Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DEXTROSE 25% INJ SYRINGE

Facility

$18.56

Service Code	NDC 409177510
Hospital Charge Code	60627955
Hospital Revenue Code	250
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$2.78
Rate for Payer: Qualcare PPO/HMO/WC	$2.78

DEXTROSE 25% INJ SYRINGE

Facility

$18.56

Service Code	NDC 409177510
Hospital Charge Code	60627955
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

DEXTROSE 50%/500CC

Facility

$99.29

Service Code	NDC 990793619
Hospital Charge Code	60635845
Hospital Revenue Code	258
Min. Negotiated Rate	$14.89
Max. Negotiated Rate	$14.89
Rate for Payer: Qualcare PPO/HMO/WC	$14.89

DEXTROSE 50%/500CC

Facility

$99.29

Service Code	NDC 990793619
Hospital Charge Code	60635845
Hospital Revenue Code	258
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$49.65
Rate for Payer: Aetna Commercial	$37.73
Rate for Payer: Aetna Medicare Advantage	$29.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.32
Rate for Payer: Cigna Commercial	$49.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.82
Rate for Payer: Oxford Commercial	$19.86
Rate for Payer: Qualcare PPO/HMO/WC	$14.89
Rate for Payer: UnitedHealthcare Commercial	$19.86
Rate for Payer: UnitedHealthcare Community & State	$3.14
Rate for Payer: Wellpoint Medicaid Managed Care	$2.82

DEXTROSE 50%/50ML

Facility

$16.48

Service Code	NDC 409664802
Hospital Charge Code	60635844
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$8.24
Rate for Payer: Aetna Commercial	$6.26
Rate for Payer: Aetna Medicare Advantage	$4.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.20
Rate for Payer: Cigna Commercial	$8.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.28
Rate for Payer: Oxford Commercial	$3.30
Rate for Payer: Qualcare PPO/HMO/WC	$2.47
Rate for Payer: UnitedHealthcare Commercial	$3.30
Rate for Payer: UnitedHealthcare Community & State	$0.52
Rate for Payer: Wellpoint Medicaid Managed Care	$0.47

DEXTROSE 50%/50ML

Facility

$16.48

Service Code	NDC 409664802
Hospital Charge Code	60635844
Hospital Revenue Code	250
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$2.47
Rate for Payer: Qualcare PPO/HMO/WC	$2.47

DEXTROSE 50% INJ SYRINGE

Facility

$36.00

Hospital Charge Code	60627956R
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna Commercial	$13.68
Rate for Payer: Aetna Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.18
Rate for Payer: Cigna Commercial	$18.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.36
Rate for Payer: Oxford Commercial	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$5.40
Rate for Payer: UnitedHealthcare Commercial	$7.20
Rate for Payer: UnitedHealthcare Community & State	$1.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1.02

DEXTROSE 50% INJ SYRINGE

Facility

$48.24

Service Code	NDC 76329330101
Hospital Charge Code	60627956
Hospital Revenue Code	250
Min. Negotiated Rate	$7.24
Max. Negotiated Rate	$7.24
Rate for Payer: Qualcare PPO/HMO/WC	$7.24

DEXTROSE 50% INJ SYRINGE

Facility

$36.00

Hospital Charge Code	60627956R
Hospital Revenue Code	250
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$5.40
Rate for Payer: Qualcare PPO/HMO/WC	$5.40

DEXTROSE 50% INJ SYRINGE

Facility

$48.24

Service Code	NDC 76329330101
Hospital Charge Code	60627956
Hospital Revenue Code	250
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$24.12
Rate for Payer: Aetna Commercial	$18.33
Rate for Payer: Aetna Medicare Advantage	$14.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.30
Rate for Payer: Cigna Commercial	$24.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.54
Rate for Payer: Oxford Commercial	$9.65
Rate for Payer: Qualcare PPO/HMO/WC	$7.24
Rate for Payer: UnitedHealthcare Commercial	$9.65
Rate for Payer: UnitedHealthcare Community & State	$1.52
Rate for Payer: Wellpoint Medicaid Managed Care	$1.37

DEXTROSE 5% 1000cc INJ

Facility

$5.60

Hospital Charge Code	270650052
Hospital Revenue Code	258
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$2.80
Rate for Payer: Aetna Commercial	$2.13
Rate for Payer: Aetna Medicare Advantage	$1.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.43
Rate for Payer: Cigna Commercial	$2.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.46
Rate for Payer: Oxford Commercial	$1.12
Rate for Payer: Qualcare PPO/HMO/WC	$0.84
Rate for Payer: UnitedHealthcare Commercial	$1.12
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

DEXTROSE 5% 1000cc INJ

Facility

$5.60

Hospital Charge Code	270650052
Hospital Revenue Code	258
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$0.84
Rate for Payer: Qualcare PPO/HMO/WC	$0.84

DEXTROSE 5% - 1/2 NS 1000 ML

Facility

$17.29

Service Code	NDC 338008504
Hospital Charge Code	60627900
Hospital Revenue Code	258
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$2.59
Rate for Payer: Qualcare PPO/HMO/WC	$2.59

