Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SEROMYCIN/250MG/CAP

Facility

$40.20

Service Code	NDC 13845120202
Hospital Charge Code	60634940
Hospital Revenue Code	250
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$20.10
Rate for Payer: Aetna Commercial	$15.28
Rate for Payer: Aetna Medicare Advantage	$12.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.25
Rate for Payer: Cigna Commercial	$20.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.45
Rate for Payer: Oxford Commercial	$8.04
Rate for Payer: Qualcare PPO/HMO/WC	$6.03
Rate for Payer: UnitedHealthcare Commercial	$8.04
Rate for Payer: UnitedHealthcare Community & State	$1.27
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

SEROMYCIN/250MG/CAP

Facility

$40.20

Service Code	NDC 13845120202
Hospital Charge Code	60634940
Hospital Revenue Code	250
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$6.03
Rate for Payer: Qualcare PPO/HMO/WC	$6.03

SEROQUEL 200MG TAB UD

Facility

$81.87

Service Code	NDC 68084053301
Hospital Charge Code	60635213
Hospital Revenue Code	250
Min. Negotiated Rate	$12.28
Max. Negotiated Rate	$12.28
Rate for Payer: Qualcare PPO/HMO/WC	$12.28

SEROQUEL 200MG TAB UD

Facility

$81.87

Service Code	NDC 68084053301
Hospital Charge Code	60635213
Hospital Revenue Code	250
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$40.94
Rate for Payer: Aetna Commercial	$31.11
Rate for Payer: Aetna Medicare Advantage	$24.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.88
Rate for Payer: Cigna Commercial	$40.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.29
Rate for Payer: Oxford Commercial	$16.37
Rate for Payer: Qualcare PPO/HMO/WC	$12.28
Rate for Payer: UnitedHealthcare Commercial	$16.37
Rate for Payer: UnitedHealthcare Community & State	$2.59
Rate for Payer: Wellpoint Medicaid Managed Care	$2.33

SEROQUEL 50MG TAB

Facility

$44.02

Service Code	NDC 310027810
Hospital Charge Code	60635585
Hospital Revenue Code	250
Min. Negotiated Rate	$1.25
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	$11.45
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	$1.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

SEROQUEL 50MG TAB

Facility

$44.02

Service Code	NDC 310027810
Hospital Charge Code	60635585
Hospital Revenue Code	250
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

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	$12.07
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	$112.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.38
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	$83.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.38
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	$110.50
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Commercial	$156.00
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	$12.07

SEROTONIN,BLOOD

Facility

$390.00

Service Code	HCPCS 84260
Hospital Charge Code	39900131
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
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	$112.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.38
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	$83.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.38
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	$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	$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	$11.08

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 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 REL ASSAY UNFR

Facility

$390.00

Service Code	HCPCS 86022
Hospital Charge Code	39900358
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
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	$66.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.64
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	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.64
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	$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	$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	$11.08

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 SERUM

Facility

$373.45

Service Code	HCPCS 84260
Hospital Charge Code	401184260
Hospital Revenue Code	301
Min. Negotiated Rate	$10.61
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	$112.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.38
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	$83.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.38
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	$97.10
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.02
Rate for Payer: UnitedHealthcare Commercial	$156.00
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	$10.61

SERO TYPING

Facility

$69.00

Service Code	HCPCS 87140
Hospital Charge Code	38475077
Hospital Revenue Code	309
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$156.00
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	$20.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.21
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	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.21
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	$17.94
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.35
Rate for Payer: UnitedHealthcare Commercial	$156.00
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	$1.96

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

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 100 MG TAB

Facility

$50.38

Service Code	NDC 49491041
Hospital Charge Code	6008700
Hospital Revenue Code	250
Min. Negotiated Rate	$1.43
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	$13.10
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	$1.59
Rate for Payer: Wellpoint Medicaid Managed Care	$1.43

SERTRALINE 20MG/ML ORAL

Facility

$7.50

Service Code	NDC 16714060102
Hospital Charge Code	606390295
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
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	$1.95
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	$0.24
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

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 25 MG TAB

Facility

$19.10

Service Code	NDC 68180035106
Hospital Charge Code	60629304
Hospital Revenue Code	250
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$9.55
Rate for Payer: Aetna Commercial	$7.26
Rate for Payer: Aetna Medicare Advantage	$5.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.87
Rate for Payer: Cigna Commercial	$9.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.97
Rate for Payer: Oxford Commercial	$3.82
Rate for Payer: Qualcare PPO/HMO/WC	$2.87
Rate for Payer: UnitedHealthcare Commercial	$3.82
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.54

SERTRALINE 25 MG TAB

Facility

$19.10

Service Code	NDC 68180035106
Hospital Charge Code	60629304
Hospital Revenue Code	250
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$2.87
Rate for Payer: Qualcare PPO/HMO/WC	$2.87

SERTRALINE 50 MG TAB

Facility

$50.38

Service Code	NDC 58151057588
Hospital Charge Code	60627781
Hospital Revenue Code	250
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$7.56
Rate for Payer: Qualcare PPO/HMO/WC	$7.56

SERTRALINE 50 MG TAB

Facility

$50.38

Service Code	NDC 58151057588
Hospital Charge Code	60627781
Hospital Revenue Code	250
Min. Negotiated Rate	$1.43
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	$13.10
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	$1.59
Rate for Payer: Wellpoint Medicaid Managed Care	$1.43

SERUM BACTERICIDAL TITER

Facility

$82.00

Service Code	HCPCS 87197
Hospital Charge Code	38477103
Hospital Revenue Code	309
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$12.30
Rate for Payer: Qualcare PPO/HMO/WC	$12.30

Know your out-of-pocket cost for care.

All Charges