Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

QUATTRO SPIKE MEDIUM 6143.2517

Facility

$7,425.00

Service Code	HCPCS C1889
Hospital Charge Code	270696763
Hospital Revenue Code	278
Min. Negotiated Rate	$210.87
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: Qualcare PPO/HMO/WC	$1,113.75
Rate for Payer: UnitedHealthcare Community & State	$234.63
Rate for Payer: Wellpoint Medicaid Managed Care	$210.87

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: 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	$210.87
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: Qualcare PPO/HMO/WC	$1,113.75
Rate for Payer: UnitedHealthcare Community & State	$234.63
Rate for Payer: Wellpoint Medicaid Managed Care	$210.87

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

QUELICIN/20MG/1ML

Facility

$76.18

Service Code	NDC 61553036465
Hospital Charge Code	60633794
Hospital Revenue Code	250
Min. Negotiated Rate	$2.16
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	$19.81
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	$2.41
Rate for Payer: Wellpoint Medicaid Managed Care	$2.16

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	$12.64
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	$66.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.75
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	$12.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.75
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	$520.57
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.33
Rate for Payer: UnitedHealthcare Commercial	$156.00
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	$56.86

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

QUEST TEST # 93883 VGKC

Facility

$2,002.17

Service Code	HCPCS 83519XU
Hospital Charge Code	3035450B
Hospital Revenue Code	301
Min. Negotiated Rate	$56.86
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	$520.56
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.33
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$63.27
Rate for Payer: Wellpoint Medicaid Managed Care	$56.86

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 100 MG TAB

Facility

$45.96

Service Code	NDC 54022125
Hospital Charge Code	60628749
Hospital Revenue Code	250
Min. Negotiated Rate	$1.31
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	$11.95
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	$1.45
Rate for Payer: Wellpoint Medicaid Managed Care	$1.31

QUETIAPINE 25 MG TAB

Facility

$26.80

Service Code	NDC 54022025
Hospital Charge Code	60628748
Hospital Revenue Code	250
Min. Negotiated Rate	$0.76
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	$6.97
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	$0.85
Rate for Payer: Wellpoint Medicaid Managed Care	$0.76

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	$3.05
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	$27.91
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	$3.39
Rate for Payer: Wellpoint Medicaid Managed Care	$3.05

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 XR 150 MG TAB

Facility

$109.75

Service Code	NDC 310028160
Hospital Charge Code	60630019
Hospital Revenue Code	250
Min. Negotiated Rate	$3.12
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	$28.54
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	$3.47
Rate for Payer: Wellpoint Medicaid Managed Care	$3.12

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

QUETIAPINE XR 200 MG TAB

Facility

$120.80

Service Code	NDC 310028239
Hospital Charge Code	60630020
Hospital Revenue Code	250
Min. Negotiated Rate	$18.12
Max. Negotiated Rate	$18.12
Rate for Payer: Qualcare PPO/HMO/WC	$18.12

QUETIAPINE XR 200 MG TAB

Facility

$120.80

Service Code	NDC 310028239
Hospital Charge Code	60630020
Hospital Revenue Code	250
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$60.40
Rate for Payer: Aetna Commercial	$45.90
Rate for Payer: Aetna Medicare Advantage	$36.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.80
Rate for Payer: Cigna Commercial	$60.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.41
Rate for Payer: Oxford Commercial	$24.16
Rate for Payer: Qualcare PPO/HMO/WC	$18.12
Rate for Payer: UnitedHealthcare Commercial	$24.16
Rate for Payer: UnitedHealthcare Community & State	$3.82
Rate for Payer: Wellpoint Medicaid Managed Care	$3.43

QUETIAPINE XR 50 MG TAB

Facility

$61.10

Service Code	NDC 310028060
Hospital Charge Code	60630018
Hospital Revenue Code	250
Min. Negotiated Rate	$9.16
Max. Negotiated Rate	$9.16
Rate for Payer: Qualcare PPO/HMO/WC	$9.16

QUETIAPINE XR 50 MG TAB

Facility

$61.10

Service Code	NDC 310028060
Hospital Charge Code	60630018
Hospital Revenue Code	250
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$30.55
Rate for Payer: Aetna Commercial	$23.22
Rate for Payer: Aetna Medicare Advantage	$18.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.58
Rate for Payer: Cigna Commercial	$30.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.89
Rate for Payer: Oxford Commercial	$12.22
Rate for Payer: Qualcare PPO/HMO/WC	$9.16
Rate for Payer: UnitedHealthcare Commercial	$12.22
Rate for Payer: UnitedHealthcare Community & State	$1.93
Rate for Payer: Wellpoint Medicaid Managed Care	$1.74

QUICKANCHOR MINI PLUS

Facility

$2,310.00

Hospital Charge Code	270671154
Hospital Revenue Code	278
Min. Negotiated Rate	$346.50
Max. Negotiated Rate	$559.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$462.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$559.02
Rate for Payer: Qualcare PPO/HMO/WC	$346.50

QUICKANCHOR MINI PLUS

Facility

$2,310.00

Hospital Charge Code	270671154
Hospital Revenue Code	278
Min. Negotiated Rate	$65.60
Max. Negotiated Rate	$1,155.00
Rate for Payer: Aetna Commercial	$877.80
Rate for Payer: Aetna Medicare Advantage	$693.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$589.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$589.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$462.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$589.05
Rate for Payer: Cigna Commercial	$1,155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$559.02
Rate for Payer: Qualcare PPO/HMO/WC	$346.50
Rate for Payer: UnitedHealthcare Community & State	$73.00
Rate for Payer: Wellpoint Medicaid Managed Care	$65.60

QUICKANCHOR MIRO PLUS #4/0 SUT

Facility

$2,335.00

Service Code	HCPCS C1713
Hospital Charge Code	270680084
Hospital Revenue Code	278
Min. Negotiated Rate	$66.31
Max. Negotiated Rate	$1,167.50
Rate for Payer: Aetna Commercial	$887.30
Rate for Payer: Aetna Medicare Advantage	$700.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$595.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$595.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$467.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$595.42
Rate for Payer: Cigna Commercial	$1,167.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$565.07
Rate for Payer: Qualcare PPO/HMO/WC	$350.25
Rate for Payer: UnitedHealthcare Community & State	$73.79
Rate for Payer: Wellpoint Medicaid Managed Care	$66.31

QUICKANCHOR MIRO PLUS #4/0 SUT

Facility

$2,335.00

Service Code	HCPCS C1713
Hospital Charge Code	270680084
Hospital Revenue Code	278
Min. Negotiated Rate	$350.25
Max. Negotiated Rate	$565.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$467.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$565.07
Rate for Payer: Qualcare PPO/HMO/WC	$350.25

Know your out-of-pocket cost for care.

All Charges