Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DEXT 5% 50ML ADD-LINE ****

Facility

$4.00

Hospital Charge Code	7000862
Hospital Revenue Code	258
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DEXT 5% 50ML ADDV

Facility

$74.90

Hospital Charge Code	60627952
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% 50ML ADDV

Facility

$74.90

Hospital Charge Code	60627952
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

DEXT 5% 5OML ADD-LINE

Facility

$11.25

Hospital Charge Code	270040120
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% 5OML ADD-LINE

Facility

$11.25

Hospital Charge Code	270040120
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% .9% NACL 40CL 1000cc

Facility

$11.25

Hospital Charge Code	270649727
Hospital Revenue Code	270
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

DEXT 5% .9% NACL 40CL 1000cc

Facility

$11.25

Hospital Charge Code	270649727
Hospital Revenue Code	270
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% ADD-LINE 50ML******

Facility

$4.00

Hospital Charge Code	7000771
Hospital Revenue Code	258
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DEXT 5% ADD-LINE 50ML******

Facility

$4.00

Hospital Charge Code	7000771
Hospital Revenue Code	258
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

DEXT 5% INJ 1000ml

Facility

$5.10

Hospital Charge Code	270649402
Hospital Revenue Code	272
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.55
Rate for Payer: Aetna Commercial	$1.94
Rate for Payer: Aetna Medicare Advantage	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.30
Rate for Payer: Cigna Commercial	$2.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.53
Rate for Payer: Oxford Commercial	$1.02
Rate for Payer: Qualcare PPO/HMO/WC	$0.77
Rate for Payer: UnitedHealthcare Commercial	$1.02
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

DEXT 5% INJ 1000ml

Facility

$5.10

Hospital Charge Code	270649402
Hospital Revenue Code	272
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$0.77
Rate for Payer: Qualcare PPO/HMO/WC	$0.77

DEXT 5%/KCL 20MeQ 1000ML

Facility

$9.00

Hospital Charge Code	6012389
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

DEXT 5%/KCL 20MeQ 1000ML

Facility

$9.00

Hospital Charge Code	6012389
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Oxford Commercial	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

DEXT 5%/KCL 40MeQ 1000ML

Facility

$9.00

Hospital Charge Code	6012397
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

DEXT 5%/KCL 40MeQ 1000ML

Facility

$9.00

Hospital Charge Code	6012397
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Oxford Commercial	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

DEXT 5%/LACT RING 1000ML

Facility

$11.25

Hospital Charge Code	270040180
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%/LACT RING 1000ML

Facility

$11.25

Hospital Charge Code	270040180
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%/LACT RING 1000ML******

Facility

$21.00

Hospital Charge Code	7000334
Hospital Revenue Code	258
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

DEXT 5%/LACT RING 1000ML******

Facility

$21.00

Hospital Charge Code	7000334
Hospital Revenue Code	258
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$7.98
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.30
Rate for Payer: Oxford Commercial	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$4.20
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

DEXT 5%/LACT RING 500ML

Facility

$11.25

Hospital Charge Code	270040185
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%/LACT RING 500ML

Facility

$11.25

Hospital Charge Code	270040185
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%/LACT RING 500ML******

Facility

$21.00

Hospital Charge Code	7000326
Hospital Revenue Code	258
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

DEXT 5%/LACT RING 500ML******

Facility

$21.00

Hospital Charge Code	7000326
Hospital Revenue Code	258
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$7.98
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.30
Rate for Payer: Oxford Commercial	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$4.20
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

DEXT 5% NACL 0.2% 1000ml

Facility

$7.20

Hospital Charge Code	270650130
Hospital Revenue Code	258
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.60
Rate for Payer: Aetna Commercial	$2.74
Rate for Payer: Aetna Medicare Advantage	$2.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.84
Rate for Payer: Cigna Commercial	$3.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.16
Rate for Payer: Oxford Commercial	$1.44
Rate for Payer: Qualcare PPO/HMO/WC	$1.08
Rate for Payer: UnitedHealthcare Commercial	$1.44
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

DEXT 5% NACL 0.2% 1000ml

Facility

$7.20

Hospital Charge Code	270650130
Hospital Revenue Code	258
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$1.08
Rate for Payer: Qualcare PPO/HMO/WC	$1.08

Know your out-of-pocket cost for care.

All Charges