Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DEXT 5% 5OML ADD-LINE

Facility

$11.25

Hospital Charge Code	270040120
Hospital Revenue Code	258
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$4.28
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.92
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$2.25
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

DEXT 5% .9% NACL 40CL 1000cc

Facility

$11.25

Hospital Charge Code	270649727
Hospital Revenue Code	270
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

DEXT 5% .9% NACL 40CL 1000cc

Facility

$11.25

Hospital Charge Code	270649727
Hospital Revenue Code	270
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$4.28
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.92
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$2.25
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

DEXT 5%/LACT RING 1000ML

Facility

$11.25

Hospital Charge Code	270040180
Hospital Revenue Code	258
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

DEXT 5%/LACT RING 1000ML

Facility

$11.25

Hospital Charge Code	270040180
Hospital Revenue Code	258
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$4.28
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.92
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$2.25
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

DEXT 5%/LACT RING 500ML

Facility

$11.25

Hospital Charge Code	270040185
Hospital Revenue Code	258
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$4.28
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.92
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$2.25
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

DEXT 5%/LACT RING 500ML

Facility

$11.25

Hospital Charge Code	270040185
Hospital Revenue Code	258
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

DEXT 5%/NACL 0.2% 500ML

Facility

$13.74

Service Code	NDC 264761610
Hospital Charge Code	60628601
Hospital Revenue Code	258
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$6.87
Rate for Payer: Aetna Commercial	$5.22
Rate for Payer: Aetna Medicare Advantage	$4.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.50
Rate for Payer: Cigna Commercial	$6.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.57
Rate for Payer: Oxford Commercial	$2.75
Rate for Payer: Qualcare PPO/HMO/WC	$2.06
Rate for Payer: UnitedHealthcare Commercial	$2.75
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.39

DEXT 5%/NACL 0.2% 500ML

Facility

$13.74

Service Code	NDC 264761610
Hospital Charge Code	60628601
Hospital Revenue Code	258
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$2.06
Rate for Payer: Qualcare PPO/HMO/WC	$2.06

DEXT 5%/NACL 0.2% 500ML

Facility

$9.65

Hospital Charge Code	270040155
Hospital Revenue Code	258
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$3.67
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.51
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$1.93
Rate for Payer: UnitedHealthcare Community & State	$0.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

DEXT 5%/NACL 0.2% 500ML

Facility

$9.65

Hospital Charge Code	270040155
Hospital Revenue Code	258
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

DEXT 5%/NACL 0.45% 100OML

Facility

$11.25

Hospital Charge Code	270040145
Hospital Revenue Code	258
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

DEXT 5%/NACL 0.45% 100OML

Facility

$11.25

Hospital Charge Code	270040145
Hospital Revenue Code	258
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$4.28
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.92
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$2.25
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

DEXT 5% NACL .09% 1000cc

Facility

$7.85

Hospital Charge Code	270650054
Hospital Revenue Code	258
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$1.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.18

DEXT 5% NACL .09% 1000cc

Facility

$7.85

Hospital Charge Code	270650054
Hospital Revenue Code	258
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$3.92
Rate for Payer: Aetna Commercial	$2.98
Rate for Payer: Aetna Medicare Advantage	$2.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.00
Rate for Payer: Cigna Commercial	$3.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.04
Rate for Payer: Oxford Commercial	$1.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.18
Rate for Payer: UnitedHealthcare Commercial	$1.57
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.22

DEXT 5%/NACL 0.9% 1000ML

Facility

$11.25

Hospital Charge Code	270040135
Hospital Revenue Code	258
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$4.28
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.92
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$2.25
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

DEXT 5%/NACL 0.9% 1000ML

Facility

$11.25

Hospital Charge Code	270040135
Hospital Revenue Code	258
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

