Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SOD CHLORIDE 5% INJ/500ML

Facility

$34.00

Hospital Charge Code	60634237
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$17.00
Rate for Payer: Aetna Commercial	$12.92
Rate for Payer: Aetna Medicare Advantage	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.67
Rate for Payer: Cigna Commercial	$17.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.20
Rate for Payer: Oxford Commercial	$6.80
Rate for Payer: Qualcare PPO/HMO/WC	$5.10
Rate for Payer: UnitedHealthcare Commercial	$6.80
Rate for Payer: UnitedHealthcare Community & State	$0.82
Rate for Payer: Wellpoint Medicaid Managed Care	$0.90

SODIUM

Facility

$47.25

Service Code	HCPCS 84295CF
Hospital Charge Code	8200327RS
Hospital Revenue Code	301
Min. Negotiated Rate	$7.09
Max. Negotiated Rate	$7.09
Rate for Payer: Qualcare PPO/HMO/WC	$7.09

SODIUM

Facility

$47.25

Service Code	HCPCS 84295CF
Hospital Charge Code	8200327RS
Hospital Revenue Code	301
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$17.95
Rate for Payer: Aetna Medicare Advantage	$14.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.05
Rate for Payer: Cigna Commercial	$23.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.18
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.09
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

SODIUM

Facility

$47.25

Service Code	HCPCS 84295
Hospital Charge Code	8200349RS
Hospital Revenue Code	301
Min. Negotiated Rate	$7.09
Max. Negotiated Rate	$7.09
Rate for Payer: Qualcare PPO/HMO/WC	$7.09

SODIUM

Facility

$47.25

Service Code	HCPCS 84295
Hospital Charge Code	8200349RS
Hospital Revenue Code	301
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$13.08
Rate for Payer: Aetna Medicare Advantage	$15.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.36
Rate for Payer: Cigna Commercial	$23.62
Rate for Payer: Cigna Medicare Advantage	$4.81
Rate for Payer: Clover Medicare Advantage	$4.57
Rate for Payer: EmblemHealth Commercial	$14.43
Rate for Payer: Humana Medicare Advantage	$4.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.18
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.09
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.81
Rate for Payer: Wellcare Medicare Advantage	$4.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

SODIUM ACETATE 2MEQ/ML

Facility

$4.00

Service Code	NDC 409729973
Hospital Charge Code	60630106
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SODIUM ACETATE 2MEQ/ML

Facility

$4.00

Service Code	NDC 409729973
Hospital Charge Code	60630106
Hospital Revenue Code	250
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

SODIUM BICARB INJ 8.4% SYR

Facility

$109.45

Hospital Charge Code	6004949
Hospital Revenue Code	250
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$54.73
Rate for Payer: Aetna Commercial	$41.59
Rate for Payer: Aetna Medicare Advantage	$32.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.91
Rate for Payer: Cigna Commercial	$54.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.84
Rate for Payer: Oxford Commercial	$21.89
Rate for Payer: Qualcare PPO/HMO/WC	$16.42
Rate for Payer: UnitedHealthcare Commercial	$21.89
Rate for Payer: UnitedHealthcare Community & State	$2.64
Rate for Payer: Wellpoint Medicaid Managed Care	$2.90

SODIUM BICARB INJ 8.4% SYR

Facility

$109.45

Hospital Charge Code	6004949
Hospital Revenue Code	250
Min. Negotiated Rate	$16.42
Max. Negotiated Rate	$16.42
Rate for Payer: Qualcare PPO/HMO/WC	$16.42

SODIUM BICARB INJ 8.4% VIAL

Facility

$10.90

Hospital Charge Code	6004956
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

SODIUM BICARB INJ 8.4% VIAL

Facility

$10.90

Hospital Charge Code	6004956
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$4.14
Rate for Payer: Aetna Medicare Advantage	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.27
Rate for Payer: Oxford Commercial	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$2.18
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

SODIUM BICARB INJ INF 4.2%

Facility

$20.10

Service Code	NDC 409553434
Hospital Charge Code	60627889
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$10.05
Rate for Payer: Aetna Commercial	$7.64
Rate for Payer: Aetna Medicare Advantage	$6.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.13
Rate for Payer: Cigna Commercial	$10.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.03
Rate for Payer: Oxford Commercial	$4.02
Rate for Payer: Qualcare PPO/HMO/WC	$3.02
Rate for Payer: UnitedHealthcare Commercial	$4.02
Rate for Payer: UnitedHealthcare Community & State	$0.48
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

