Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DEXTROSE 50%/500CC

Facility

$99.29

Service Code	NDC 990793619
Hospital Charge Code	60635845
Hospital Revenue Code	258
Min. Negotiated Rate	$14.89
Max. Negotiated Rate	$14.89
Rate for Payer: Qualcare PPO/HMO/WC	$14.89

DEXTROSE 50%/50ML

Facility

$16.48

Service Code	NDC 409664802
Hospital Charge Code	60635844
Hospital Revenue Code	250
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$2.47
Rate for Payer: Qualcare PPO/HMO/WC	$2.47

DEXTROSE 50%/50ML

Facility

$16.48

Service Code	NDC 409664802
Hospital Charge Code	60635844
Hospital Revenue Code	250
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$8.24
Rate for Payer: Aetna Commercial	$6.26
Rate for Payer: Aetna Medicare Advantage	$4.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.20
Rate for Payer: Cigna Commercial	$8.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.94
Rate for Payer: Oxford Commercial	$3.30
Rate for Payer: Qualcare PPO/HMO/WC	$2.47
Rate for Payer: UnitedHealthcare Commercial	$3.30
Rate for Payer: UnitedHealthcare Community & State	$0.40
Rate for Payer: Wellpoint Medicaid Managed Care	$0.44

DEXTROSE 50% 50ML LIFESHI

Facility

$18.00

Hospital Charge Code	60635862
Hospital Revenue Code	636
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$6.84
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.36
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

DEXTROSE 50% 50ML LIFESHI

Facility

$18.00

Hospital Charge Code	60635862
Hospital Revenue Code	636
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$4.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.36
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

DEXTROSE 50% INJ SYRINGE

Facility

$36.00

Hospital Charge Code	60627956R
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna Commercial	$13.68
Rate for Payer: Aetna Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.18
Rate for Payer: Cigna Commercial	$18.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.80
Rate for Payer: Oxford Commercial	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$5.40
Rate for Payer: UnitedHealthcare Commercial	$7.20
Rate for Payer: UnitedHealthcare Community & State	$0.87
Rate for Payer: Wellpoint Medicaid Managed Care	$0.95

DEXTROSE 50% INJ SYRINGE

Facility

$48.24

Service Code	NDC 76329330101
Hospital Charge Code	60627956
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$24.12
Rate for Payer: Aetna Commercial	$18.33
Rate for Payer: Aetna Medicare Advantage	$14.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.30
Rate for Payer: Cigna Commercial	$24.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.47
Rate for Payer: Oxford Commercial	$9.65
Rate for Payer: Qualcare PPO/HMO/WC	$7.24
Rate for Payer: UnitedHealthcare Commercial	$9.65
Rate for Payer: UnitedHealthcare Community & State	$1.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1.28

DEXTROSE 50% INJ SYRINGE

Facility

$48.24

Service Code	NDC 76329330101
Hospital Charge Code	60627956
Hospital Revenue Code	250
Min. Negotiated Rate	$7.24
Max. Negotiated Rate	$7.24
Rate for Payer: Qualcare PPO/HMO/WC	$7.24

DEXTROSE 50% INJ SYRINGE

Facility

$36.00

Hospital Charge Code	60627956R
Hospital Revenue Code	250
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$5.40
Rate for Payer: Qualcare PPO/HMO/WC	$5.40

DEXTROSE 50% VL 50ML

Facility

$2.00

Hospital Charge Code	60635863
Hospital Revenue Code	258
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.76
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.60
Rate for Payer: Oxford Commercial	$0.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$0.40
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

DEXTROSE 50% VL 50ML

Facility

$2.00

Hospital Charge Code	60635863
Hospital Revenue Code	258
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

DEXTROSE 5% 1000cc INJ

Facility

$5.60

Hospital Charge Code	270650052
Hospital Revenue Code	258
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.80
Rate for Payer: Aetna Commercial	$2.13
Rate for Payer: Aetna Medicare Advantage	$1.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.43
Rate for Payer: Cigna Commercial	$2.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.68
Rate for Payer: Oxford Commercial	$1.12
Rate for Payer: Qualcare PPO/HMO/WC	$0.84
Rate for Payer: UnitedHealthcare Commercial	$1.12
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

DEXTROSE 5% 1000cc INJ

Facility

$5.60

Hospital Charge Code	270650052
Hospital Revenue Code	258
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$0.84
Rate for Payer: Qualcare PPO/HMO/WC	$0.84

DEXTROSE 5% - 1/2 NS 1000 ML

Facility

$17.29

Service Code	NDC 338008504
Hospital Charge Code	60627900
Hospital Revenue Code	258
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$2.59
Rate for Payer: Qualcare PPO/HMO/WC	$2.59

