Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BUPIVACAINE VL 0.75% 30ML

Facility

$3.20

Hospital Charge Code	6022222
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

BUPIVACAINE VL 0.75% 30ML

Facility

$3.20

Hospital Charge Code	6022222
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 VL PF 0.25% 50ML

Facility

$10.90

Hospital Charge Code	6012330
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 PF 0.25% 50ML

Facility

$10.90

Hospital Charge Code	6012330
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

BUPIVCAIN EPI 0.25%10ML1 20000

Facility

$32.03

Service Code	NDC 409904201
Hospital Charge Code	606390131
Hospital Revenue Code	250
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$16.02
Rate for Payer: Aetna Commercial	$12.17
Rate for Payer: Aetna Medicare Advantage	$9.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.17
Rate for Payer: Cigna Commercial	$16.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.61
Rate for Payer: Oxford Commercial	$6.41
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$6.41
Rate for Payer: UnitedHealthcare Community & State	$0.77
Rate for Payer: Wellpoint Medicaid Managed Care	$0.85

BUPIVCAIN EPI 0.25%10ML1 20000

Facility

$32.03

Service Code	NDC 409904201
Hospital Charge Code	606390131
Hospital Revenue Code	250
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

BUPIVICAINE/EPI 0.5% 30 ML

Facility

$66.67

Service Code	NDC 63323046237
Hospital Charge Code	6063943329
Hospital Revenue Code	250
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$33.34
Rate for Payer: Aetna Commercial	$25.33
Rate for Payer: Aetna Medicare Advantage	$20.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.00
Rate for Payer: Cigna Commercial	$33.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.00
Rate for Payer: Oxford Commercial	$13.33
Rate for Payer: Qualcare PPO/HMO/WC	$10.00
Rate for Payer: UnitedHealthcare Commercial	$13.33
Rate for Payer: UnitedHealthcare Community & State	$1.61
Rate for Payer: Wellpoint Medicaid Managed Care	$1.77

BUPIVICAINE/EPI 0.5% 30 ML

Facility

$66.67

Service Code	NDC 63323046237
Hospital Charge Code	6063943329
Hospital Revenue Code	250
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$10.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.00

BUPREN/NALOXONE 2/0.5 MG TAB

Facility

$31.83

Service Code	NDC 50268014415
Hospital Charge Code	606390332
Hospital Revenue Code	250
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$15.91
Rate for Payer: Aetna Commercial	$12.10
Rate for Payer: Aetna Medicare Advantage	$9.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.12
Rate for Payer: Cigna Commercial	$15.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.55
Rate for Payer: Oxford Commercial	$6.37
Rate for Payer: Qualcare PPO/HMO/WC	$4.77
Rate for Payer: UnitedHealthcare Commercial	$6.37
Rate for Payer: UnitedHealthcare Community & State	$0.77
Rate for Payer: Wellpoint Medicaid Managed Care	$0.84

BUPREN/NALOXONE 2/0.5 MG TAB

Facility

$31.83

Service Code	NDC 50268014415
Hospital Charge Code	606390332
Hospital Revenue Code	250
Min. Negotiated Rate	$4.77
Max. Negotiated Rate	$4.77
Rate for Payer: Qualcare PPO/HMO/WC	$4.77

BUPREN/NALOXONE 8/2 MG TAB

Facility

$56.68

Service Code	NDC 50268014515
Hospital Charge Code	606390333
Hospital Revenue Code	250
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$8.50
Rate for Payer: Qualcare PPO/HMO/WC	$8.50

BUPREN/NALOXONE 8/2 MG TAB

Facility

$56.68

Service Code	NDC 50268014515
Hospital Charge Code	606390333
Hospital Revenue Code	250
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$28.34
Rate for Payer: Aetna Commercial	$21.54
Rate for Payer: Aetna Medicare Advantage	$17.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.45
Rate for Payer: Cigna Commercial	$28.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.00
Rate for Payer: Oxford Commercial	$11.34
Rate for Payer: Qualcare PPO/HMO/WC	$8.50
Rate for Payer: UnitedHealthcare Commercial	$11.34
Rate for Payer: UnitedHealthcare Community & State	$1.37
Rate for Payer: Wellpoint Medicaid Managed Care	$1.50

BUPRENORHINE/NALOXONE HCL8-2MG

Facility

$56.62

Service Code	NDC 12496120803
Hospital Charge Code	606390128
Hospital Revenue Code	250
Min. Negotiated Rate	$8.49
Max. Negotiated Rate	$8.49
Rate for Payer: Qualcare PPO/HMO/WC	$8.49

