Heights University Hospital

All Charges

Charge

Type

Setting

Price

BUN POST

Facility

$390.00

Service Code	HCPCS 84520
Hospital Charge Code	3002665
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BUN POST

Facility

$65.65

Service Code	HCPCS 84520
Hospital Charge Code	8200334RS
Hospital Revenue Code	301
Min. Negotiated Rate	$9.85
Max. Negotiated Rate	$9.85
Rate for Payer: Qualcare PPO/HMO/WC	$9.85

BUN POST

Facility

$65.65

Service Code	HCPCS 84520
Hospital Charge Code	8200334RS
Hospital Revenue Code	301
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$12.80
Rate for Payer: Aetna Medicare Advantage	$3.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.47
Rate for Payer: Cigna Commercial	$3.95
Rate for Payer: Cigna Medicare Advantage	$1.98
Rate for Payer: Clover Medicare Advantage	$3.75
Rate for Payer: EmblemHealth Commercial	$11.85
Rate for Payer: Humana Medicare Advantage	$4.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.53
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.85
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.95
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.19
Rate for Payer: Wellcare Medicare Advantage	$3.95

BUN POST

Facility

$390.00

Service Code	HCPCS 84520
Hospital Charge Code	3002665
Hospital Revenue Code	301
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$12.80
Rate for Payer: Aetna Medicare Advantage	$3.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.47
Rate for Payer: Cigna Commercial	$3.95
Rate for Payer: Cigna Medicare Advantage	$1.98
Rate for Payer: Clover Medicare Advantage	$3.75
Rate for Payer: EmblemHealth Commercial	$11.85
Rate for Payer: Humana Medicare Advantage	$4.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.95
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.19
Rate for Payer: Wellcare Medicare Advantage	$3.95

BUN,POST-DIAL

Facility

$208.00

Service Code	HCPCS 84520
Hospital Charge Code	38479004
Hospital Revenue Code	301
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$12.80
Rate for Payer: Aetna Medicare Advantage	$3.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.47
Rate for Payer: Cigna Commercial	$3.95
Rate for Payer: Cigna Medicare Advantage	$1.98
Rate for Payer: Clover Medicare Advantage	$3.75
Rate for Payer: EmblemHealth Commercial	$11.85
Rate for Payer: Humana Medicare Advantage	$4.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.04
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.20
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.95
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.19
Rate for Payer: Wellcare Medicare Advantage	$3.95

BUN,POST-DIAL

Facility

$208.00

Service Code	HCPCS 84520
Hospital Charge Code	38479004
Hospital Revenue Code	301
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$31.20
Rate for Payer: Qualcare PPO/HMO/WC	$31.20

BUN,PRE-DIAL

Facility

$208.00

Service Code	HCPCS 84520
Hospital Charge Code	38479003
Hospital Revenue Code	301
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$12.80
Rate for Payer: Aetna Medicare Advantage	$3.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.47
Rate for Payer: Cigna Commercial	$3.95
Rate for Payer: Cigna Medicare Advantage	$1.98
Rate for Payer: Clover Medicare Advantage	$3.75
Rate for Payer: EmblemHealth Commercial	$11.85
Rate for Payer: Humana Medicare Advantage	$4.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.04
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.20
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.95
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.19
Rate for Payer: Wellcare Medicare Advantage	$3.95

BUN,PRE-DIAL

Facility

$208.00

Service Code	HCPCS 84520
Hospital Charge Code	38479003
Hospital Revenue Code	301
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$31.20
Rate for Payer: Qualcare PPO/HMO/WC	$31.20

BUN (UREA NITROGEN)

Facility

$208.00

Service Code	HCPCS 84520
Hospital Charge Code	38472145
Hospital Revenue Code	301
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$31.20
Rate for Payer: Qualcare PPO/HMO/WC	$31.20

BUN (UREA NITROGEN)

