Heights University Hospital

All Charges

Charge

Type

Setting

Price

BUPIVACAINE HCL INJ 0.5%

Facility

$19.00

Hospital Charge Code	60634431
Hospital Revenue Code	250
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$2.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.85

BUPIVACAINE HCL INJ 0.5%

Facility

$19.00

Hospital Charge Code	60634431
Hospital Revenue Code	250
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$9.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$5.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.84
Rate for Payer: Cigna Commercial	$9.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.47
Rate for Payer: Oxford Commercial	$9.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.85
Rate for Payer: UnitedHealthcare Commercial	$9.50

BUPIVACAINE HCL INJ 0.5% 10ML

Facility

$21.15

Hospital Charge Code	6006654
Hospital Revenue Code	250
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

BUPIVACAINE HCL INJ 0.5% 10ML

Facility

$21.15

Hospital Charge Code	6006654
Hospital Revenue Code	250
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$6.34
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.75
Rate for Payer: Oxford Commercial	$10.57
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$10.57

BUPIVACAINE HCL INJ 0.5% 30ML

Facility

$30.10

Hospital Charge Code	6606662
Hospital Revenue Code	250
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$4.51
Rate for Payer: Qualcare PPO/HMO/WC	$4.51

BUPIVACAINE HCL INJ 0.5% 30ML

Facility

$30.10

Hospital Charge Code	6606662
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 HCL INJ 0.75% 30ML

Facility

$43.55

Hospital Charge Code	6006688
Hospital Revenue Code	250
Min. Negotiated Rate	$6.53
Max. Negotiated Rate	$6.53
Rate for Payer: Qualcare PPO/HMO/WC	$6.53

BUPIVACAINE HCL INJ 0.75% 30ML

Facility

$43.55

Hospital Charge Code	6006688
Hospital Revenue Code	250
Min. Negotiated Rate	$5.66
Max. Negotiated Rate	$21.77
Rate for Payer: Aetna Commercial	$13.06
Rate for Payer: Aetna Medicare Advantage	$13.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.11
Rate for Payer: Cigna Commercial	$21.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.66
Rate for Payer: Oxford Commercial	$21.77
Rate for Payer: Qualcare PPO/HMO/WC	$6.53
Rate for Payer: UnitedHealthcare Commercial	$21.77

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 LIP 13.3MG/ML 20ML

Facility

$2,290.73

Service Code	NDC 65250026620
Hospital Charge Code	606390157
Hospital Revenue Code	250
Min. Negotiated Rate	$297.79
Max. Negotiated Rate	$1,145.37
Rate for Payer: Aetna Commercial	$687.22
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	$297.79
Rate for Payer: Oxford Commercial	$1,145.37
Rate for Payer: Qualcare PPO/HMO/WC	$343.61
Rate for Payer: UnitedHealthcare Commercial	$1,145.37

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	$703.90
Rate for Payer: Aetna Commercial	$422.34
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

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	$391.29
Max. Negotiated Rate	$1,304.29
Rate for Payer: Aetna Commercial	$782.57
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

BUPIVACAINE VL 0.25%

Facility

$10.90

Hospital Charge Code	6012306
Hospital Revenue Code	250
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$3.27
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	$1.42
Rate for Payer: Oxford Commercial	$5.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$5.45

BUPIVACAINE VL 0.25%

Facility

$10.90

Hospital Charge Code	6012306
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 0.5% 30ML

Facility

$10.90

Hospital Charge Code	6012314
Hospital Revenue Code	250
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$3.27
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	$1.42
Rate for Payer: Oxford Commercial	$5.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$5.45

BUPIVACAINE VL 0.5% 30ML

Facility

$10.90

Hospital Charge Code	6012314
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 0.75% 30ML

Facility

$3.20

Hospital Charge Code	6022222
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 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 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	$1.42
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$3.27
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	$1.42
Rate for Payer: Oxford Commercial	$5.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$5.45

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

BUPIVCAIN EPI 0.25%10ML1 20000

Facility

$32.03

Service Code	NDC 409904201
Hospital Charge Code	606390131
Hospital Revenue Code	250
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$16.02
Rate for Payer: Aetna Commercial	$9.61
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	$4.16
Rate for Payer: Oxford Commercial	$16.02
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$16.02

BUPIVICAINE/EPI 0.5% 30 ML

Facility

$66.67

Service Code	NDC 63323046237
Hospital Charge Code	6063943329
Hospital Revenue Code	250
Min. Negotiated Rate	$8.67
Max. Negotiated Rate	$33.34
Rate for Payer: Aetna Commercial	$20.00
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	$8.67
Rate for Payer: Oxford Commercial	$33.34
Rate for Payer: Qualcare PPO/HMO/WC	$10.00
Rate for Payer: UnitedHealthcare Commercial	$33.34

Know your out-of-pocket cost for care.

All Charges