BUPRENORHINE/NALOXONE HCL8-2MG

Facility

$56.62

Service Code	NDC 12496120803
Hospital Charge Code	606390128
Hospital Revenue Code	250
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$28.31
Rate for Payer: Aetna Commercial	$21.52
Rate for Payer: Aetna Medicare Advantage	$16.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.44
Rate for Payer: Cigna Commercial	$28.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.99
Rate for Payer: Oxford Commercial	$11.32
Rate for Payer: Qualcare PPO/HMO/WC	$8.49
Rate for Payer: UnitedHealthcare Commercial	$11.32
Rate for Payer: UnitedHealthcare Community & State	$1.36
Rate for Payer: Wellpoint Medicaid Managed Care	$1.50

BUPRENORPHINE 2MG TAB

Facility

$27.74

Service Code	NDC 54017613
Hospital Charge Code	606361024
Hospital Revenue Code	250
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$4.16
Rate for Payer: Qualcare PPO/HMO/WC	$4.16

BUPRENORPHINE 2MG TAB

Facility

$27.74

Service Code	NDC 54017613
Hospital Charge Code	606361024
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$13.87
Rate for Payer: Aetna Commercial	$10.54
Rate for Payer: Aetna Medicare Advantage	$8.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.07
Rate for Payer: Cigna Commercial	$13.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.32
Rate for Payer: Oxford Commercial	$5.55
Rate for Payer: Qualcare PPO/HMO/WC	$4.16
Rate for Payer: UnitedHealthcare Commercial	$5.55
Rate for Payer: UnitedHealthcare Community & State	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.74

BUPRENORPHINE 8MG TAB

Facility

$56.82

Service Code	NDC 50383093093
Hospital Charge Code	606361023
Hospital Revenue Code	250
Min. Negotiated Rate	$8.52
Max. Negotiated Rate	$8.52
Rate for Payer: Qualcare PPO/HMO/WC	$8.52

BUPRENORPHINE 8MG TAB

Facility

$56.82

Service Code	NDC 50383093093
Hospital Charge Code	606361023
Hospital Revenue Code	250
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$28.41
Rate for Payer: Aetna Commercial	$21.59
Rate for Payer: Aetna Medicare Advantage	$17.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.49
Rate for Payer: Cigna Commercial	$28.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.05
Rate for Payer: Oxford Commercial	$11.36
Rate for Payer: Qualcare PPO/HMO/WC	$8.52
Rate for Payer: UnitedHealthcare Commercial	$11.36
Rate for Payer: UnitedHealthcare Community & State	$1.37
Rate for Payer: Wellpoint Medicaid Managed Care	$1.51

BUPRENORPHINE QUANT URINE

Facility

$399.70

Service Code	HCPCS 80348
Hospital Charge Code	39708043
Hospital Revenue Code	306
Min. Negotiated Rate	$10.59
Max. Negotiated Rate	$199.85
Rate for Payer: Aetna Commercial	$151.89
Rate for Payer: Aetna Medicare Advantage	$119.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$101.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$101.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$101.92
Rate for Payer: Cigna Commercial	$199.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.91
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$17.38
Rate for Payer: Wellpoint Medicaid Managed Care	$10.59

BUPRENORPHINE QUANT URINE

Facility

$399.70

Service Code	HCPCS 80348
Hospital Charge Code	39708043
Hospital Revenue Code	306
Min. Negotiated Rate	$59.95
Max. Negotiated Rate	$59.95
Rate for Payer: Qualcare PPO/HMO/WC	$59.95

BUPROPION 100 MG SR TAB

Facility

$37.32

Service Code	NDC 173094755
Hospital Charge Code	60627756
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$5.60
Rate for Payer: Qualcare PPO/HMO/WC	$5.60

BUPROPION 100 MG SR TAB

Facility

$37.32

Service Code	NDC 173094755
Hospital Charge Code	60627756
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$18.66
Rate for Payer: Aetna Commercial	$14.18
Rate for Payer: Aetna Medicare Advantage	$11.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.52
Rate for Payer: Cigna Commercial	$18.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.20
Rate for Payer: Oxford Commercial	$7.46
Rate for Payer: Qualcare PPO/HMO/WC	$5.60
Rate for Payer: UnitedHealthcare Commercial	$7.46
Rate for Payer: UnitedHealthcare Community & State	$0.90
Rate for Payer: Wellpoint Medicaid Managed Care	$0.99

BUPROPION 100 MG TAB

Facility

$13.13

Service Code	NDC 51079094420
Hospital Charge Code	6017669
Hospital Revenue Code	250
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$1.97
Rate for Payer: Qualcare PPO/HMO/WC	$1.97

BUPROPION 100 MG TAB

Facility

$13.13

Service Code	NDC 51079094420
Hospital Charge Code	6017669
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
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	$3.94
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	$0.32
Rate for Payer: Wellpoint Medicaid Managed Care	$0.35

BUPROPION 150 MG CR TAB

Facility

$11.25

Hospital Charge Code	60628579
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
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	$3.38
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	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

Know your out-of-pocket cost for care.

All Charges