Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SEROQUEL 50MG TAB

Facility

$44.02

Service Code	NDC 310027810
Hospital Charge Code	60635585
Hospital Revenue Code	250
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$22.01
Rate for Payer: Aetna Commercial	$16.73
Rate for Payer: Aetna Medicare Advantage	$13.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.23
Rate for Payer: Cigna Commercial	$22.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.21
Rate for Payer: Oxford Commercial	$8.80
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$8.80
Rate for Payer: UnitedHealthcare Community & State	$1.06
Rate for Payer: Wellpoint Medicaid Managed Care	$1.17

SEROQUEL XR 300MG TAB

Facility

$48.00

Hospital Charge Code	60635656
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

SEROQUEL XR 300MG TAB

Facility

$48.00

Hospital Charge Code	60635656
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$18.24
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.40
Rate for Payer: Oxford Commercial	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$9.60
Rate for Payer: UnitedHealthcare Community & State	$1.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

SEROQUEL XR 50MG

Facility

$27.18

Hospital Charge Code	60635820
Hospital Revenue Code	250
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$13.59
Rate for Payer: Aetna Commercial	$10.33
Rate for Payer: Aetna Medicare Advantage	$8.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.93
Rate for Payer: Cigna Commercial	$13.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.15
Rate for Payer: Oxford Commercial	$5.44
Rate for Payer: Qualcare PPO/HMO/WC	$4.08
Rate for Payer: UnitedHealthcare Commercial	$5.44
Rate for Payer: UnitedHealthcare Community & State	$0.66
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

SEROQUEL XR 50MG

Facility

$27.18

Hospital Charge Code	60635820
Hospital Revenue Code	250
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$4.08
Rate for Payer: Qualcare PPO/HMO/WC	$4.08

SEROTONIN

Facility

$425.00

Service Code	HCPCS 84260
Hospital Charge Code	38472666
Hospital Revenue Code	301
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$63.75
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

SEROTONIN

Facility

$425.00

Service Code	HCPCS 84260
Hospital Charge Code	38472666
Hospital Revenue Code	301
Min. Negotiated Rate	$11.26
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$84.27
Rate for Payer: Aetna Medicare Advantage	$100.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$97.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.83
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: Cigna Medicare Advantage	$30.98
Rate for Payer: Clover Medicare Advantage	$29.43
Rate for Payer: EmblemHealth Commercial	$92.94
Rate for Payer: Humana Medicare Advantage	$31.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$30.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$24.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$30.98
Rate for Payer: Wellcare Medicare Advantage	$30.98
Rate for Payer: Wellpoint Medicaid Managed Care	$11.26

SEROTONIN,BLOOD

Facility

$390.00

Service Code	HCPCS 84260
Hospital Charge Code	39900131
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SEROTONIN,BLOOD

Facility

$390.00

Service Code	HCPCS 84260
Hospital Charge Code	39900131
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$84.27
Rate for Payer: Aetna Medicare Advantage	$100.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$97.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.83
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$30.98
Rate for Payer: Clover Medicare Advantage	$29.43
Rate for Payer: EmblemHealth Commercial	$92.94
Rate for Payer: Humana Medicare Advantage	$31.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$30.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$24.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$30.98
Rate for Payer: Wellcare Medicare Advantage	$30.98
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

SEROTONIN REL ASSAY UNFR

Facility

$390.00

Service Code	HCPCS 86022
Hospital Charge Code	39900358
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$49.97
Rate for Payer: Aetna Medicare Advantage	$59.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.31
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$18.37
Rate for Payer: Clover Medicare Advantage	$17.45
Rate for Payer: EmblemHealth Commercial	$55.11
Rate for Payer: Humana Medicare Advantage	$18.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.37
Rate for Payer: Wellcare Medicare Advantage	$18.37
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

SEROTONIN REL ASSAY UNFR

Facility

$390.00

Service Code	HCPCS 86022
Hospital Charge Code	39900358
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SEROTONIN SERUM

Facility

$373.45

Service Code	HCPCS 84260
Hospital Charge Code	401184260
Hospital Revenue Code	301
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$186.72
Rate for Payer: Aetna Commercial	$84.27
Rate for Payer: Aetna Medicare Advantage	$100.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$97.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.83
Rate for Payer: Cigna Commercial	$186.72
Rate for Payer: Cigna Medicare Advantage	$30.98
Rate for Payer: Clover Medicare Advantage	$29.43
Rate for Payer: EmblemHealth Commercial	$92.94
Rate for Payer: Humana Medicare Advantage	$31.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$30.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.03
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.02
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$24.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$30.98
Rate for Payer: Wellcare Medicare Advantage	$30.98
Rate for Payer: Wellpoint Medicaid Managed Care	$9.90