Facility

$208.00

Service Code	HCPCS 84520
Hospital Charge Code	38472145
Hospital Revenue Code	301
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$12.80
Rate for Payer: Aetna Medicare Advantage	$3.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.47
Rate for Payer: Cigna Commercial	$3.95
Rate for Payer: Cigna Medicare Advantage	$1.98
Rate for Payer: Clover Medicare Advantage	$3.75
Rate for Payer: EmblemHealth Commercial	$11.85
Rate for Payer: Humana Medicare Advantage	$4.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.04
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.20
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.95
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.19
Rate for Payer: Wellcare Medicare Advantage	$3.95

BUN,URINE RANDOM

Facility

$160.00

Service Code	HCPCS 84540
Hospital Charge Code	38479005
Hospital Revenue Code	301
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$18.01
Rate for Payer: Aetna Medicare Advantage	$5.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.37
Rate for Payer: Cigna Commercial	$5.56
Rate for Payer: Cigna Medicare Advantage	$2.78
Rate for Payer: Clover Medicare Advantage	$5.28
Rate for Payer: EmblemHealth Commercial	$16.68
Rate for Payer: Humana Medicare Advantage	$5.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.56
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.89
Rate for Payer: Wellcare Medicare Advantage	$5.56

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	$15.93
Max. Negotiated Rate	$15.93
Rate for Payer: Qualcare PPO/HMO/WC	$15.93

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	$13.81
Max. Negotiated Rate	$53.10
Rate for Payer: Aetna Commercial	$31.86
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	$13.81
Rate for Payer: Oxford Commercial	$53.10
Rate for Payer: Qualcare PPO/HMO/WC	$15.93
Rate for Payer: UnitedHealthcare Commercial	$53.10

BUPIVAACAINE 0.75% 10ML

Facility

$5.00

Hospital Charge Code	60635708
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

BUPIVAACAINE 0.75% 10ML

Facility

$5.00

Hospital Charge Code	60635708
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

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 0.25% INJ (30ML)

Facility

$14.87

Service Code	NDC 409115902
Hospital Charge Code	6006639
Hospital Revenue Code	250
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$7.43
Rate for Payer: Aetna Commercial	$4.46
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	$1.93
Rate for Payer: Oxford Commercial	$7.43
Rate for Payer: Qualcare PPO/HMO/WC	$2.23
Rate for Payer: UnitedHealthcare Commercial	$7.43

BUPIVACAINE 0.5%/EP1 1.8 ML IN

Facility

$42.85

Hospital Charge Code	606380004
Hospital Revenue Code	250
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$21.43
Rate for Payer: Aetna Commercial	$12.86
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	$5.57
Rate for Payer: Oxford Commercial	$21.43
Rate for Payer: Qualcare PPO/HMO/WC	$6.43
Rate for Payer: UnitedHealthcare Commercial	$21.43

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	$1.76
Max. Negotiated Rate	$6.76
Rate for Payer: Aetna Commercial	$4.06
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	$1.76
Rate for Payer: Oxford Commercial	$6.76
Rate for Payer: Qualcare PPO/HMO/WC	$2.03
Rate for Payer: UnitedHealthcare Commercial	$6.76

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% INJ 50 ML

Facility

$52.85

Hospital Charge Code	60628267
Hospital Revenue Code	250
Min. Negotiated Rate	$6.87
Max. Negotiated Rate	$26.43
Rate for Payer: Aetna Commercial	$15.86
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	$6.87
Rate for Payer: Oxford Commercial	$26.43
Rate for Payer: Qualcare PPO/HMO/WC	$7.93
Rate for Payer: UnitedHealthcare Commercial	$26.43

BUPIVACAINE 0.5% SDV

Facility

$8.68

Hospital Charge Code	60635818
Hospital Revenue Code	250
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$4.34
Rate for Payer: Aetna Commercial	$2.60
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	$1.13
Rate for Payer: Oxford Commercial	$4.34
Rate for Payer: Qualcare PPO/HMO/WC	$1.30
Rate for Payer: UnitedHealthcare Commercial	$4.34

Know your out-of-pocket cost for care.

All Charges