Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DEXTROSE 5%+40MEQ POT CHL

Facility

$38.00

Hospital Charge Code	60635856
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%+40MEQ POT CHL

Facility

$38.00

Hospital Charge Code	60635856
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% 500cc INJ

Facility

$5.40

Hospital Charge Code	270650058
Hospital Revenue Code	258
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.70
Rate for Payer: Aetna Commercial	$2.05
Rate for Payer: Aetna Medicare Advantage	$1.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.38
Rate for Payer: Cigna Commercial	$2.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.62
Rate for Payer: Oxford Commercial	$1.08
Rate for Payer: Qualcare PPO/HMO/WC	$0.81
Rate for Payer: UnitedHealthcare Commercial	$1.08
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

DEXTROSE 5% 500cc INJ

Facility

$5.40

Hospital Charge Code	270650058
Hospital Revenue Code	258
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$0.81
Rate for Payer: Qualcare PPO/HMO/WC	$0.81

DEXTROSE 5%/500ML/GLASS

Facility

$61.00

Hospital Charge Code	60635861
Hospital Revenue Code	258
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$9.15
Rate for Payer: Qualcare PPO/HMO/WC	$9.15

DEXTROSE 5%/500ML/GLASS

Facility

$61.00

Hospital Charge Code	60635861
Hospital Revenue Code	258
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$30.50
Rate for Payer: Aetna Commercial	$23.18
Rate for Payer: Aetna Medicare Advantage	$18.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.55
Rate for Payer: Cigna Commercial	$30.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.30
Rate for Payer: Oxford Commercial	$12.20
Rate for Payer: Qualcare PPO/HMO/WC	$9.15
Rate for Payer: UnitedHealthcare Commercial	$12.20
Rate for Payer: UnitedHealthcare Community & State	$1.47
Rate for Payer: Wellpoint Medicaid Managed Care	$1.62

DEXTROSE 5% ADDVANT/100ML

Facility

$61.00

Hospital Charge Code	60635857
Hospital Revenue Code	258
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$30.50
Rate for Payer: Aetna Commercial	$23.18
Rate for Payer: Aetna Medicare Advantage	$18.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.55
Rate for Payer: Cigna Commercial	$30.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.30
Rate for Payer: Oxford Commercial	$12.20
Rate for Payer: Qualcare PPO/HMO/WC	$9.15
Rate for Payer: UnitedHealthcare Commercial	$12.20
Rate for Payer: UnitedHealthcare Community & State	$1.47
Rate for Payer: Wellpoint Medicaid Managed Care	$1.62

DEXTROSE 5% ADDVANT/100ML

Facility

$61.00

Hospital Charge Code	60635857
Hospital Revenue Code	258
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$9.15
Rate for Payer: Qualcare PPO/HMO/WC	$9.15

DEXTROSE 5% ADDVANT/250ML

Facility

$66.00

Hospital Charge Code	60635858
Hospital Revenue Code	258
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

DEXTROSE 5% ADDVANT/250ML

Facility

$66.00

Hospital Charge Code	60635858
Hospital Revenue Code	258
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$25.08
Rate for Payer: Aetna Medicare Advantage	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.83
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.80
Rate for Payer: Oxford Commercial	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$13.20
Rate for Payer: UnitedHealthcare Community & State	$1.59
Rate for Payer: Wellpoint Medicaid Managed Care	$1.75

DEXTROSE 5% ADDVANT/50ML

Facility

$66.00

Hospital Charge Code	60635859
Hospital Revenue Code	258
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

DEXTROSE 5% ADDVANT/50ML

Facility

$66.00

Hospital Charge Code	60635859
Hospital Revenue Code	258
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$25.08
Rate for Payer: Aetna Medicare Advantage	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.83
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.80
Rate for Payer: Oxford Commercial	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$13.20
Rate for Payer: UnitedHealthcare Community & State	$1.59
Rate for Payer: Wellpoint Medicaid Managed Care	$1.75

DEXTROSE 5% INJ 50ml

Facility

$7.72

Hospital Charge Code	270649401
Hospital Revenue Code	272
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.86
Rate for Payer: Aetna Commercial	$2.93
Rate for Payer: Aetna Medicare Advantage	$2.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.97
Rate for Payer: Cigna Commercial	$3.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.32
Rate for Payer: Oxford Commercial	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$1.54
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

DEXTROSE 5% INJ 50ml

Facility

$7.72

Hospital Charge Code	270649401
Hospital Revenue Code	272
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

DEXTROSE 5% IN WATER 1000 ML

Facility

$182.17

Service Code	NDC 990792209
Hospital Charge Code	60627948
Hospital Revenue Code	258
Min. Negotiated Rate	$27.33
Max. Negotiated Rate	$27.33
Rate for Payer: Qualcare PPO/HMO/WC	$27.33

