Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SODIUM CHLORIDE 0.9%

Facility

$19.10

Service Code	NDC 264780020
Hospital Charge Code	60627914
Hospital Revenue Code	258
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$2.87
Rate for Payer: Qualcare PPO/HMO/WC	$2.87

SODIUM CHLORIDE 0.9%

Facility

$12.46

Service Code	NDC 338004948
Hospital Charge Code	60627913
Hospital Revenue Code	258
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$1.87
Rate for Payer: Qualcare PPO/HMO/WC	$1.87

SODIUM CHLORIDE 0.9%

Facility

$12.46

Service Code	NDC 338004948
Hospital Charge Code	60627913
Hospital Revenue Code	258
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$6.23
Rate for Payer: Aetna Commercial	$4.73
Rate for Payer: Aetna Medicare Advantage	$3.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.18
Rate for Payer: Cigna Commercial	$6.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.74
Rate for Payer: Oxford Commercial	$2.49
Rate for Payer: Qualcare PPO/HMO/WC	$1.87
Rate for Payer: UnitedHealthcare Commercial	$2.49
Rate for Payer: UnitedHealthcare Community & State	$0.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.33

SODIUM CHLORIDE 0.9% 1000 ML

Facility

$15.75

Service Code	NDC 338004904
Hospital Charge Code	60627918
Hospital Revenue Code	258
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$7.88
Rate for Payer: Aetna Commercial	$5.99
Rate for Payer: Aetna Medicare Advantage	$4.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.02
Rate for Payer: Cigna Commercial	$7.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.72
Rate for Payer: Oxford Commercial	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$2.36
Rate for Payer: UnitedHealthcare Commercial	$3.15
Rate for Payer: UnitedHealthcare Community & State	$0.38
Rate for Payer: Wellpoint Medicaid Managed Care	$0.42

SODIUM CHLORIDE 0.9% 1000 ML

Facility

$15.75

Service Code	NDC 338004904
Hospital Charge Code	60627918
Hospital Revenue Code	258
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$2.36
Rate for Payer: Qualcare PPO/HMO/WC	$2.36

SODIUM CHLORIDE 0.9% 2000ML

Facility

$47.00

Hospital Charge Code	270331923
Hospital Revenue Code	272
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$23.50
Rate for Payer: Aetna Commercial	$17.86
Rate for Payer: Aetna Medicare Advantage	$14.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.98
Rate for Payer: Cigna Commercial	$23.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.10
Rate for Payer: Oxford Commercial	$9.40
Rate for Payer: Qualcare PPO/HMO/WC	$7.05
Rate for Payer: UnitedHealthcare Commercial	$9.40
Rate for Payer: UnitedHealthcare Community & State	$1.13
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

SODIUM CHLORIDE 0.9% 2000ML

Facility

$47.00

Hospital Charge Code	270331923
Hospital Revenue Code	272
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$7.05
Rate for Payer: Qualcare PPO/HMO/WC	$7.05

SODIUM CHLORIDE 0.9% 20ML

Facility

$7.64

Service Code	NDC 409488820
Hospital Charge Code	60635595
Hospital Revenue Code	250
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$1.15
Rate for Payer: Qualcare PPO/HMO/WC	$1.15

SODIUM CHLORIDE 0.9% 20ML

Facility

$7.64

Service Code	NDC 409488820
Hospital Charge Code	60635595
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.82
Rate for Payer: Aetna Commercial	$2.90
Rate for Payer: Aetna Medicare Advantage	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.95
Rate for Payer: Cigna Commercial	$3.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.29
Rate for Payer: Oxford Commercial	$1.53
Rate for Payer: Qualcare PPO/HMO/WC	$1.15
Rate for Payer: UnitedHealthcare Commercial	$1.53
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

SODIUM CHLORIDE 0.9% 250ml

Facility

$15.95

Hospital Charge Code	270650189
Hospital Revenue Code	258
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$2.39
Rate for Payer: Qualcare PPO/HMO/WC	$2.39

SODIUM CHLORIDE 0.9% 250ml

Facility

$15.95

Hospital Charge Code	270650189
Hospital Revenue Code	258
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$7.97
Rate for Payer: Aetna Commercial	$6.06
Rate for Payer: Aetna Medicare Advantage	$4.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.07
Rate for Payer: Cigna Commercial	$7.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.79
Rate for Payer: Oxford Commercial	$3.19
Rate for Payer: Qualcare PPO/HMO/WC	$2.39
Rate for Payer: UnitedHealthcare Commercial	$3.19
Rate for Payer: UnitedHealthcare Community & State	$0.38
Rate for Payer: Wellpoint Medicaid Managed Care	$0.42

SODIUM CHLORIDE 0.9%/2ML

Facility

$3.00

Hospital Charge Code	60634974
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SODIUM CHLORIDE 0.9%/2ML

