Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

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

BUPIVICAINE/EPI 0.5% 30 ML

Facility

$66.67

Service Code	NDC 63323046237
Hospital Charge Code	6063943329
Hospital Revenue Code	250
Min. Negotiated Rate	$1.89
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	$17.33
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	$2.11
Rate for Payer: Wellpoint Medicaid Managed Care	$1.89

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 2/0.5 MG TAB

Facility

$31.83

Service Code	NDC 50268014415
Hospital Charge Code	606390332
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
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	$8.28
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	$1.01
Rate for Payer: Wellpoint Medicaid Managed Care	$0.90

BUPREN/NALOXONE 8/2 MG TAB

Facility

$56.68

Service Code	NDC 50268014515
Hospital Charge Code	606390333
Hospital Revenue Code	250
Min. Negotiated Rate	$1.61
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	$14.74
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	$1.79
Rate for Payer: Wellpoint Medicaid Managed Care	$1.61

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

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	$1.61
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	$14.72
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	$1.79
Rate for Payer: Wellpoint Medicaid Managed Care	$1.61

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	$0.79
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	$7.21
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	$0.88
Rate for Payer: Wellpoint Medicaid Managed Care	$0.79

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	$1.61
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	$14.77
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	$1.80
Rate for Payer: Wellpoint Medicaid Managed Care	$1.61

BUPRENORPHINE QUANT URINE

Facility

$399.70

Service Code	HCPCS 80348
Hospital Charge Code	39708043
Hospital Revenue Code	306
Min. Negotiated Rate	$11.35
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	$103.92
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.95
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$17.38
Rate for Payer: Wellpoint Medicaid Managed Care	$11.35

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	$1.06
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	$9.70
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	$1.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.06

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	$0.37
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

BUPROPION 150 MG SR TAB

Facility

$40.00

Service Code	NDC 173013555
Hospital Charge Code	60627757
Hospital Revenue Code	250
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

BUPROPION 150 MG SR TAB

Facility

$40.00

Service Code	NDC 173013555
Hospital Charge Code	60627757
Hospital Revenue Code	250
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna Commercial	$15.20
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.20
Rate for Payer: Cigna Commercial	$20.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.40
Rate for Payer: Oxford Commercial	$8.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Commercial	$8.00
Rate for Payer: UnitedHealthcare Community & State	$1.26
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

BUPROPION 75 MG TAB UD

Facility

$10.39

Service Code	NDC 51079094320
Hospital Charge Code	60627758
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$5.20
Rate for Payer: Aetna Commercial	$3.95
Rate for Payer: Aetna Medicare Advantage	$3.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.65
Rate for Payer: Cigna Commercial	$5.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Oxford Commercial	$2.08
Rate for Payer: Qualcare PPO/HMO/WC	$1.56
Rate for Payer: UnitedHealthcare Commercial	$2.08
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

BUPROPION 75 MG TAB UD

Facility

$10.39

Service Code	NDC 51079094320
Hospital Charge Code	60627758
Hospital Revenue Code	250
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$1.56
Rate for Payer: Qualcare PPO/HMO/WC	$1.56

BUPROPION XL(WELLBUTRIN)300

Facility

$204.02

Service Code	NDC 904657304
Hospital Charge Code	60630150
Hospital Revenue Code	250
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$30.60
Rate for Payer: Qualcare PPO/HMO/WC	$30.60

BUPROPION XL(WELLBUTRIN)300

Facility

$204.02

Service Code	NDC 904657304
Hospital Charge Code	60630150
Hospital Revenue Code	250
Min. Negotiated Rate	$5.79
Max. Negotiated Rate	$102.01
Rate for Payer: Aetna Commercial	$77.53
Rate for Payer: Aetna Medicare Advantage	$61.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.03
Rate for Payer: Cigna Commercial	$102.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.05
Rate for Payer: Oxford Commercial	$40.80
Rate for Payer: Qualcare PPO/HMO/WC	$30.60
Rate for Payer: UnitedHealthcare Commercial	$40.80
Rate for Payer: UnitedHealthcare Community & State	$6.45
Rate for Payer: Wellpoint Medicaid Managed Care	$5.79

BUR 1.6MMX9CM MIDAS REX MR8

Facility

$1,660.00

Hospital Charge Code	270696446
Hospital Revenue Code	272
Min. Negotiated Rate	$47.14
Max. Negotiated Rate	$830.00
Rate for Payer: Aetna Commercial	$630.80
Rate for Payer: Aetna Medicare Advantage	$498.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$423.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$423.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$423.30
Rate for Payer: Cigna Commercial	$830.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$431.60
Rate for Payer: Oxford Commercial	$332.00
Rate for Payer: Qualcare PPO/HMO/WC	$249.00
Rate for Payer: UnitedHealthcare Commercial	$332.00
Rate for Payer: UnitedHealthcare Community & State	$52.46
Rate for Payer: Wellpoint Medicaid Managed Care	$47.14

Know your out-of-pocket cost for care.

All Charges