Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SODIUM CHLORIDE 0.9% 20ML

Facility

$7.64

Service Code	NDC 409488820
Hospital Charge Code	60635595
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
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	$1.99
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	$0.24
Rate for Payer: Wellpoint Medicaid Managed Care	$0.22

SODIUM CHLORIDE 0.9% 250ml

Facility

$15.95

Hospital Charge Code	270650189
Hospital Revenue Code	258
Min. Negotiated Rate	$0.45
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	$4.15
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	$0.50
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

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% 500 ML

Facility

$15.68

Service Code	NDC 264780010
Hospital Charge Code	60627915
Hospital Revenue Code	258
Min. Negotiated Rate	$0.45
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	$4.08
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	$0.50
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

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% 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	$0.49
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	$4.44
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	$0.54
Rate for Payer: Wellpoint Medicaid Managed Care	$0.49

SODIUM CHLORIDE 0.9% IRRIG

Facility

$62.91

Service Code	NDC 990797208
Hospital Charge Code	606361020
Hospital Revenue Code	272
Min. Negotiated Rate	$1.79
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	$16.36
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	$1.99
Rate for Payer: Wellpoint Medicaid Managed Care	$1.79

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	$6.33
Max. Negotiated Rate	$6.33
Rate for Payer: Qualcare PPO/HMO/WC	$6.33

SODIUM CHLORIDE 0.9% IRRIG SOLN

Facility

$42.21

Service Code	NDC 990713809
Hospital Charge Code	6063943245
Hospital Revenue Code	272
Min. Negotiated Rate	$1.20
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	$10.97
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	$1.33
Rate for Payer: Wellpoint Medicaid Managed Care	$1.20

SODIUM CHLORIDE 3% HYPERTONIC

Facility

$33.50

Service Code	NDC 264780510
Hospital Charge Code	60628857
Hospital Revenue Code	258
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$5.03
Rate for Payer: Qualcare PPO/HMO/WC	$5.03

SODIUM CHLORIDE 3% HYPERTONIC

Facility

$33.50

Service Code	NDC 264780510
Hospital Charge Code	60628857
Hospital Revenue Code	258
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$16.75
Rate for Payer: Aetna Commercial	$12.73
Rate for Payer: Aetna Medicare Advantage	$10.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.54
Rate for Payer: Cigna Commercial	$16.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.71
Rate for Payer: Oxford Commercial	$6.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.03
Rate for Payer: UnitedHealthcare Commercial	$6.70
Rate for Payer: UnitedHealthcare Community & State	$1.06
Rate for Payer: Wellpoint Medicaid Managed Care	$0.95

SODIUM CHLORIDE 3% INH SOL 4ML

Facility

$4.00

Service Code	NDC 487900360
Hospital Charge Code	606390070
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
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	$1.04
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	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

SODIUM CHLORIDE 3% INH SOL 4ML

Facility

$4.00

Service Code	NDC 487900360
Hospital Charge Code	606390070
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SODIUM CHLORIDE 45 ML

Facility

$31.56

Service Code	NDC 187526001
Hospital Charge Code	6004980
Hospital Revenue Code	251
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$15.78
Rate for Payer: Aetna Commercial	$11.99
Rate for Payer: Aetna Medicare Advantage	$9.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.05
Rate for Payer: Cigna Commercial	$15.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.21
Rate for Payer: Oxford Commercial	$6.31
Rate for Payer: Qualcare PPO/HMO/WC	$4.73
Rate for Payer: UnitedHealthcare Commercial	$6.31
Rate for Payer: UnitedHealthcare Community & State	$1.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.90

SODIUM CHLORIDE 45 ML

Facility

$31.56

Service Code	NDC 187526001
Hospital Charge Code	6004980
Hospital Revenue Code	251
Min. Negotiated Rate	$4.73
Max. Negotiated Rate	$4.73
Rate for Payer: Qualcare PPO/HMO/WC	$4.73

SODIUM CHLOR INJ 0.9% 10ML

Facility

$9.25

Service Code	NDC 409108151
Hospital Charge Code	60627917
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$4.62
Rate for Payer: Aetna Commercial	$3.52
Rate for Payer: Aetna Medicare Advantage	$2.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.36
Rate for Payer: Cigna Commercial	$4.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.40
Rate for Payer: Oxford Commercial	$1.85
Rate for Payer: Qualcare PPO/HMO/WC	$1.39
Rate for Payer: UnitedHealthcare Commercial	$1.85
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.26

SODIUM CHLOR INJ 0.9% 10ML

Facility

$9.25

Service Code	NDC 409108151
Hospital Charge Code	60627917
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$1.39
Rate for Payer: Qualcare PPO/HMO/WC	$1.39

SODIUM CHLOR SOL 0.9% IRRIG

Facility

$98.09

Service Code	NDC 338004747
Hospital Charge Code	60629145
Hospital Revenue Code	272
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$49.05
Rate for Payer: Aetna Commercial	$37.27
Rate for Payer: Aetna Medicare Advantage	$29.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.01
Rate for Payer: Cigna Commercial	$49.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.50
Rate for Payer: Oxford Commercial	$19.62
Rate for Payer: Qualcare PPO/HMO/WC	$14.71
Rate for Payer: UnitedHealthcare Commercial	$19.62
Rate for Payer: UnitedHealthcare Community & State	$3.10
Rate for Payer: Wellpoint Medicaid Managed Care	$2.79

SODIUM CHLOR SOL 0.9% IRRIG

Facility

$98.09

Service Code	NDC 338004747
Hospital Charge Code	60629145
Hospital Revenue Code	272
Min. Negotiated Rate	$14.71
Max. Negotiated Rate	$14.71
Rate for Payer: Qualcare PPO/HMO/WC	$14.71

SODIUM CHLOR TAB 1GM

Facility

$4.00

Service Code	NDC 223176001
Hospital Charge Code	6004998
Hospital Revenue Code	251
Min. Negotiated Rate	$0.11
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	$1.04
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	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

SODIUM CHLOR TAB 1GM

Facility

$4.00

Service Code	NDC 223176001
Hospital Charge Code	6004998
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SODIUM CL 0.9% INH SOL 3 ML

Facility

$4.00

Service Code	NDC 487930103
Hospital Charge Code	60629119
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
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	$1.04
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	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

SODIUM CL 0.9% INH SOL 3 ML

Facility

$4.00

Service Code	NDC 487930103
Hospital Charge Code	60629119
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

Know your out-of-pocket cost for care.

All Charges