Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BUN,URINE RANDOM

Facility

$160.00

Service Code	HCPCS 84540
Hospital Charge Code	38479005
Hospital Revenue Code	301
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00

BUPIV 0.5% EPI 1 200000 (50ML

Facility

$106.20

Service Code	NDC 63323046357
Hospital Charge Code	6063943067
Hospital Revenue Code	250
Min. Negotiated Rate	$3.02
Max. Negotiated Rate	$53.10
Rate for Payer: Aetna Commercial	$40.36
Rate for Payer: Aetna Medicare Advantage	$31.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.08
Rate for Payer: Cigna Commercial	$53.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.61
Rate for Payer: Oxford Commercial	$21.24
Rate for Payer: Qualcare PPO/HMO/WC	$15.93
Rate for Payer: UnitedHealthcare Commercial	$21.24
Rate for Payer: UnitedHealthcare Community & State	$3.36
Rate for Payer: Wellpoint Medicaid Managed Care	$3.02

BUPIV 0.5% EPI 1 200000 (50ML

Facility

$106.20

Service Code	NDC 63323046357
Hospital Charge Code	6063943067
Hospital Revenue Code	250
Min. Negotiated Rate	$15.93
Max. Negotiated Rate	$15.93
Rate for Payer: Qualcare PPO/HMO/WC	$15.93

BUPIVACAINE 0.25% INJ (30ML)

Facility

$14.87

Service Code	NDC 409115902
Hospital Charge Code	6006639
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$7.43
Rate for Payer: Aetna Commercial	$5.65
Rate for Payer: Aetna Medicare Advantage	$4.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.79
Rate for Payer: Cigna Commercial	$7.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.87
Rate for Payer: Oxford Commercial	$2.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.23
Rate for Payer: UnitedHealthcare Commercial	$2.97
Rate for Payer: UnitedHealthcare Community & State	$0.47
Rate for Payer: Wellpoint Medicaid Managed Care	$0.42

BUPIVACAINE 0.25% INJ (30ML)

Facility

$14.87

Service Code	NDC 409115902
Hospital Charge Code	6006639
Hospital Revenue Code	250
Min. Negotiated Rate	$2.23
Max. Negotiated Rate	$2.23
Rate for Payer: Qualcare PPO/HMO/WC	$2.23

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	$0.38
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	$3.52
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	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.38

BUPIVACAINE 0.75% 10ML

Facility

$38.19

Service Code	NDC 63323047217
Hospital Charge Code	60635756
Hospital Revenue Code	250
Min. Negotiated Rate	$1.08
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	$9.93
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	$1.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.08

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	$4.56
Max. Negotiated Rate	$4.56
Rate for Payer: Qualcare PPO/HMO/WC	$4.56

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	$0.86
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	$7.91
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	$0.96
Rate for Payer: Wellpoint Medicaid Managed Care	$0.86

BUPIVACAINE 0.75% INJ (30ML)

Facility

$28.94

Service Code	NDC 409158229
Hospital Charge Code	6006670
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
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	$7.52
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	$0.91
Rate for Payer: Wellpoint Medicaid Managed Care	$0.82

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 EPI .25% 10ML

Facility

$28.34

Service Code	NDC 63323046837
Hospital Charge Code	6000764
Hospital Revenue Code	250
Min. Negotiated Rate	$0.80
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	$7.37
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	$0.90
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 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 EPI INJ 0.5%

Facility

$55.54

Service Code	NDC 409174929
Hospital Charge Code	60628268
Hospital Revenue Code	250
Min. Negotiated Rate	$1.58
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	$14.44
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	$1.76
Rate for Payer: Wellpoint Medicaid Managed Care	$1.58

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	$65.06
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	$595.59
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	$72.39
Rate for Payer: Wellpoint Medicaid Managed Care	$65.06

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	$39.98
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	$44.49
Rate for Payer: Wellpoint Medicaid Managed Care	$39.98

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	$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 LIPOSOME 266/20ML

Facility

$2,608.58

Service Code	HCPCS C9290
Hospital Charge Code	606390263
Hospital Revenue Code	636
Min. Negotiated Rate	$74.08
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	$82.43
Rate for Payer: Wellpoint Medicaid Managed Care	$74.08

BUPIVCAIN EPI 0.25%10ML1 20000

Facility

$32.03

Service Code	NDC 409904201
Hospital Charge Code	606390131
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
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	$8.33
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	$1.01
Rate for Payer: Wellpoint Medicaid Managed Care	$0.91

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

Know your out-of-pocket cost for care.

All Charges