Heights University Hospital

All Charges

Charge

Type

Setting

Price

BUPIVACAINE 0.5% SDV

Facility

$8.68

Hospital Charge Code	60635818
Hospital Revenue Code	250
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$1.30
Rate for Payer: Qualcare PPO/HMO/WC	$1.30

BUPIVACAINE 0.5% W/EPI 1.8ML

Facility

$4.85

Hospital Charge Code	60628793
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$2.42
Rate for Payer: Aetna Commercial	$1.46
Rate for Payer: Aetna Medicare Advantage	$1.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.24
Rate for Payer: Cigna Commercial	$2.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.63
Rate for Payer: Oxford Commercial	$2.42
Rate for Payer: Qualcare PPO/HMO/WC	$0.73
Rate for Payer: UnitedHealthcare Commercial	$2.42

BUPIVACAINE 0.5% W/EPI 1.8ML

Facility

$3.20

Hospital Charge Code	6012322
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

BUPIVACAINE 0.5% W/EPI 1.8ML

Facility

$4.85

Hospital Charge Code	60628793
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.73

BUPIVACAINE 0.5% W/EPI 1.8ML

Facility

$3.20

Hospital Charge Code	6012322
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$0.96
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	$0.42
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$1.60

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% 10ML

Facility

$38.19

Service Code	NDC 63323047217
Hospital Charge Code	60635756
Hospital Revenue Code	250
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$19.09
Rate for Payer: Aetna Commercial	$11.46
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	$4.96
Rate for Payer: Oxford Commercial	$19.09
Rate for Payer: Qualcare PPO/HMO/WC	$5.73
Rate for Payer: UnitedHealthcare Commercial	$19.09

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	$3.95
Max. Negotiated Rate	$15.21
Rate for Payer: Aetna Commercial	$9.13
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	$3.95
Rate for Payer: Oxford Commercial	$15.21
Rate for Payer: Qualcare PPO/HMO/WC	$4.56
Rate for Payer: UnitedHealthcare Commercial	$15.21

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% INJ (30ML)

Facility

$28.94

Service Code	NDC 409158229
Hospital Charge Code	6006670
Hospital Revenue Code	250
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$14.47
Rate for Payer: Aetna Commercial	$8.68
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	$3.76
Rate for Payer: Oxford Commercial	$14.47
Rate for Payer: Qualcare PPO/HMO/WC	$4.34
Rate for Payer: UnitedHealthcare Commercial	$14.47

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 0.75% INJ30ML

Facility

$13.00

Hospital Charge Code	60635350
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Oxford Commercial	$6.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$6.50

BUPIVACAINE 0.75% INJ30ML

Facility

$13.00

Hospital Charge Code	60635350
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

BUPIVACAINE EPI 05% 10ML

Facility

$30.10

Hospital Charge Code	6000780
Hospital Revenue Code	250
Min. Negotiated Rate	$3.91
Max. Negotiated Rate	$15.05
Rate for Payer: Aetna Commercial	$9.03
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	$3.91
Rate for Payer: Oxford Commercial	$15.05
Rate for Payer: Qualcare PPO/HMO/WC	$4.51
Rate for Payer: UnitedHealthcare Commercial	$15.05

BUPIVACAINE EPI 05% 10ML

Facility

$30.10

Hospital Charge Code	6000780
Hospital Revenue Code	250
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$4.51
Rate for Payer: Qualcare PPO/HMO/WC	$4.51

BUPIVACAINE EPI .25% 10ML

Facility

$28.34

Service Code	NDC 63323046837
Hospital Charge Code	6000764
Hospital Revenue Code	250
Min. Negotiated Rate	$3.68
Max. Negotiated Rate	$14.17
Rate for Payer: Aetna Commercial	$8.50
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	$3.68
Rate for Payer: Oxford Commercial	$14.17
Rate for Payer: Qualcare PPO/HMO/WC	$4.25
Rate for Payer: UnitedHealthcare Commercial	$14.17

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 .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 .25% 30ML

Facility

$61.45

Hospital Charge Code	6000772
Hospital Revenue Code	250
Min. Negotiated Rate	$7.99
Max. Negotiated Rate	$30.73
Rate for Payer: Aetna Commercial	$18.43
Rate for Payer: Aetna Medicare Advantage	$18.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.67
Rate for Payer: Cigna Commercial	$30.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.99
Rate for Payer: Oxford Commercial	$30.73
Rate for Payer: Qualcare PPO/HMO/WC	$9.22
Rate for Payer: UnitedHealthcare Commercial	$30.73

BUPIVACAINE EPI .5% 30ML

Facility

$41.60

Hospital Charge Code	6000798
Hospital Revenue Code	250
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$20.80
Rate for Payer: Aetna Commercial	$12.48
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	$5.41
Rate for Payer: Oxford Commercial	$20.80
Rate for Payer: Qualcare PPO/HMO/WC	$6.24
Rate for Payer: UnitedHealthcare Commercial	$20.80

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	$6.83
Max. Negotiated Rate	$26.25
Rate for Payer: Aetna Commercial	$15.75
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	$6.83
Rate for Payer: Oxford Commercial	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$7.88
Rate for Payer: UnitedHealthcare Commercial	$26.25

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	$7.22
Max. Negotiated Rate	$27.77
Rate for Payer: Aetna Commercial	$16.66
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	$7.22
Rate for Payer: Oxford Commercial	$27.77
Rate for Payer: Qualcare PPO/HMO/WC	$8.33
Rate for Payer: UnitedHealthcare Commercial	$27.77

Know your out-of-pocket cost for care.

All Charges