Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SODIUM BICARBONATE 8.4%

Facility

$142.00

Hospital Charge Code	60635716
Hospital Revenue Code	250
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$21.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.30

SODIUM BICARBONATE 8.4%

Facility

$142.00

Hospital Charge Code	60635716
Hospital Revenue Code	250
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$71.00
Rate for Payer: Aetna Commercial	$53.96
Rate for Payer: Aetna Medicare Advantage	$42.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.21
Rate for Payer: Cigna Commercial	$71.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.60
Rate for Payer: Oxford Commercial	$28.40
Rate for Payer: Qualcare PPO/HMO/WC	$21.30
Rate for Payer: UnitedHealthcare Commercial	$28.40
Rate for Payer: UnitedHealthcare Community & State	$3.42
Rate for Payer: Wellpoint Medicaid Managed Care	$3.76

SODIUM BICARBONATE 8.4%(PED) S

Facility

$88.91

Service Code	NDC 409490034
Hospital Charge Code	6063943244
Hospital Revenue Code	250
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$44.45
Rate for Payer: Aetna Commercial	$33.79
Rate for Payer: Aetna Medicare Advantage	$26.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.67
Rate for Payer: Cigna Commercial	$44.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.67
Rate for Payer: Oxford Commercial	$17.78
Rate for Payer: Qualcare PPO/HMO/WC	$13.34
Rate for Payer: UnitedHealthcare Commercial	$17.78
Rate for Payer: UnitedHealthcare Community & State	$2.14
Rate for Payer: Wellpoint Medicaid Managed Care	$2.36

SODIUM BICARBONATE 8.4%(PED) S

Facility

$88.91

Service Code	NDC 409490034
Hospital Charge Code	6063943244
Hospital Revenue Code	250
Min. Negotiated Rate	$13.34
Max. Negotiated Rate	$13.34
Rate for Payer: Qualcare PPO/HMO/WC	$13.34

SODIUM BICARBONATE 8.4% SOLN

Facility

$26.50

Hospital Charge Code	60627887
Hospital Revenue Code	250
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$13.25
Rate for Payer: Aetna Commercial	$10.07
Rate for Payer: Aetna Medicare Advantage	$7.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.76
Rate for Payer: Cigna Commercial	$13.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.95
Rate for Payer: Oxford Commercial	$5.30
Rate for Payer: Qualcare PPO/HMO/WC	$3.98
Rate for Payer: UnitedHealthcare Commercial	$5.30
Rate for Payer: UnitedHealthcare Community & State	$0.64
Rate for Payer: Wellpoint Medicaid Managed Care	$0.70

SODIUM BICARBONATE 8.4% SOLN

Facility

$26.50

Hospital Charge Code	60627887
Hospital Revenue Code	250
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$3.98
Rate for Payer: Qualcare PPO/HMO/WC	$3.98

SODIUM BICARB POWD 100% 120G

Facility

$10.90

Hospital Charge Code	60629061
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 POWD 100% 120G

Facility

$10.90

Hospital Charge Code	60629061
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 SYRG 50MEQ

Facility

$54.27

Service Code	NDC 76329335201
Hospital Charge Code	60627888
Hospital Revenue Code	250
Min. Negotiated Rate	$8.14
Max. Negotiated Rate	$8.14
Rate for Payer: Qualcare PPO/HMO/WC	$8.14

SODIUM BICARB SYRG 50MEQ

Facility

$54.27

Service Code	NDC 76329335201
Hospital Charge Code	60627888
Hospital Revenue Code	250
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$27.14
Rate for Payer: Aetna Commercial	$20.62
Rate for Payer: Aetna Medicare Advantage	$16.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.84
Rate for Payer: Cigna Commercial	$27.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.28
Rate for Payer: Oxford Commercial	$10.85
Rate for Payer: Qualcare PPO/HMO/WC	$8.14
Rate for Payer: UnitedHealthcare Commercial	$10.85
Rate for Payer: UnitedHealthcare Community & State	$1.31
Rate for Payer: Wellpoint Medicaid Managed Care	$1.44

SODIUM BICARB VL 4% 5ML

Facility

$10.45

Hospital Charge Code	6017693
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.57

SODIUM BICARB VL 4% 5ML

Facility

$10.45

Hospital Charge Code	6017693
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$5.22
Rate for Payer: Aetna Commercial	$3.97
Rate for Payer: Aetna Medicare Advantage	$3.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.66
Rate for Payer: Cigna Commercial	$5.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.13
Rate for Payer: Oxford Commercial	$2.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.57
Rate for Payer: UnitedHealthcare Commercial	$2.09
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.28

SODIUMCHLOR 0.9% IRRIG 1000ml

Facility

$22.50

Hospital Charge Code	270649320
Hospital Revenue Code	272
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna Commercial	$8.55
Rate for Payer: Aetna Medicare Advantage	$6.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.74
Rate for Payer: Cigna Commercial	$11.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.75
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.38
Rate for Payer: UnitedHealthcare Commercial	$4.50
Rate for Payer: UnitedHealthcare Community & State	$0.54
Rate for Payer: Wellpoint Medicaid Managed Care	$0.60

