Heights 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

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	$4.14
Max. Negotiated Rate	$15.91
Rate for Payer: Aetna Commercial	$9.55
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	$4.14
Rate for Payer: Oxford Commercial	$15.91
Rate for Payer: Qualcare PPO/HMO/WC	$4.77
Rate for Payer: UnitedHealthcare Commercial	$15.91

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

BUPREN/NALOXONE 8/2 MG TAB

Facility

$56.68

Service Code	NDC 50268014515
Hospital Charge Code	606390333
Hospital Revenue Code	250
Min. Negotiated Rate	$7.37
Max. Negotiated Rate	$28.34
Rate for Payer: Aetna Commercial	$17.00
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	$7.37
Rate for Payer: Oxford Commercial	$28.34
Rate for Payer: Qualcare PPO/HMO/WC	$8.50
Rate for Payer: UnitedHealthcare Commercial	$28.34

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	$7.36
Max. Negotiated Rate	$28.31
Rate for Payer: Aetna Commercial	$16.99
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	$7.36
Rate for Payer: Oxford Commercial	$28.31
Rate for Payer: Qualcare PPO/HMO/WC	$8.49
Rate for Payer: UnitedHealthcare Commercial	$28.31

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	$3.61
Max. Negotiated Rate	$13.87
Rate for Payer: Aetna Commercial	$8.32
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	$3.61
Rate for Payer: Oxford Commercial	$13.87
Rate for Payer: Qualcare PPO/HMO/WC	$4.16
Rate for Payer: UnitedHealthcare Commercial	$13.87

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	$7.39
Max. Negotiated Rate	$28.41
Rate for Payer: Aetna Commercial	$17.05
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	$7.39
Rate for Payer: Oxford Commercial	$28.41
Rate for Payer: Qualcare PPO/HMO/WC	$8.52
Rate for Payer: UnitedHealthcare Commercial	$28.41

BUPRENORPHINE QUANT URINE

Facility

$399.70

Service Code	HCPCS 80348
Hospital Charge Code	39708043
Hospital Revenue Code	306
Min. Negotiated Rate	$51.96
Max. Negotiated Rate	$199.85
Rate for Payer: Aetna Commercial	$119.91
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	$51.96
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.95
Rate for Payer: UnitedHealthcare Commercial	$114.00

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	$4.85
Max. Negotiated Rate	$18.66
Rate for Payer: Aetna Commercial	$11.20
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	$4.85
Rate for Payer: Oxford Commercial	$18.66
Rate for Payer: Qualcare PPO/HMO/WC	$5.60
Rate for Payer: UnitedHealthcare Commercial	$18.66

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	$1.71
Max. Negotiated Rate	$6.57
Rate for Payer: Aetna Commercial	$3.94
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	$1.71
Rate for Payer: Oxford Commercial	$6.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.97
Rate for Payer: UnitedHealthcare Commercial	$6.57

BUPROPION 150 MG CR TAB

Facility

$11.25

Hospital Charge Code	60628579
Hospital Revenue Code	250
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$3.38
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.46
Rate for Payer: Oxford Commercial	$5.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$5.62

BUPROPION 150 MG CR TAB

Facility

$11.25

Hospital Charge Code	60628579
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

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	$5.20
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna Commercial	$12.00
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	$5.20
Rate for Payer: Oxford Commercial	$20.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Commercial	$20.00

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 75 MG TAB UD

Facility

$10.39

Service Code	NDC 51079094320
Hospital Charge Code	60627758
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$5.20
Rate for Payer: Aetna Commercial	$3.12
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	$1.35
Rate for Payer: Oxford Commercial	$5.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.56
Rate for Payer: UnitedHealthcare Commercial	$5.20

BUPROPION TAB 75MG

Facility

$3.85

Hospital Charge Code	6027049
Hospital Revenue Code	252
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Qualcare PPO/HMO/WC	$0.58

BUPROPION TAB 75MG

Facility

$3.85

Hospital Charge Code	6027049
Hospital Revenue Code	252
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.93
Rate for Payer: Aetna Commercial	$1.16
Rate for Payer: Aetna Medicare Advantage	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.98
Rate for Payer: Cigna Commercial	$1.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.50
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$0.58
Rate for Payer: UnitedHealthcare Commercial	$1.93

Know your out-of-pocket cost for care.

All Charges