Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

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%(PED) S

Facility

$88.91

Service Code	NDC 409490034
Hospital Charge Code	6063943244
Hospital Revenue Code	250
Min. Negotiated Rate	$2.53
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	$23.12
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	$2.81
Rate for Payer: Wellpoint Medicaid Managed Care	$2.53

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	$1.54
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	$14.11
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	$1.71
Rate for Payer: Wellpoint Medicaid Managed Care	$1.54

SODIUMCHLOR 0.9% IRRIG 1000ml

Facility

$22.50

Hospital Charge Code	270649320
Hospital Revenue Code	272
Min. Negotiated Rate	$0.64
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	$5.85
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	$0.71
Rate for Payer: Wellpoint Medicaid Managed Care	$0.64

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	$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	$0.64
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	$5.85
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	$0.71
Rate for Payer: Wellpoint Medicaid Managed Care	$0.64

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 CHLOR CONC 4MEQ/ML 30ML

Facility

$64.59

Service Code	NDC 63323008861
Hospital Charge Code	60627935
Hospital Revenue Code	250
Min. Negotiated Rate	$1.83
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	$16.79
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	$2.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1.83

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	$0.52
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	$4.77
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	$0.58
Rate for Payer: Wellpoint Medicaid Managed Care	$0.52

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	$0.31
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	$2.86
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	$0.35
Rate for Payer: Wellpoint Medicaid Managed Care	$0.31

SODIUM CHLORIDE 0.45% 500 ML

Facility

$9.38

Service Code	NDC 409798503
Hospital Charge Code	60629307
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
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	$2.44
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	$0.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

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 0.9%

Facility

$12.46

Service Code	NDC 338004948
Hospital Charge Code	60627913
Hospital Revenue Code	258
Min. Negotiated Rate	$0.35
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	$3.24
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	$0.39
Rate for Payer: Wellpoint Medicaid Managed Care	$0.35

SODIUM CHLORIDE 0.9%

Facility

$19.10

Service Code	NDC 264780020
Hospital Charge Code	60627914
Hospital Revenue Code	258
Min. Negotiated Rate	$0.54
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	$4.97
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	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.54

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

$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% 1000 ML

Facility

$15.75

Service Code	NDC 338004904
Hospital Charge Code	60627918
Hospital Revenue Code	258
Min. Negotiated Rate	$0.45
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	$4.09
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	$0.50
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

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	$7.05
Max. Negotiated Rate	$7.05
Rate for Payer: Qualcare PPO/HMO/WC	$7.05

SODIUM CHLORIDE 0.9% 2000ML

Facility

$47.00

Hospital Charge Code	270331923
Hospital Revenue Code	272
Min. Negotiated Rate	$1.33
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	$12.22
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	$1.49
Rate for Payer: Wellpoint Medicaid Managed Care	$1.33

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

Know your out-of-pocket cost for care.

All Charges