DEXTROSE 5% - 1/2 NS 1000 ML

Facility

$17.29

Service Code	NDC 338008504
Hospital Charge Code	60627900
Hospital Revenue Code	258
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$6.57
Rate for Payer: Aetna Medicare Advantage	$5.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.41
Rate for Payer: Cigna Commercial	$8.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$3.46
Rate for Payer: Qualcare PPO/HMO/WC	$2.59
Rate for Payer: UnitedHealthcare Commercial	$3.46
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.49

DEXTROSE 5% - 1/3 NS 1000 ML

Facility

$11.73

Service Code	NDC 990792509
Hospital Charge Code	60627899
Hospital Revenue Code	258
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$1.76
Rate for Payer: Qualcare PPO/HMO/WC	$1.76

DEXTROSE 5% - 1/3 NS 1000 ML

Facility

$11.73

Service Code	NDC 990792509
Hospital Charge Code	60627899
Hospital Revenue Code	258
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$5.87
Rate for Payer: Aetna Commercial	$4.46
Rate for Payer: Aetna Medicare Advantage	$3.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.99
Rate for Payer: Cigna Commercial	$5.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.05
Rate for Payer: Oxford Commercial	$2.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.76
Rate for Payer: UnitedHealthcare Commercial	$2.35
Rate for Payer: UnitedHealthcare Community & State	$0.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.33

DEXTROSE 5% 500cc INJ

Facility

$5.40

Hospital Charge Code	270650058
Hospital Revenue Code	258
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$0.81
Rate for Payer: Qualcare PPO/HMO/WC	$0.81

DEXTROSE 5% 500cc INJ

Facility

$5.40

Hospital Charge Code	270650058
Hospital Revenue Code	258
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$2.70
Rate for Payer: Aetna Commercial	$2.05
Rate for Payer: Aetna Medicare Advantage	$1.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.38
Rate for Payer: Cigna Commercial	$2.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.40
Rate for Payer: Oxford Commercial	$1.08
Rate for Payer: Qualcare PPO/HMO/WC	$0.81
Rate for Payer: UnitedHealthcare Commercial	$1.08
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

DEXTROSE 5% IN WATER 1000 ML

Facility

$182.17

Service Code	NDC 990792209
Hospital Charge Code	60627948
Hospital Revenue Code	258
Min. Negotiated Rate	$5.17
Max. Negotiated Rate	$91.08
Rate for Payer: Aetna Commercial	$69.22
Rate for Payer: Aetna Medicare Advantage	$54.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.45
Rate for Payer: Cigna Commercial	$91.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.36
Rate for Payer: Oxford Commercial	$36.43
Rate for Payer: Qualcare PPO/HMO/WC	$27.33
Rate for Payer: UnitedHealthcare Commercial	$36.43
Rate for Payer: UnitedHealthcare Community & State	$5.76
Rate for Payer: Wellpoint Medicaid Managed Care	$5.17

DEXTROSE 5% IN WATER 1000 ML

Facility

$182.17

Service Code	NDC 990792209
Hospital Charge Code	60627948
Hospital Revenue Code	258
Min. Negotiated Rate	$27.33
Max. Negotiated Rate	$27.33
Rate for Payer: Qualcare PPO/HMO/WC	$27.33

DEXTROSE 5% IN WATER 100 ML

Facility

$12.93

Service Code	NDC 990792337
Hospital Charge Code	60627946
Hospital Revenue Code	258
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$6.46
Rate for Payer: Aetna Commercial	$4.91
Rate for Payer: Aetna Medicare Advantage	$3.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.30
Rate for Payer: Cigna Commercial	$6.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.36
Rate for Payer: Oxford Commercial	$2.59
Rate for Payer: Qualcare PPO/HMO/WC	$1.94
Rate for Payer: UnitedHealthcare Commercial	$2.59
Rate for Payer: UnitedHealthcare Community & State	$0.41
Rate for Payer: Wellpoint Medicaid Managed Care	$0.37

DEXTROSE 5% IN WATER 100 ML

Facility

$12.93

Service Code	NDC 990792337
Hospital Charge Code	60627946
Hospital Revenue Code	258
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$1.94
Rate for Payer: Qualcare PPO/HMO/WC	$1.94

DEXTROSE 5% IN WATER 250 ML

Facility

$13.13

Service Code	NDC 338001702
Hospital Charge Code	60627950
Hospital Revenue Code	258
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$6.57
Rate for Payer: Aetna Commercial	$4.99
Rate for Payer: Aetna Medicare Advantage	$3.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.35
Rate for Payer: Cigna Commercial	$6.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.41
Rate for Payer: Oxford Commercial	$2.63
Rate for Payer: Qualcare PPO/HMO/WC	$1.97
Rate for Payer: UnitedHealthcare Commercial	$2.63
Rate for Payer: UnitedHealthcare Community & State	$0.41
Rate for Payer: Wellpoint Medicaid Managed Care	$0.37

DEXTROSE 5% IN WATER 250 ML

Facility

$13.13

Service Code	NDC 338001702
Hospital Charge Code	60627950
Hospital Revenue Code	258
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$1.97
Rate for Payer: Qualcare PPO/HMO/WC	$1.97

DEXTROSE 5% IN WATER 500ML

Facility

$13.20

Service Code	NDC 338001703
Hospital Charge Code	60627951
Hospital Revenue Code	258
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$1.98
Rate for Payer: Qualcare PPO/HMO/WC	$1.98

Know your out-of-pocket cost for care.

All Charges