Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DEXT 4.25% 5000ML PD 5B5195

Facility

$71.25

Hospital Charge Code	270606339
Hospital Revenue Code	270
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$35.62
Rate for Payer: Aetna Commercial	$27.07
Rate for Payer: Aetna Medicare Advantage	$21.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.17
Rate for Payer: Cigna Commercial	$35.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.38
Rate for Payer: Oxford Commercial	$14.25
Rate for Payer: Qualcare PPO/HMO/WC	$10.69
Rate for Payer: UnitedHealthcare Commercial	$14.25
Rate for Payer: UnitedHealthcare Community & State	$1.72
Rate for Payer: Wellpoint Medicaid Managed Care	$1.89

DEXT 5%/0.225% NACL 1000ml

Facility

$5.05

Hospital Charge Code	270649404
Hospital Revenue Code	272
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$0.76
Rate for Payer: Qualcare PPO/HMO/WC	$0.76

DEXT 5%/0.225% NACL 1000ml

Facility

$5.05

Hospital Charge Code	270649404
Hospital Revenue Code	272
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.52
Rate for Payer: Aetna Commercial	$1.92
Rate for Payer: Aetna Medicare Advantage	$1.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.29
Rate for Payer: Cigna Commercial	$2.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.51
Rate for Payer: Oxford Commercial	$1.01
Rate for Payer: Qualcare PPO/HMO/WC	$0.76
Rate for Payer: UnitedHealthcare Commercial	$1.01
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

DEXT 5%/0.45% NACL 1000ml

Facility

$22.50

Hospital Charge Code	270649414
Hospital Revenue Code	272
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$3.38
Rate for Payer: Qualcare PPO/HMO/WC	$3.38

DEXT 5%/0.45% NACL 1000ml

Facility

$22.50

Hospital Charge Code	270649414
Hospital Revenue Code	272
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna Commercial	$8.55
Rate for Payer: Aetna Medicare Advantage	$6.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.74
Rate for Payer: Cigna Commercial	$11.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.75
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.38
Rate for Payer: UnitedHealthcare Commercial	$4.50
Rate for Payer: UnitedHealthcare Community & State	$0.54
Rate for Payer: Wellpoint Medicaid Managed Care	$0.60

DEXT 5%/0.45% NACL 500ml

Facility

$22.50

Hospital Charge Code	270649415
Hospital Revenue Code	272
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna Commercial	$8.55
Rate for Payer: Aetna Medicare Advantage	$6.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.74
Rate for Payer: Cigna Commercial	$11.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.75
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.38
Rate for Payer: UnitedHealthcare Commercial	$4.50
Rate for Payer: UnitedHealthcare Community & State	$0.54
Rate for Payer: Wellpoint Medicaid Managed Care	$0.60

DEXT 5%/0.45% NACL 500ml

Facility

$22.50

Hospital Charge Code	270649415
Hospital Revenue Code	272
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$3.38
Rate for Payer: Qualcare PPO/HMO/WC	$3.38

DEXT 5%/0.9% NACL 1000ml

Facility

$22.50

Hospital Charge Code	270649417
Hospital Revenue Code	272
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$3.38
Rate for Payer: Qualcare PPO/HMO/WC	$3.38

DEXT 5%/0.9% NACL 1000ml

Facility

$22.50

Hospital Charge Code	270649417
Hospital Revenue Code	272
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna Commercial	$8.55
Rate for Payer: Aetna Medicare Advantage	$6.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.74
Rate for Payer: Cigna Commercial	$11.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.75
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.38
Rate for Payer: UnitedHealthcare Commercial	$4.50
Rate for Payer: UnitedHealthcare Community & State	$0.54
Rate for Payer: Wellpoint Medicaid Managed Care	$0.60

DEXT 5%/0.9% NACL 500ml

Facility

$5.95

Hospital Charge Code	270649416
Hospital Revenue Code	272
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.98
Rate for Payer: Aetna Commercial	$2.26
Rate for Payer: Aetna Medicare Advantage	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.52
Rate for Payer: Cigna Commercial	$2.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.78
Rate for Payer: Oxford Commercial	$1.19
Rate for Payer: Qualcare PPO/HMO/WC	$0.89
Rate for Payer: UnitedHealthcare Commercial	$1.19
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

DEXT 5%/0.9% NACL 500ml

Facility

$5.95

Hospital Charge Code	270649416
Hospital Revenue Code	272
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$0.89
Rate for Payer: Qualcare PPO/HMO/WC	$0.89