DEXTROSE 5% - 1/2 NS 1000 ML

Facility

$17.29

Service Code	NDC 338008504
Hospital Charge Code	60627900
Hospital Revenue Code	258
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$6.57
Rate for Payer: Aetna Medicare Advantage	$5.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.41
Rate for Payer: Cigna Commercial	$8.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.19
Rate for Payer: Oxford Commercial	$3.46
Rate for Payer: Qualcare PPO/HMO/WC	$2.59
Rate for Payer: UnitedHealthcare Commercial	$3.46
Rate for Payer: UnitedHealthcare Community & State	$0.42
Rate for Payer: Wellpoint Medicaid Managed Care	$0.46

DEXTROSE 5% - 1/3 NS 1000 ML

Facility

$11.73

Service Code	NDC 990792509
Hospital Charge Code	60627899
Hospital Revenue Code	258
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$5.87
Rate for Payer: Aetna Commercial	$4.46
Rate for Payer: Aetna Medicare Advantage	$3.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.99
Rate for Payer: Cigna Commercial	$5.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.52
Rate for Payer: Oxford Commercial	$2.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.76
Rate for Payer: UnitedHealthcare Commercial	$2.35
Rate for Payer: UnitedHealthcare Community & State	$0.28
Rate for Payer: Wellpoint Medicaid Managed Care	$0.31

DEXTROSE 5% - 1/3 NS 1000 ML

Facility

$11.73

Service Code	NDC 990792509
Hospital Charge Code	60627899
Hospital Revenue Code	258
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$1.76
Rate for Payer: Qualcare PPO/HMO/WC	$1.76

DEXTROSE 5% 20 KCL 1000cc

Facility

$6.20

Hospital Charge Code	270650084
Hospital Revenue Code	258
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$0.93
Rate for Payer: Qualcare PPO/HMO/WC	$0.93

DEXTROSE 5% 20 KCL 1000cc

Facility

$6.20

Hospital Charge Code	270650084
Hospital Revenue Code	258
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$3.10
Rate for Payer: Aetna Commercial	$2.36
Rate for Payer: Aetna Medicare Advantage	$1.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.58
Rate for Payer: Cigna Commercial	$3.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.86
Rate for Payer: Oxford Commercial	$1.24
Rate for Payer: Qualcare PPO/HMO/WC	$0.93
Rate for Payer: UnitedHealthcare Commercial	$1.24
Rate for Payer: UnitedHealthcare Community & State	$0.15
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

DEXTROSE 5%+20MEQ POT CHL

Facility

$38.00

Hospital Charge Code	60635855
Hospital Revenue Code	258
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$5.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.70

DEXTROSE 5%+20MEQ POT CHL

Facility

$38.00

Hospital Charge Code	60635855
Hospital Revenue Code	258
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$19.00
Rate for Payer: Aetna Commercial	$14.44
Rate for Payer: Aetna Medicare Advantage	$11.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.69
Rate for Payer: Cigna Commercial	$19.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.40
Rate for Payer: Oxford Commercial	$7.60
Rate for Payer: Qualcare PPO/HMO/WC	$5.70
Rate for Payer: UnitedHealthcare Commercial	$7.60
Rate for Payer: UnitedHealthcare Community & State	$0.92
Rate for Payer: Wellpoint Medicaid Managed Care	$1.01

DEXTROSE 5% 250CC LIFECARE

Facility

$4.25

Hospital Charge Code	270650048
Hospital Revenue Code	258
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.64
Rate for Payer: Qualcare PPO/HMO/WC	$0.64

DEXTROSE 5% 250CC LIFECARE

Facility

$4.25

Hospital Charge Code	270650048
Hospital Revenue Code	258
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.12
Rate for Payer: Aetna Commercial	$1.61
Rate for Payer: Aetna Medicare Advantage	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.08
Rate for Payer: Cigna Commercial	$2.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.27
Rate for Payer: Oxford Commercial	$0.85
Rate for Payer: Qualcare PPO/HMO/WC	$0.64
Rate for Payer: UnitedHealthcare Commercial	$0.85
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

DEXTROSE 5%/250ML/GLASS

Facility

$44.00

Hospital Charge Code	60635860
Hospital Revenue Code	258
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$22.00
Rate for Payer: Aetna Commercial	$16.72
Rate for Payer: Aetna Medicare Advantage	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.22
Rate for Payer: Cigna Commercial	$22.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.20
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	$1.06
Rate for Payer: Wellpoint Medicaid Managed Care	$1.17

DEXTROSE 5%/250ML/GLASS

Facility

$44.00

Hospital Charge Code	60635860
Hospital Revenue Code	258
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

Know your out-of-pocket cost for care.

All Charges