Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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

BUPIVACAINE EPI .5% 30ML

Facility

$41.60

Hospital Charge Code	6000798
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$20.80
Rate for Payer: Aetna Commercial	$15.81
Rate for Payer: Aetna Medicare Advantage	$12.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.61
Rate for Payer: Cigna Commercial	$20.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.48
Rate for Payer: Oxford Commercial	$8.32
Rate for Payer: Qualcare PPO/HMO/WC	$6.24
Rate for Payer: UnitedHealthcare Commercial	$8.32
Rate for Payer: UnitedHealthcare Community & State	$1.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1.10

BUPIVACAINE EPI .5% 30ML

Facility

$41.60

Hospital Charge Code	6000798
Hospital Revenue Code	250
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$6.24
Rate for Payer: Qualcare PPO/HMO/WC	$6.24

BUPIVACAINE EPI .75% 30ML

Facility

$52.50

Hospital Charge Code	6000806
Hospital Revenue Code	250
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$7.88
Rate for Payer: Qualcare PPO/HMO/WC	$7.88

BUPIVACAINE EPI .75% 30ML

Facility

$52.50

Hospital Charge Code	6000806
Hospital Revenue Code	250
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$26.25
Rate for Payer: Aetna Commercial	$19.95
Rate for Payer: Aetna Medicare Advantage	$15.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.39
Rate for Payer: Cigna Commercial	$26.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.75
Rate for Payer: Oxford Commercial	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.88
Rate for Payer: UnitedHealthcare Commercial	$10.50
Rate for Payer: UnitedHealthcare Community & State	$1.27
Rate for Payer: Wellpoint Medicaid Managed Care	$1.39

BUPIVACAINE EPI INJ 0.5%

Facility

$55.54

Service Code	NDC 409174929
Hospital Charge Code	60628268
Hospital Revenue Code	250
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$27.77
Rate for Payer: Aetna Commercial	$21.11
Rate for Payer: Aetna Medicare Advantage	$16.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.16
Rate for Payer: Cigna Commercial	$27.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.66
Rate for Payer: Oxford Commercial	$11.11
Rate for Payer: Qualcare PPO/HMO/WC	$8.33
Rate for Payer: UnitedHealthcare Commercial	$11.11
Rate for Payer: UnitedHealthcare Community & State	$1.34
Rate for Payer: Wellpoint Medicaid Managed Care	$1.47

BUPIVACAINE EPI INJ 0.5%

Facility

$55.54

Service Code	NDC 409174929
Hospital Charge Code	60628268
Hospital Revenue Code	250
Min. Negotiated Rate	$8.33
Max. Negotiated Rate	$8.33
Rate for Payer: Qualcare PPO/HMO/WC	$8.33

BUPIVACAINE HCL INJ 0.5%

Facility

$19.00

Hospital Charge Code	60634431
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$9.50
Rate for Payer: Aetna Commercial	$7.22
Rate for Payer: Aetna Medicare Advantage	$5.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.84
Rate for Payer: Cigna Commercial	$9.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.70
Rate for Payer: Oxford Commercial	$3.80
Rate for Payer: Qualcare PPO/HMO/WC	$2.85
Rate for Payer: UnitedHealthcare Commercial	$3.80
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.50

BUPIVACAINE HCL INJ 0.5%

Facility

$19.00

Hospital Charge Code	60634431
Hospital Revenue Code	250
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$2.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.85

BUPIVACAINE HCL INJ 0.5% 10ML

Facility

$21.15

Hospital Charge Code	6006654
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$8.04
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.34
Rate for Payer: Oxford Commercial	$4.23
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$4.23
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

BUPIVACAINE HCL INJ 0.5% 10ML

Facility

$21.15

Hospital Charge Code	6006654
Hospital Revenue Code	250
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

BUPIVACAINE HCL INJ 0.5% 30ML

Facility

$30.10

Hospital Charge Code	6606662
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 HCL INJ 0.5% 30ML

Facility

$30.10

Hospital Charge Code	6606662
Hospital Revenue Code	250
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$4.51
Rate for Payer: Qualcare PPO/HMO/WC	$4.51

BUPIVACAINE HCL INJ 0.75% 30ML

Facility

$43.55

Hospital Charge Code	6006688
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$21.77
Rate for Payer: Aetna Commercial	$16.55
Rate for Payer: Aetna Medicare Advantage	$13.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.11
Rate for Payer: Cigna Commercial	$21.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.06
Rate for Payer: Oxford Commercial	$8.71
Rate for Payer: Qualcare PPO/HMO/WC	$6.53
Rate for Payer: UnitedHealthcare Commercial	$8.71
Rate for Payer: UnitedHealthcare Community & State	$1.05
Rate for Payer: Wellpoint Medicaid Managed Care	$1.15

