Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BUPIVACAINE 0.5%/EP1 1.8 ML IN

Facility

$42.85

Hospital Charge Code	606380004
Hospital Revenue Code	250
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$21.43
Rate for Payer: Aetna Commercial	$16.28
Rate for Payer: Aetna Medicare Advantage	$12.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.93
Rate for Payer: Cigna Commercial	$21.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.86
Rate for Payer: Oxford Commercial	$8.57
Rate for Payer: Qualcare PPO/HMO/WC	$6.43
Rate for Payer: UnitedHealthcare Commercial	$8.57
Rate for Payer: UnitedHealthcare Community & State	$1.03
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

BUPIVACAINE 0.5%/EP1 1.8 ML IN

Facility

$42.85

Hospital Charge Code	606380004
Hospital Revenue Code	250
Min. Negotiated Rate	$6.43
Max. Negotiated Rate	$6.43
Rate for Payer: Qualcare PPO/HMO/WC	$6.43

BUPIVACAINE 0.5% INJ (30ML)

Facility

$13.53

Service Code	NDC 409116202
Hospital Charge Code	6006662
Hospital Revenue Code	250
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$2.03
Rate for Payer: Qualcare PPO/HMO/WC	$2.03

BUPIVACAINE 0.5% INJ (30ML)

Facility

$13.53

Service Code	NDC 409116202
Hospital Charge Code	6006662
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$6.76
Rate for Payer: Aetna Commercial	$5.14
Rate for Payer: Aetna Medicare Advantage	$4.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.45
Rate for Payer: Cigna Commercial	$6.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.06
Rate for Payer: Oxford Commercial	$2.71
Rate for Payer: Qualcare PPO/HMO/WC	$2.03
Rate for Payer: UnitedHealthcare Commercial	$2.71
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.36

BUPIVACAINE 0.5% INJ 50 ML

Facility

$52.85

Hospital Charge Code	60628267
Hospital Revenue Code	250
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$26.43
Rate for Payer: Aetna Commercial	$20.08
Rate for Payer: Aetna Medicare Advantage	$15.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.48
Rate for Payer: Cigna Commercial	$26.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.86
Rate for Payer: Oxford Commercial	$10.57
Rate for Payer: Qualcare PPO/HMO/WC	$7.93
Rate for Payer: UnitedHealthcare Commercial	$10.57
Rate for Payer: UnitedHealthcare Community & State	$1.27
Rate for Payer: Wellpoint Medicaid Managed Care	$1.40

BUPIVACAINE 0.5% INJ 50 ML

Facility

$52.85

Hospital Charge Code	60628267
Hospital Revenue Code	250
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$7.93
Rate for Payer: Qualcare PPO/HMO/WC	$7.93

BUPIVACAINE 0.5% SDV

Facility

$8.68

Hospital Charge Code	60635818
Hospital Revenue Code	250
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$1.30
Rate for Payer: Qualcare PPO/HMO/WC	$1.30

BUPIVACAINE 0.5% SDV

Facility

$8.68

Hospital Charge Code	60635818
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$4.34
Rate for Payer: Aetna Commercial	$3.30
Rate for Payer: Aetna Medicare Advantage	$2.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.21
Rate for Payer: Cigna Commercial	$4.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.60
Rate for Payer: Oxford Commercial	$1.74
Rate for Payer: Qualcare PPO/HMO/WC	$1.30
Rate for Payer: UnitedHealthcare Commercial	$1.74
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

BUPIVACAINE 0.5% W/EPI 1.8ML

Facility

$3.20

Hospital Charge Code	6012322
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$1.22
Rate for Payer: Aetna Medicare Advantage	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.82
Rate for Payer: Cigna Commercial	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.96
Rate for Payer: Oxford Commercial	$0.64
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$0.64
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

BUPIVACAINE 0.5% W/EPI 1.8ML

Facility

$3.20

Hospital Charge Code	6012322
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

BUPIVACAINE 0.5% W/EPI 1.8ML

Facility

$4.85

Hospital Charge Code	60628793
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.42
Rate for Payer: Aetna Commercial	$1.84
Rate for Payer: Aetna Medicare Advantage	$1.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.24
Rate for Payer: Cigna Commercial	$2.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.46
Rate for Payer: Oxford Commercial	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.73
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

BUPIVACAINE 0.5% W/EPI 1.8ML

Facility

$4.85

Hospital Charge Code	60628793
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.73

BUPIVACAINE 0.75% 10ML

Facility

$38.19

Service Code	NDC 63323047217
Hospital Charge Code	60635756
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$19.09
Rate for Payer: Aetna Commercial	$14.51
Rate for Payer: Aetna Medicare Advantage	$11.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.74
Rate for Payer: Cigna Commercial	$19.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.46
Rate for Payer: Oxford Commercial	$7.64
Rate for Payer: Qualcare PPO/HMO/WC	$5.73
Rate for Payer: UnitedHealthcare Commercial	$7.64
Rate for Payer: UnitedHealthcare Community & State	$0.92
Rate for Payer: Wellpoint Medicaid Managed Care	$1.01

