Medicare Advantage	$32.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.37
Rate for Payer: Cigna Commercial	$53.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.20
Rate for Payer: Oxford Commercial	$21.47
Rate for Payer: Qualcare PPO/HMO/WC	$16.10
Rate for Payer: UnitedHealthcare Commercial	$21.47
Rate for Payer: UnitedHealthcare Community & State	$2.59
Rate for Payer: Wellpoint Medicaid Managed Care	$2.84

QUETIAPINE XR 150 MG TAB

Facility

$109.75

Service Code	NDC 310028160
Hospital Charge Code	60630019
Hospital Revenue Code	250
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$54.88
Rate for Payer: Aetna Commercial	$41.70
Rate for Payer: Aetna Medicare Advantage	$32.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.99
Rate for Payer: Cigna Commercial	$54.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.92
Rate for Payer: Oxford Commercial	$21.95
Rate for Payer: Qualcare PPO/HMO/WC	$16.46
Rate for Payer: UnitedHealthcare Commercial	$21.95
Rate for Payer: UnitedHealthcare Community & State	$2.64
Rate for Payer: Wellpoint Medicaid Managed Care	$2.91

QUETIAPINE XR 150 MG TAB

Facility

$109.75

Service Code	NDC 310028160
Hospital Charge Code	60630019
Hospital Revenue Code	250
Min. Negotiated Rate	$16.46
Max. Negotiated Rate	$16.46
Rate for Payer: Qualcare PPO/HMO/WC	$16.46

Know your out-of-pocket cost for care.

All Charges