BUPIVACAINE HCL INJ 0.75% 30ML

Facility

$43.55

Hospital Charge Code	6006688
Hospital Revenue Code	250
Min. Negotiated Rate	$6.53
Max. Negotiated Rate	$6.53
Rate for Payer: Qualcare PPO/HMO/WC	$6.53

BUPIVACAINE LIP 13.3MG/ML 20ML

Facility

$2,290.73

Service Code	NDC 65250026620
Hospital Charge Code	606390157
Hospital Revenue Code	250
Min. Negotiated Rate	$55.21
Max. Negotiated Rate	$1,145.37
Rate for Payer: Aetna Commercial	$870.48
Rate for Payer: Aetna Medicare Advantage	$687.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$584.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$584.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$584.14
Rate for Payer: Cigna Commercial	$1,145.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$687.22
Rate for Payer: Oxford Commercial	$458.15
Rate for Payer: Qualcare PPO/HMO/WC	$343.61
Rate for Payer: UnitedHealthcare Commercial	$458.15
Rate for Payer: UnitedHealthcare Community & State	$55.21
Rate for Payer: Wellpoint Medicaid Managed Care	$60.70

BUPIVACAINE LIP 13.3MG/ML 20ML

Facility

$2,290.73

Service Code	NDC 65250026620
Hospital Charge Code	606390157
Hospital Revenue Code	250
Min. Negotiated Rate	$343.61
Max. Negotiated Rate	$343.61
Rate for Payer: Qualcare PPO/HMO/WC	$343.61

BUPIVACAINE LIPOSOME 133/10ML

Facility

$1,407.80

Service Code	HCPCS C9290
Hospital Charge Code	606390262
Hospital Revenue Code	636
Min. Negotiated Rate	$33.93
Max. Negotiated Rate	$703.90
Rate for Payer: Aetna Commercial	$534.96
Rate for Payer: Aetna Medicare Advantage	$422.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$358.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$358.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$358.99
Rate for Payer: Cigna Commercial	$703.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$340.69
Rate for Payer: Qualcare PPO/HMO/WC	$211.17
Rate for Payer: UnitedHealthcare Community & State	$33.93
Rate for Payer: Wellpoint Medicaid Managed Care	$37.31

BUPIVACAINE LIPOSOME 133/10ML

Facility

$1,407.80

Service Code	HCPCS C9290
Hospital Charge Code	606390262
Hospital Revenue Code	636
Min. Negotiated Rate	$211.17
Max. Negotiated Rate	$340.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$340.69
Rate for Payer: Qualcare PPO/HMO/WC	$211.17

BUPIVACAINE LIPOSOME 266/20ML

Facility

$2,608.58

Service Code	HCPCS C9290
Hospital Charge Code	606390263
Hospital Revenue Code	636
Min. Negotiated Rate	$62.87
Max. Negotiated Rate	$1,304.29
Rate for Payer: Aetna Commercial	$991.26
Rate for Payer: Aetna Medicare Advantage	$782.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$665.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$665.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$665.19
Rate for Payer: Cigna Commercial	$1,304.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$631.28
Rate for Payer: Qualcare PPO/HMO/WC	$391.29
Rate for Payer: UnitedHealthcare Community & State	$62.87
Rate for Payer: Wellpoint Medicaid Managed Care	$69.13

BUPIVACAINE LIPOSOME 266/20ML

Facility

$2,608.58

Service Code	HCPCS C9290
Hospital Charge Code	606390263
Hospital Revenue Code	636
Min. Negotiated Rate	$391.29
Max. Negotiated Rate	$631.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$631.28
Rate for Payer: Qualcare PPO/HMO/WC	$391.29

BUPIVACAINE VL 0.25%

Facility

$10.90

Hospital Charge Code	6012306
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

BUPIVACAINE VL 0.25%

Facility

$10.90

Hospital Charge Code	6012306
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$4.14
Rate for Payer: Aetna Medicare Advantage	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.27
Rate for Payer: Oxford Commercial	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$2.18
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

BUPIVACAINE VL 0.5% 30ML

Facility

$10.90

Hospital Charge Code	6012314
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

BUPIVACAINE VL 0.5% 30ML

Facility

$10.90

Hospital Charge Code	6012314
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$4.14
Rate for Payer: Aetna Medicare Advantage	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.27
Rate for Payer: Oxford Commercial	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$2.18
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

Know your out-of-pocket cost for care.

All Charges