SODIUM BICARB INJ INF 4.2%

Facility

$20.10

Service Code	NDC 409553434
Hospital Charge Code	60627889
Hospital Revenue Code	250
Min. Negotiated Rate	$3.02
Max. Negotiated Rate	$3.02
Rate for Payer: Qualcare PPO/HMO/WC	$3.02

SODIUM BICARBONATE 2.5 MEQ/5 ML VIAL

Facility

$20.50

Service Code	NDC 63323002605
Hospital Charge Code	6063943242
Hospital Revenue Code	250
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$3.08
Rate for Payer: Qualcare PPO/HMO/WC	$3.08

SODIUM BICARBONATE 2.5 MEQ/5 ML VIAL

Facility

$20.50

Service Code	NDC 63323002605
Hospital Charge Code	6063943242
Hospital Revenue Code	250
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$10.25
Rate for Payer: Aetna Commercial	$7.79
Rate for Payer: Aetna Medicare Advantage	$6.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.23
Rate for Payer: Cigna Commercial	$10.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.15
Rate for Payer: Oxford Commercial	$4.10
Rate for Payer: Qualcare PPO/HMO/WC	$3.08
Rate for Payer: UnitedHealthcare Commercial	$4.10
Rate for Payer: UnitedHealthcare Community & State	$0.49
Rate for Payer: Wellpoint Medicaid Managed Care	$0.54

SODIUM BICARBONATE/650MG

Facility

$1.00

Hospital Charge Code	60633903
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

SODIUM BICARBONATE/650MG

Facility

$1.00

Hospital Charge Code	60633903
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.38
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.30
Rate for Payer: Oxford Commercial	$0.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.20
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

SODIUM BICARBONATE 650 MG TAB

Facility

$4.00

Service Code	NDC 64980018210
Hospital Charge Code	60628112
Hospital Revenue Code	250
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

SODIUM BICARBONATE 650 MG TAB

Facility

$4.00

Service Code	NDC 64980018210
Hospital Charge Code	60628112
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SODIUM BICARBONATE 7.5%/4

Facility

$32.00

Hospital Charge Code	60633904
Hospital Revenue Code	250
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

SODIUM BICARBONATE 7.5%/4

Facility

$32.00

Hospital Charge Code	60633904
Hospital Revenue Code	250
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$16.00
Rate for Payer: Aetna Commercial	$12.16
Rate for Payer: Aetna Medicare Advantage	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.16
Rate for Payer: Cigna Commercial	$16.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.60
Rate for Payer: Oxford Commercial	$6.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$6.40
Rate for Payer: UnitedHealthcare Community & State	$0.77
Rate for Payer: Wellpoint Medicaid Managed Care	$0.85

SODIUM BICARBONATE 7.5% 50ML S

Facility

$97.15

Service Code	NDC 409491634
Hospital Charge Code	6063943243
Hospital Revenue Code	250
Min. Negotiated Rate	$14.57
Max. Negotiated Rate	$14.57
Rate for Payer: Qualcare PPO/HMO/WC	$14.57

SODIUM BICARBONATE 7.5% 50ML S

Facility

$97.15

Service Code	NDC 409491634
Hospital Charge Code	6063943243
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$48.58
Rate for Payer: Aetna Commercial	$36.92
Rate for Payer: Aetna Medicare Advantage	$29.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.77
Rate for Payer: Cigna Commercial	$48.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.14
Rate for Payer: Oxford Commercial	$19.43
Rate for Payer: Qualcare PPO/HMO/WC	$14.57
Rate for Payer: UnitedHealthcare Commercial	$19.43
Rate for Payer: UnitedHealthcare Community & State	$2.34
Rate for Payer: Wellpoint Medicaid Managed Care	$2.57

SODIUM BICARBONATE (8.4%)

Facility

$4.42

Service Code	NDC 409662502
Hospital Charge Code	60627890
Hospital Revenue Code	250
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.66
Rate for Payer: Qualcare PPO/HMO/WC	$0.66

SODIUM BICARBONATE (8.4%)

Facility

$4.42

Service Code	NDC 409662502
Hospital Charge Code	60627890
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.21
Rate for Payer: Aetna Commercial	$1.68
Rate for Payer: Aetna Medicare Advantage	$1.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.13
Rate for Payer: Cigna Commercial	$2.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.33
Rate for Payer: Oxford Commercial	$0.88
Rate for Payer: Qualcare PPO/HMO/WC	$0.66
Rate for Payer: UnitedHealthcare Commercial	$0.88
Rate for Payer: UnitedHealthcare Community & State	$0.11
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

Know your out-of-pocket cost for care.

All Charges