DEXT 5% NACL .45% 500cc

Facility

$6.35

Hospital Charge Code	270650129
Hospital Revenue Code	258
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.17
Rate for Payer: Aetna Commercial	$2.41
Rate for Payer: Aetna Medicare Advantage	$1.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.62
Rate for Payer: Cigna Commercial	$3.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.65
Rate for Payer: Oxford Commercial	$1.27
Rate for Payer: Qualcare PPO/HMO/WC	$0.95
Rate for Payer: UnitedHealthcare Commercial	$1.27
Rate for Payer: UnitedHealthcare Community & State	$0.20
Rate for Payer: Wellpoint Medicaid Managed Care	$0.18

DEXT 5% NACL .45% 500cc

Facility

$6.35

Hospital Charge Code	270650129
Hospital Revenue Code	258
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$0.95
Rate for Payer: Qualcare PPO/HMO/WC	$0.95

DEXTRAN 40 10%-DEXTROSE 5% INJ

Facility

$182.58

Service Code	NDC 409741803
Hospital Charge Code	60627907
Hospital Revenue Code	258
Min. Negotiated Rate	$27.39
Max. Negotiated Rate	$27.39
Rate for Payer: Qualcare PPO/HMO/WC	$27.39

DEXTRAN 40 10%-DEXTROSE 5% INJ

Facility

$182.58

Service Code	NDC 409741803
Hospital Charge Code	60627907
Hospital Revenue Code	258
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$91.29
Rate for Payer: Aetna Commercial	$69.38
Rate for Payer: Aetna Medicare Advantage	$54.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.56
Rate for Payer: Cigna Commercial	$91.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.47
Rate for Payer: Oxford Commercial	$36.52
Rate for Payer: Qualcare PPO/HMO/WC	$27.39
Rate for Payer: UnitedHealthcare Commercial	$36.52
Rate for Payer: UnitedHealthcare Community & State	$5.77
Rate for Payer: Wellpoint Medicaid Managed Care	$5.19

DEXTRAN 40 10%-NACL 0.9% INJ

Facility

$228.81

Service Code	NDC 409741903
Hospital Charge Code	60627908
Hospital Revenue Code	258
Min. Negotiated Rate	$34.32
Max. Negotiated Rate	$34.32
Rate for Payer: Qualcare PPO/HMO/WC	$34.32

DEXTRAN 40 10%-NACL 0.9% INJ

Facility

$228.81

Service Code	NDC 409741903
Hospital Charge Code	60627908
Hospital Revenue Code	258
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$114.41
Rate for Payer: Aetna Commercial	$86.95
Rate for Payer: Aetna Medicare Advantage	$68.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.35
Rate for Payer: Cigna Commercial	$114.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.49
Rate for Payer: Oxford Commercial	$45.76
Rate for Payer: Qualcare PPO/HMO/WC	$34.32
Rate for Payer: UnitedHealthcare Commercial	$45.76
Rate for Payer: UnitedHealthcare Community & State	$7.23
Rate for Payer: Wellpoint Medicaid Managed Care	$6.50

DEXTROMETHORP-GUAIFEN 5-100MG

Facility

$18.56

Service Code	NDC 121127600
Hospital Charge Code	60629011
Hospital Revenue Code	250
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$9.28
Rate for Payer: Aetna Commercial	$7.05
Rate for Payer: Aetna Medicare Advantage	$5.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.73
Rate for Payer: Cigna Commercial	$9.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.83
Rate for Payer: Oxford Commercial	$3.71
Rate for Payer: Qualcare PPO/HMO/WC	$2.78
Rate for Payer: UnitedHealthcare Commercial	$3.71
Rate for Payer: UnitedHealthcare Community & State	$0.59
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

DEXTROMETHORP-GUAIFEN 5-100MG

Facility

$18.56

Service Code	NDC 121127600
Hospital Charge Code	60629011
Hospital Revenue Code	250
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$2.78
Rate for Payer: Qualcare PPO/HMO/WC	$2.78

Know your out-of-pocket cost for care.

All Charges