Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DEXT 5%/NACL 0.9% 1000ML ****

Facility

$21.00

Hospital Charge Code	7000177
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% NACL.09% 20 KCL 1000cc

Facility

$7.09

Hospital Charge Code	270650088
Hospital Revenue Code	258
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$1.06
Rate for Payer: Qualcare PPO/HMO/WC	$1.06

DEXT 5% NACL.09% 20 KCL 1000cc

Facility

$7.09

Hospital Charge Code	270650088
Hospital Revenue Code	258
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.54
Rate for Payer: Aetna Commercial	$2.69
Rate for Payer: Aetna Medicare Advantage	$2.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.81
Rate for Payer: Cigna Commercial	$3.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.13
Rate for Payer: Oxford Commercial	$1.42
Rate for Payer: Qualcare PPO/HMO/WC	$1.06
Rate for Payer: UnitedHealthcare Commercial	$1.42
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

DEXT 5% NACL 0.9% 500CC

Facility

$3.71

Hospital Charge Code	270650131
Hospital Revenue Code	258
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$1.85
Rate for Payer: Aetna Commercial	$1.41
Rate for Payer: Aetna Medicare Advantage	$1.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.95
Rate for Payer: Cigna Commercial	$1.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.11
Rate for Payer: Oxford Commercial	$0.74
Rate for Payer: Qualcare PPO/HMO/WC	$0.56
Rate for Payer: UnitedHealthcare Commercial	$0.74
Rate for Payer: UnitedHealthcare Community & State	$0.09
Rate for Payer: Wellpoint Medicaid Managed Care	$0.10

DEXT 5% NACL 0.9% 500CC

Facility

$3.71

Hospital Charge Code	270650131
Hospital Revenue Code	258
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$0.56
Rate for Payer: Qualcare PPO/HMO/WC	$0.56

DEXT 5% NACL .25% 500ML

Facility

$4.84

Hospital Charge Code	270650110
Hospital Revenue Code	270
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.73

DEXT 5% NACL .25% 500ML

Facility

$4.84

Hospital Charge Code	270650110
Hospital Revenue Code	270
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.42
Rate for Payer: Aetna Commercial	$1.84
Rate for Payer: Aetna Medicare Advantage	$1.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.23
Rate for Payer: Cigna Commercial	$2.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.45
Rate for Payer: Oxford Commercial	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.73
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

DEXT 5% NACL.45% 20 KCL 1000cc

Facility

$5.30

Hospital Charge Code	270650085
Hospital Revenue Code	258
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.80

DEXT 5% NACL.45% 20 KCL 1000cc

Facility

$5.30

Hospital Charge Code	270650085
Hospital Revenue Code	258
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.65
Rate for Payer: Aetna Commercial	$2.01
Rate for Payer: Aetna Medicare Advantage	$1.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.35
Rate for Payer: Cigna Commercial	$2.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.59
Rate for Payer: Oxford Commercial	$1.06
Rate for Payer: Qualcare PPO/HMO/WC	$0.80
Rate for Payer: UnitedHealthcare Commercial	$1.06
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

DEXT 5% NACL.45% 40 KCL 1000cc

Facility

$8.25

Hospital Charge Code	270650086
Hospital Revenue Code	258
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$1.24
Rate for Payer: Qualcare PPO/HMO/WC	$1.24

DEXT 5% NACL.45% 40 KCL 1000cc

Facility

$8.25

Hospital Charge Code	270650086
Hospital Revenue Code	258
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$4.12
Rate for Payer: Aetna Commercial	$3.13
Rate for Payer: Aetna Medicare Advantage	$2.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.10
Rate for Payer: Cigna Commercial	$4.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.48
Rate for Payer: Oxford Commercial	$1.65
Rate for Payer: Qualcare PPO/HMO/WC	$1.24
Rate for Payer: UnitedHealthcare Commercial	$1.65
Rate for Payer: UnitedHealthcare Community & State	$0.20
Rate for Payer: Wellpoint Medicaid Managed Care	$0.22

DEXT 5% NACL .45% 500cc

Facility

$6.35

Hospital Charge Code	270650129
Hospital Revenue Code	258
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$0.95
Rate for Payer: Qualcare PPO/HMO/WC	$0.95

DEXT 5% NACL .45% 500cc

Facility

$6.35

Hospital Charge Code	270650129
Hospital Revenue Code	258
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$3.17
Rate for Payer: Aetna Commercial	$2.41
Rate for Payer: Aetna Medicare Advantage	$1.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.62
Rate for Payer: Cigna Commercial	$3.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.91
Rate for Payer: Oxford Commercial	$1.27
Rate for Payer: Qualcare PPO/HMO/WC	$0.95
Rate for Payer: UnitedHealthcare Commercial	$1.27
Rate for Payer: UnitedHealthcare Community & State	$0.15
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