BUPIVACAINE 0.75% 10ML

Facility

$38.19

Service Code	NDC 63323047217
Hospital Charge Code	60635756
Hospital Revenue Code	250
Min. Negotiated Rate	$5.73
Max. Negotiated Rate	$5.73
Rate for Payer: Qualcare PPO/HMO/WC	$5.73

BUPIVACAINE 0.75%/D 8.25% 2 ML

Facility

$30.42

Service Code	NDC 409176110
Hospital Charge Code	606353813
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$15.21
Rate for Payer: Aetna Commercial	$11.56
Rate for Payer: Aetna Medicare Advantage	$9.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.76
Rate for Payer: Cigna Commercial	$15.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.13
Rate for Payer: Oxford Commercial	$6.08
Rate for Payer: Qualcare PPO/HMO/WC	$4.56
Rate for Payer: UnitedHealthcare Commercial	$6.08
Rate for Payer: UnitedHealthcare Community & State	$0.73
Rate for Payer: Wellpoint Medicaid Managed Care	$0.81

BUPIVACAINE 0.75%/D 8.25% 2 ML

Facility

$30.42

Service Code	NDC 409176110
Hospital Charge Code	606353813
Hospital Revenue Code	250
Min. Negotiated Rate	$4.56
Max. Negotiated Rate	$4.56
Rate for Payer: Qualcare PPO/HMO/WC	$4.56

BUPIVACAINE 0.75% INJ (30ML)

Facility

$28.94

Service Code	NDC 409158229
Hospital Charge Code	6006670
Hospital Revenue Code	250
Min. Negotiated Rate	$4.34
Max. Negotiated Rate	$4.34
Rate for Payer: Qualcare PPO/HMO/WC	$4.34

BUPIVACAINE 0.75% INJ (30ML)

Facility

$28.94

Service Code	NDC 409158229
Hospital Charge Code	6006670
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$14.47
Rate for Payer: Aetna Commercial	$11.00
Rate for Payer: Aetna Medicare Advantage	$8.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.38
Rate for Payer: Cigna Commercial	$14.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.68
Rate for Payer: Oxford Commercial	$5.79
Rate for Payer: Qualcare PPO/HMO/WC	$4.34
Rate for Payer: UnitedHealthcare Commercial	$5.79
Rate for Payer: UnitedHealthcare Community & State	$0.70
Rate for Payer: Wellpoint Medicaid Managed Care	$0.77

BUPIVACAINE 0.75% INJ30ML

Facility

$13.00

Hospital Charge Code	60635350
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$2.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$2.60
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

BUPIVACAINE 0.75% INJ30ML

Facility

$13.00

Hospital Charge Code	60635350
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

BUPIVACAINE EPI 05% 10ML

Facility

$30.10

Hospital Charge Code	6000780
Hospital Revenue Code	250
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$4.51
Rate for Payer: Qualcare PPO/HMO/WC	$4.51

BUPIVACAINE EPI 05% 10ML

Facility

$30.10

Hospital Charge Code	6000780
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$15.05
Rate for Payer: Aetna Commercial	$11.44
Rate for Payer: Aetna Medicare Advantage	$9.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.68
Rate for Payer: Cigna Commercial	$15.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.03
Rate for Payer: Oxford Commercial	$6.02
Rate for Payer: Qualcare PPO/HMO/WC	$4.51
Rate for Payer: UnitedHealthcare Commercial	$6.02
Rate for Payer: UnitedHealthcare Community & State	$0.73
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

BUPIVACAINE EPI .25% 10ML

Facility

$28.34

Service Code	NDC 63323046837
Hospital Charge Code	6000764
Hospital Revenue Code	250
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.25
Rate for Payer: Qualcare PPO/HMO/WC	$4.25

BUPIVACAINE EPI .25% 10ML

Facility

$28.34

Service Code	NDC 63323046837
Hospital Charge Code	6000764
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$14.17
Rate for Payer: Aetna Commercial	$10.77
Rate for Payer: Aetna Medicare Advantage	$8.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.23
Rate for Payer: Cigna Commercial	$14.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.50
Rate for Payer: Oxford Commercial	$5.67
Rate for Payer: Qualcare PPO/HMO/WC	$4.25
Rate for Payer: UnitedHealthcare Commercial	$5.67
Rate for Payer: UnitedHealthcare Community & State	$0.68
Rate for Payer: Wellpoint Medicaid Managed Care	$0.75

BUPIVACAINE EPI .25% 30ML

Facility

$61.45

Hospital Charge Code	6000772
Hospital Revenue Code	250
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$9.22
Rate for Payer: Qualcare PPO/HMO/WC	$9.22

Know your out-of-pocket cost for care.

All Charges