Facility

$3.00

Hospital Charge Code	60634974
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

SODIUM CHLORIDE 0.9% 500 ML

Facility

$15.68

Service Code	NDC 264780010
Hospital Charge Code	60627915
Hospital Revenue Code	258
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$2.35
Rate for Payer: Qualcare PPO/HMO/WC	$2.35

SODIUM CHLORIDE 0.9% 500 ML

Facility

$15.68

Service Code	NDC 264780010
Hospital Charge Code	60627915
Hospital Revenue Code	258
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$7.84
Rate for Payer: Aetna Commercial	$5.96
Rate for Payer: Aetna Medicare Advantage	$4.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.00
Rate for Payer: Cigna Commercial	$7.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.70
Rate for Payer: Oxford Commercial	$3.14
Rate for Payer: Qualcare PPO/HMO/WC	$2.35
Rate for Payer: UnitedHealthcare Commercial	$3.14
Rate for Payer: UnitedHealthcare Community & State	$0.38
Rate for Payer: Wellpoint Medicaid Managed Care	$0.42

SODIUM CHLORIDE 0.9% 50 ML

Facility

$17.09

Service Code	NDC 990798413
Hospital Charge Code	60627916
Hospital Revenue Code	250
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$2.56
Rate for Payer: Qualcare PPO/HMO/WC	$2.56

SODIUM CHLORIDE 0.9% 50 ML

Facility

$17.09

Service Code	NDC 990798413
Hospital Charge Code	60627916
Hospital Revenue Code	250
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$8.54
Rate for Payer: Aetna Commercial	$6.49
Rate for Payer: Aetna Medicare Advantage	$5.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.36
Rate for Payer: Cigna Commercial	$8.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.13
Rate for Payer: Oxford Commercial	$3.42
Rate for Payer: Qualcare PPO/HMO/WC	$2.56
Rate for Payer: UnitedHealthcare Commercial	$3.42
Rate for Payer: UnitedHealthcare Community & State	$0.41
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

SODIUM CHLORIDE 0.9% BACT

Facility

$7.00

Hospital Charge Code	60633905
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

SODIUM CHLORIDE 0.9% BACT

Facility

$7.00

Hospital Charge Code	60633905
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

SODIUM CHLORIDE 0.9% IRRIG

Facility

$62.91

Service Code	NDC 990797208
Hospital Charge Code	606361020
Hospital Revenue Code	272
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$31.45
Rate for Payer: Aetna Commercial	$23.91
Rate for Payer: Aetna Medicare Advantage	$18.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.04
Rate for Payer: Cigna Commercial	$31.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.87
Rate for Payer: Oxford Commercial	$12.58
Rate for Payer: Qualcare PPO/HMO/WC	$9.44
Rate for Payer: UnitedHealthcare Commercial	$12.58
Rate for Payer: UnitedHealthcare Community & State	$1.52
Rate for Payer: Wellpoint Medicaid Managed Care	$1.67

SODIUM CHLORIDE 0.9% IRRIG

Facility

$62.91

Service Code	NDC 990797208
Hospital Charge Code	606361020
Hospital Revenue Code	272
Min. Negotiated Rate	$9.44
Max. Negotiated Rate	$9.44
Rate for Payer: Qualcare PPO/HMO/WC	$9.44

SODIUM CHLORIDE 0.9% IRRIG SOLN

Facility

$42.21

Service Code	NDC 990713809
Hospital Charge Code	6063943245
Hospital Revenue Code	272
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$21.11
Rate for Payer: Aetna Commercial	$16.04
Rate for Payer: Aetna Medicare Advantage	$12.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.76
Rate for Payer: Cigna Commercial	$21.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.66
Rate for Payer: Oxford Commercial	$8.44
Rate for Payer: Qualcare PPO/HMO/WC	$6.33
Rate for Payer: UnitedHealthcare Commercial	$8.44
Rate for Payer: UnitedHealthcare Community & State	$1.02
Rate for Payer: Wellpoint Medicaid Managed Care	$1.12

SODIUM CHLORIDE 0.9% IRRIG SOLN

Facility

$42.21

Service Code	NDC 990713809
Hospital Charge Code	6063943245
Hospital Revenue Code	272
Min. Negotiated Rate	$6.33
Max. Negotiated Rate	$6.33
Rate for Payer: Qualcare PPO/HMO/WC	$6.33

SODIUM CHLORIDE 14.6%/2.5

Facility

$18.00

Hospital Charge Code	60633906
Hospital Revenue Code	250
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	$5.40
Rate for Payer: Oxford Commercial	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$3.60
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

SODIUM CHLORIDE 14.6%/2.5

Facility

$18.00

Hospital Charge Code	60633906
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

Know your out-of-pocket cost for care.

All Charges