DEXT 50% INJ 50ML

Facility

$80.65

Hospital Charge Code	6001812
Hospital Revenue Code	250
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$40.33
Rate for Payer: Aetna Commercial	$30.65
Rate for Payer: Aetna Medicare Advantage	$24.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.57
Rate for Payer: Cigna Commercial	$40.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.20
Rate for Payer: Oxford Commercial	$16.13
Rate for Payer: Qualcare PPO/HMO/WC	$12.10
Rate for Payer: UnitedHealthcare Commercial	$16.13
Rate for Payer: UnitedHealthcare Community & State	$1.94
Rate for Payer: Wellpoint Medicaid Managed Care	$2.14

DEXT 50% INJ 50ML

Facility

$80.65

Hospital Charge Code	6001812
Hospital Revenue Code	250
Min. Negotiated Rate	$12.10
Max. Negotiated Rate	$12.10
Rate for Payer: Qualcare PPO/HMO/WC	$12.10

DEXT 5% 1000ML

Facility

$11.25

Hospital Charge Code	270040105
Hospital Revenue Code	258
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

DEXT 5% 1000ML

Facility

$11.25

Hospital Charge Code	270040105
Hospital Revenue Code	258
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$4.28
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.38
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$2.25
Rate for Payer: UnitedHealthcare Community & State	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

DEXT 5% 1000ML *****

Facility

$8.00

Hospital Charge Code	7000086
Hospital Revenue Code	258
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.04
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.40
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$1.60
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

DEXT 5% 1000ML *****

Facility

$8.00

Hospital Charge Code	7000086
Hospital Revenue Code	258
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

DEXT 5% 100ML

Facility

$8.00

Hospital Charge Code	270649138
Hospital Revenue Code	258
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

DEXT 5% 100ML

Facility

$8.00

Hospital Charge Code	270649138
Hospital Revenue Code	258
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.04
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.40
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$1.60
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

DEXT 5% 100ML ADD-LINE

Facility

$16.85

Hospital Charge Code	270040115
Hospital Revenue Code	258
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$8.43
Rate for Payer: Aetna Commercial	$6.40
Rate for Payer: Aetna Medicare Advantage	$5.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.30
Rate for Payer: Cigna Commercial	$8.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.05
Rate for Payer: Oxford Commercial	$3.37
Rate for Payer: Qualcare PPO/HMO/WC	$2.53
Rate for Payer: UnitedHealthcare Commercial	$3.37
Rate for Payer: UnitedHealthcare Community & State	$0.41
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

DEXT 5% 100ML ADD-LINE

Facility

$16.85

Hospital Charge Code	270040115
Hospital Revenue Code	258
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$2.53
Rate for Payer: Qualcare PPO/HMO/WC	$2.53

DEXT 5% 100ML ADD-LINE******

Facility

$10.00

Hospital Charge Code	7000094
Hospital Revenue Code	258
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$5.00
Rate for Payer: Aetna Commercial	$3.80
Rate for Payer: Aetna Medicare Advantage	$3.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.55
Rate for Payer: Cigna Commercial	$5.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.00
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.50
Rate for Payer: UnitedHealthcare Commercial	$2.00
Rate for Payer: UnitedHealthcare Community & State	$0.24
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

DEXT 5% 100ML ADD-LINE******

Facility

$10.00

Hospital Charge Code	7000094
Hospital Revenue Code	258
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.50

DEXT 5% 100ML ADDV

Facility

$74.90

Hospital Charge Code	60627947
Hospital Revenue Code	250
Min. Negotiated Rate	$11.23
Max. Negotiated Rate	$11.23
Rate for Payer: Qualcare PPO/HMO/WC	$11.23

DEXT 5% 100ML ADDV

Facility

$74.90

Hospital Charge Code	60627947
Hospital Revenue Code	250
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$37.45
Rate for Payer: Aetna Commercial	$28.46
Rate for Payer: Aetna Medicare Advantage	$22.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.10
Rate for Payer: Cigna Commercial	$37.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.47
Rate for Payer: Oxford Commercial	$14.98
Rate for Payer: Qualcare PPO/HMO/WC	$11.23
Rate for Payer: UnitedHealthcare Commercial	$14.98
Rate for Payer: UnitedHealthcare Community & State	$1.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1.98

Know your out-of-pocket cost for care.

All Charges