DEXT 70% INJ

Facility

$2.45

Hospital Charge Code	60627957
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.93
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.62
Rate for Payer: Cigna Commercial	$1.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.74
Rate for Payer: Oxford Commercial	$0.49
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$0.49
Rate for Payer: UnitedHealthcare Community & State	$0.06
Rate for Payer: Wellpoint Medicaid Managed Care	$0.06

DEXT 70% INJ

Facility

$2.45

Hospital Charge Code	60627957
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

DEXT-FRUCT-PHOSPHORIC LQ 118ML

Facility

$46.45

Hospital Charge Code	60629015
Hospital Revenue Code	250
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$6.97
Rate for Payer: Qualcare PPO/HMO/WC	$6.97

DEXT-FRUCT-PHOSPHORIC LQ 118ML

Facility

$46.45

Hospital Charge Code	60629015
Hospital Revenue Code	250
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$23.23
Rate for Payer: Aetna Commercial	$17.65
Rate for Payer: Aetna Medicare Advantage	$13.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.84
Rate for Payer: Cigna Commercial	$23.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.94
Rate for Payer: Oxford Commercial	$9.29
Rate for Payer: Qualcare PPO/HMO/WC	$6.97
Rate for Payer: UnitedHealthcare Commercial	$9.29
Rate for Payer: UnitedHealthcare Community & State	$1.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1.23

DEXTRAM 70 32%

Facility

$150.00

Hospital Charge Code	60634720
Hospital Revenue Code	250
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.00
Rate for Payer: Oxford Commercial	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$30.00
Rate for Payer: UnitedHealthcare Community & State	$3.62
Rate for Payer: Wellpoint Medicaid Managed Care	$3.98

DEXTRAM 70 32%

Facility

$150.00

Hospital Charge Code	60634720
Hospital Revenue Code	250
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

DEXTRAN 40 10%-DEXTROSE 5% INJ

Facility

$182.58

Service Code	NDC 409741803
Hospital Charge Code	60627907
Hospital Revenue Code	258
Min. Negotiated Rate	$27.39
Max. Negotiated Rate	$27.39
Rate for Payer: Qualcare PPO/HMO/WC	$27.39

DEXTRAN 40 10%-DEXTROSE 5% INJ

Facility

$182.58

Service Code	NDC 409741803
Hospital Charge Code	60627907
Hospital Revenue Code	258
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$91.29
Rate for Payer: Aetna Commercial	$69.38
Rate for Payer: Aetna Medicare Advantage	$54.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.56
Rate for Payer: Cigna Commercial	$91.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.77
Rate for Payer: Oxford Commercial	$36.52
Rate for Payer: Qualcare PPO/HMO/WC	$27.39
Rate for Payer: UnitedHealthcare Commercial	$36.52
Rate for Payer: UnitedHealthcare Community & State	$4.40
Rate for Payer: Wellpoint Medicaid Managed Care	$4.84

DEXTRAN 40 (10%) IN D5W/5

Facility

$235.00

Hospital Charge Code	60635843
Hospital Revenue Code	258
Min. Negotiated Rate	$5.66
Max. Negotiated Rate	$117.50
Rate for Payer: Aetna Commercial	$89.30
Rate for Payer: Aetna Medicare Advantage	$70.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.92
Rate for Payer: Cigna Commercial	$117.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.50
Rate for Payer: Oxford Commercial	$47.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.25
Rate for Payer: UnitedHealthcare Commercial	$47.00
Rate for Payer: UnitedHealthcare Community & State	$5.66
Rate for Payer: Wellpoint Medicaid Managed Care	$6.23

DEXTRAN 40 (10%) IN D5W/5

Facility

$235.00

Hospital Charge Code	60635843
Hospital Revenue Code	258
Min. Negotiated Rate	$35.25
Max. Negotiated Rate	$35.25
Rate for Payer: Qualcare PPO/HMO/WC	$35.25

DEXTRAN 40 10%-NACL 0.9% INJ

Facility

$228.81

Service Code	NDC 409741903
Hospital Charge Code	60627908
Hospital Revenue Code	258
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$114.41
Rate for Payer: Aetna Commercial	$86.95
Rate for Payer: Aetna Medicare Advantage	$68.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.35
Rate for Payer: Cigna Commercial	$114.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.64
Rate for Payer: Oxford Commercial	$45.76
Rate for Payer: Qualcare PPO/HMO/WC	$34.32
Rate for Payer: UnitedHealthcare Commercial	$45.76
Rate for Payer: UnitedHealthcare Community & State	$5.51
Rate for Payer: Wellpoint Medicaid Managed Care	$6.06

DEXTRAN 40 10%-NACL 0.9% INJ

Facility

$228.81

Service Code	NDC 409741903
Hospital Charge Code	60627908
Hospital Revenue Code	258
Min. Negotiated Rate	$34.32
Max. Negotiated Rate	$34.32
Rate for Payer: Qualcare PPO/HMO/WC	$34.32

Know your out-of-pocket cost for care.

All Charges