DEXTROSE 5% IN WATER 1000 ML

Facility

$182.17

Service Code	NDC 990792209
Hospital Charge Code	60627948
Hospital Revenue Code	258
Min. Negotiated Rate	$4.39
Max. Negotiated Rate	$91.08
Rate for Payer: Aetna Commercial	$69.22
Rate for Payer: Aetna Medicare Advantage	$54.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.45
Rate for Payer: Cigna Commercial	$91.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.65
Rate for Payer: Oxford Commercial	$36.43
Rate for Payer: Qualcare PPO/HMO/WC	$27.33
Rate for Payer: UnitedHealthcare Commercial	$36.43
Rate for Payer: UnitedHealthcare Community & State	$4.39
Rate for Payer: Wellpoint Medicaid Managed Care	$4.83

DEXTROSE 5% IN WATER 100 ML

Facility

$12.93

Service Code	NDC 990792337
Hospital Charge Code	60627946
Hospital Revenue Code	258
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$1.94
Rate for Payer: Qualcare PPO/HMO/WC	$1.94

DEXTROSE 5% IN WATER 100 ML

Facility

$12.93

Service Code	NDC 990792337
Hospital Charge Code	60627946
Hospital Revenue Code	258
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.46
Rate for Payer: Aetna Commercial	$4.91
Rate for Payer: Aetna Medicare Advantage	$3.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.30
Rate for Payer: Cigna Commercial	$6.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.88
Rate for Payer: Oxford Commercial	$2.59
Rate for Payer: Qualcare PPO/HMO/WC	$1.94
Rate for Payer: UnitedHealthcare Commercial	$2.59
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

DEXTROSE 5% IN WATER 250 ML

Facility

$13.13

Service Code	NDC 338001702
Hospital Charge Code	60627950
Hospital Revenue Code	258
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$6.57
Rate for Payer: Aetna Commercial	$4.99
Rate for Payer: Aetna Medicare Advantage	$3.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.35
Rate for Payer: Cigna Commercial	$6.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.94
Rate for Payer: Oxford Commercial	$2.63
Rate for Payer: Qualcare PPO/HMO/WC	$1.97
Rate for Payer: UnitedHealthcare Commercial	$2.63
Rate for Payer: UnitedHealthcare Community & State	$0.32
Rate for Payer: Wellpoint Medicaid Managed Care	$0.35

DEXTROSE 5% IN WATER 250 ML

Facility

$13.13

Service Code	NDC 338001702
Hospital Charge Code	60627950
Hospital Revenue Code	258
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$1.97
Rate for Payer: Qualcare PPO/HMO/WC	$1.97

DEXTROSE 5% IN WATER 500ML

Facility

$13.20

Service Code	NDC 338001703
Hospital Charge Code	60627951
Hospital Revenue Code	258
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$6.60
Rate for Payer: Aetna Commercial	$5.02
Rate for Payer: Aetna Medicare Advantage	$3.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.37
Rate for Payer: Cigna Commercial	$6.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.96
Rate for Payer: Oxford Commercial	$2.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.98
Rate for Payer: UnitedHealthcare Commercial	$2.64
Rate for Payer: UnitedHealthcare Community & State	$0.32
Rate for Payer: Wellpoint Medicaid Managed Care	$0.35

DEXTROSE 5% IN WATER 500ML

Facility

$13.20

Service Code	NDC 338001703
Hospital Charge Code	60627951
Hospital Revenue Code	258
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$1.98
Rate for Payer: Qualcare PPO/HMO/WC	$1.98

DEXTROSE 5% IN WATER 50 ML

Facility

$12.93

Service Code	NDC 338001731
Hospital Charge Code	60627953
Hospital Revenue Code	250
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$1.94
Rate for Payer: Qualcare PPO/HMO/WC	$1.94

DEXTROSE 5% IN WATER 50 ML

Facility

$12.93

Service Code	NDC 338001731
Hospital Charge Code	60627953
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.46
Rate for Payer: Aetna Commercial	$4.91
Rate for Payer: Aetna Medicare Advantage	$3.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.30
Rate for Payer: Cigna Commercial	$6.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.88
Rate for Payer: Oxford Commercial	$2.59
Rate for Payer: Qualcare PPO/HMO/WC	$1.94
Rate for Payer: UnitedHealthcare Commercial	$2.59
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

DEXTROSE 5% / LACTAID RINGERS

Facility

$17.49

Service Code	NDC 338012504
Hospital Charge Code	60628602
Hospital Revenue Code	258
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$2.62
Rate for Payer: Qualcare PPO/HMO/WC	$2.62

Know your out-of-pocket cost for care.

All Charges