SODIUMCHLOR 0.9% IRRIG 1000ml

Facility

$22.50

Hospital Charge Code	270649320
Hospital Revenue Code	272
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$3.38
Rate for Payer: Qualcare PPO/HMO/WC	$3.38

SODIUM CHLOR 0.9% IRRIG 500ml

Facility

$22.50

Hospital Charge Code	270649319
Hospital Revenue Code	272
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna Commercial	$8.55
Rate for Payer: Aetna Medicare Advantage	$6.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.74
Rate for Payer: Cigna Commercial	$11.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.75
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.38
Rate for Payer: UnitedHealthcare Commercial	$4.50
Rate for Payer: UnitedHealthcare Community & State	$0.54
Rate for Payer: Wellpoint Medicaid Managed Care	$0.60

SODIUM CHLOR 0.9% IRRIG 500ml

Facility

$22.50

Hospital Charge Code	270649319
Hospital Revenue Code	272
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$3.38
Rate for Payer: Qualcare PPO/HMO/WC	$3.38

SODIUM CHLOR CONC 4MEQ/ML 30ML

Facility

$64.59

Service Code	NDC 63323008861
Hospital Charge Code	60627935
Hospital Revenue Code	250
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$32.30
Rate for Payer: Aetna Commercial	$24.54
Rate for Payer: Aetna Medicare Advantage	$19.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.47
Rate for Payer: Cigna Commercial	$32.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.38
Rate for Payer: Oxford Commercial	$12.92
Rate for Payer: Qualcare PPO/HMO/WC	$9.69
Rate for Payer: UnitedHealthcare Commercial	$12.92
Rate for Payer: UnitedHealthcare Community & State	$1.56
Rate for Payer: Wellpoint Medicaid Managed Care	$1.71

SODIUM CHLOR CONC 4MEQ/ML 30ML

Facility

$64.59

Service Code	NDC 63323008861
Hospital Charge Code	60627935
Hospital Revenue Code	250
Min. Negotiated Rate	$9.69
Max. Negotiated Rate	$9.69
Rate for Payer: Qualcare PPO/HMO/WC	$9.69

SODIUM CHLORIDE 0.45% 1000 ML

Facility

$18.36

Service Code	NDC 338004304
Hospital Charge Code	60627912
Hospital Revenue Code	258
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$2.75
Rate for Payer: Qualcare PPO/HMO/WC	$2.75

SODIUM CHLORIDE 0.45% 1000 ML

Facility

$18.36

Service Code	NDC 338004304
Hospital Charge Code	60627912
Hospital Revenue Code	258
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$9.18
Rate for Payer: Aetna Commercial	$6.98
Rate for Payer: Aetna Medicare Advantage	$5.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.68
Rate for Payer: Cigna Commercial	$9.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.51
Rate for Payer: Oxford Commercial	$3.67
Rate for Payer: Qualcare PPO/HMO/WC	$2.75
Rate for Payer: UnitedHealthcare Commercial	$3.67
Rate for Payer: UnitedHealthcare Community & State	$0.44
Rate for Payer: Wellpoint Medicaid Managed Care	$0.49

SODIUM CHLORIDE 0.45% 250 ML

Facility

$10.99

Service Code	NDC 378077101
Hospital Charge Code	60629308
Hospital Revenue Code	250
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$1.65
Rate for Payer: Qualcare PPO/HMO/WC	$1.65

SODIUM CHLORIDE 0.45% 250 ML

Facility

$10.99

Service Code	NDC 378077101
Hospital Charge Code	60629308
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$5.50
Rate for Payer: Aetna Commercial	$4.18
Rate for Payer: Aetna Medicare Advantage	$3.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.80
Rate for Payer: Cigna Commercial	$5.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.30
Rate for Payer: Oxford Commercial	$2.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.65
Rate for Payer: UnitedHealthcare Commercial	$2.20
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

SODIUM CHLORIDE 0.45% 500 ML

Facility

$9.38

Service Code	NDC 409798503
Hospital Charge Code	60629307
Hospital Revenue Code	250
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$1.41
Rate for Payer: Qualcare PPO/HMO/WC	$1.41

SODIUM CHLORIDE 0.45% 500 ML

Facility

$9.38

Service Code	NDC 409798503
Hospital Charge Code	60629307
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.69
Rate for Payer: Aetna Commercial	$3.56
Rate for Payer: Aetna Medicare Advantage	$2.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.39
Rate for Payer: Cigna Commercial	$4.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.81
Rate for Payer: Oxford Commercial	$1.88
Rate for Payer: Qualcare PPO/HMO/WC	$1.41
Rate for Payer: UnitedHealthcare Commercial	$1.88
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

SODIUM CHLORIDE 0.9%

Facility

$19.10

Service Code	NDC 264780020
Hospital Charge Code	60627914
Hospital Revenue Code	258
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$9.55
Rate for Payer: Aetna Commercial	$7.26
Rate for Payer: Aetna Medicare Advantage	$5.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.87
Rate for Payer: Cigna Commercial	$9.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.73
Rate for Payer: Oxford Commercial	$3.82
Rate for Payer: Qualcare PPO/HMO/WC	$2.87
Rate for Payer: UnitedHealthcare Commercial	$3.82
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

Know your out-of-pocket cost for care.

All Charges