SEROTONIN SERUM

Facility

$373.45

Service Code	HCPCS 84260
Hospital Charge Code	401184260
Hospital Revenue Code	301
Min. Negotiated Rate	$56.02
Max. Negotiated Rate	$56.02
Rate for Payer: Qualcare PPO/HMO/WC	$56.02

SEROTONIN, WHOLE BLOOD

Facility

$460.85

Service Code	HCPCS 84260
Hospital Charge Code	3002417
Hospital Revenue Code	301
Min. Negotiated Rate	$69.13
Max. Negotiated Rate	$69.13
Rate for Payer: Qualcare PPO/HMO/WC	$69.13

SEROTONIN, WHOLE BLOOD

Facility

$460.85

Service Code	HCPCS 84260
Hospital Charge Code	3002417
Hospital Revenue Code	301
Min. Negotiated Rate	$12.21
Max. Negotiated Rate	$230.43
Rate for Payer: Aetna Commercial	$84.27
Rate for Payer: Aetna Medicare Advantage	$100.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$97.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.83
Rate for Payer: Cigna Commercial	$230.43
Rate for Payer: Cigna Medicare Advantage	$30.98
Rate for Payer: Clover Medicare Advantage	$29.43
Rate for Payer: EmblemHealth Commercial	$92.94
Rate for Payer: Humana Medicare Advantage	$31.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$30.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.13
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$24.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$30.98
Rate for Payer: Wellcare Medicare Advantage	$30.98
Rate for Payer: Wellpoint Medicaid Managed Care	$12.21

SERO TYPING

Facility

$69.00

Service Code	HCPCS 87140
Hospital Charge Code	38475077
Hospital Revenue Code	309
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$15.15
Rate for Payer: Aetna Medicare Advantage	$18.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.11
Rate for Payer: Cigna Commercial	$34.50
Rate for Payer: Cigna Medicare Advantage	$5.57
Rate for Payer: Clover Medicare Advantage	$5.29
Rate for Payer: EmblemHealth Commercial	$16.71
Rate for Payer: Humana Medicare Advantage	$5.74
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.35
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.57
Rate for Payer: Wellcare Medicare Advantage	$5.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1.83

SERO TYPING

Facility

$69.00

Service Code	HCPCS 87140
Hospital Charge Code	38475077
Hospital Revenue Code	309
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$10.35
Rate for Payer: Qualcare PPO/HMO/WC	$10.35

SERPASIL/0.1MG/TAB

Facility

$3.00

Hospital Charge Code	60634396
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SERPASIL/0.1MG/TAB

Facility

$3.00

Hospital Charge Code	60634396
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

SERPASIL/0.25MG/TAB

Facility

$3.00

Hospital Charge Code	60633877
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

SERPASIL/0.25MG/TAB

Facility

$3.00

Hospital Charge Code	60633877
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SERTRALINE 100 MG TAB

Facility

$50.38

Service Code	NDC 49491041
Hospital Charge Code	6008700
Hospital Revenue Code	250
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$25.19
Rate for Payer: Aetna Commercial	$19.14
Rate for Payer: Aetna Medicare Advantage	$15.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.85
Rate for Payer: Cigna Commercial	$25.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.11
Rate for Payer: Oxford Commercial	$10.08
Rate for Payer: Qualcare PPO/HMO/WC	$7.56
Rate for Payer: UnitedHealthcare Commercial	$10.08
Rate for Payer: UnitedHealthcare Community & State	$1.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.34

SERTRALINE 100 MG TAB

Facility

$50.38

Service Code	NDC 49491041
Hospital Charge Code	6008700
Hospital Revenue Code	250
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$7.56
Rate for Payer: Qualcare PPO/HMO/WC	$7.56

SERTRALINE 20MG/ML ORAL

Facility

$7.50

Service Code	NDC 16714060102
Hospital Charge Code	606390295
Hospital Revenue Code	250
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.12

SERTRALINE 20MG/ML ORAL

Facility

$7.50

Service Code	NDC 16714060102
Hospital Charge Code	606390295
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Commercial	$2.85
Rate for Payer: Aetna Medicare Advantage	$2.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.91
Rate for Payer: Cigna Commercial	$3.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.25
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.12
Rate for Payer: UnitedHealthcare Commercial	$1.50
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

Know your out-of-pocket cost for care.

All Charges