Heights University Hospital

All Charges

Charge

Type

Setting

Price

BENTSON WIRE GUIGE 80CM

Facility

$132.45

Hospital Charge Code	270704889
Hospital Revenue Code	279
Min. Negotiated Rate	$17.22
Max. Negotiated Rate	$66.22
Rate for Payer: Aetna Commercial	$39.73
Rate for Payer: Aetna Medicare Advantage	$39.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.77
Rate for Payer: Cigna Commercial	$66.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.22
Rate for Payer: Oxford Commercial	$66.22
Rate for Payer: Qualcare PPO/HMO/WC	$19.87
Rate for Payer: UnitedHealthcare Commercial	$66.22

BENYLIN COUGH/4OZ

Facility

$8.00

Hospital Charge Code	60634516
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

BENYLIN COUGH/4OZ

Facility

$8.00

Hospital Charge Code	60634516
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$2.40
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$4.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$4.00

BENZALKONIUM CHLOR SOL .13%

Facility

$73.00

Hospital Charge Code	6000574
Hospital Revenue Code	251
Min. Negotiated Rate	$10.95
Max. Negotiated Rate	$10.95
Rate for Payer: Qualcare PPO/HMO/WC	$10.95

BENZALKONIUM CHLOR SOL .13%

Facility

$73.00

Hospital Charge Code	6000574
Hospital Revenue Code	251
Min. Negotiated Rate	$9.49
Max. Negotiated Rate	$36.50
Rate for Payer: Aetna Commercial	$21.90
Rate for Payer: Aetna Medicare Advantage	$21.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.61
Rate for Payer: Cigna Commercial	$36.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.49
Rate for Payer: Oxford Commercial	$36.50
Rate for Payer: Qualcare PPO/HMO/WC	$10.95
Rate for Payer: UnitedHealthcare Commercial	$36.50

BENZENE,SERUM

Facility

$111.25

Service Code	HCPCS 84600
Hospital Charge Code	3000410
Hospital Revenue Code	301
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.44
Rate for Payer: Aetna Medicare Advantage	$17.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.69
Rate for Payer: Cigna Commercial	$17.11
Rate for Payer: Cigna Medicare Advantage	$8.55
Rate for Payer: Clover Medicare Advantage	$16.25
Rate for Payer: EmblemHealth Commercial	$51.33
Rate for Payer: Humana Medicare Advantage	$17.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.46
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.69
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.11
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.14
Rate for Payer: Wellcare Medicare Advantage	$17.11

BENZENE,SERUM

Facility

$111.25

Service Code	HCPCS 84600
Hospital Charge Code	3000410
Hospital Revenue Code	301
Min. Negotiated Rate	$16.69
Max. Negotiated Rate	$16.69
Rate for Payer: Qualcare PPO/HMO/WC	$16.69

BENZOCAINE 20 % SPR

Facility

$9.65

Hospital Charge Code	6000582
Hospital Revenue Code	251
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

BENZOCAINE 20 % SPR

Facility

$9.65

Hospital Charge Code	6000582
Hospital Revenue Code	251
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$2.90
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.25
Rate for Payer: Oxford Commercial	$4.83
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$4.83

BENZOCAINE5%-RESORCINOL2% CREA

Facility

$3.80

Hospital Charge Code	60629957
Hospital Revenue Code	250
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$1.90
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$1.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.97
Rate for Payer: Cigna Commercial	$1.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.49
Rate for Payer: Oxford Commercial	$1.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.57
Rate for Payer: UnitedHealthcare Commercial	$1.90

BENZOCAINE5%-RESORCINOL2% CREA

Facility

$3.80

Hospital Charge Code	60629957
Hospital Revenue Code	250
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$0.57
Rate for Payer: Qualcare PPO/HMO/WC	$0.57

BENZOCAINE ANTIPY OTIC 10ML

Facility

$64.00

Hospital Charge Code	6000590
Hospital Revenue Code	251
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.60

BENZOCAINE ANTIPY OTIC 10ML

Facility

$64.00

Hospital Charge Code	6000590
Hospital Revenue Code	251
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$32.00
Rate for Payer: Aetna Commercial	$19.20
Rate for Payer: Aetna Medicare Advantage	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.32
Rate for Payer: Cigna Commercial	$32.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.32
Rate for Payer: Oxford Commercial	$32.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.60
Rate for Payer: UnitedHealthcare Commercial	$32.00

BENZOCAINE GEL

Facility

$4.89

Service Code	NDC 10310031840
Hospital Charge Code	606390415
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.73

BENZOCAINE GEL

Facility

$4.89

Service Code	NDC 10310031840
Hospital Charge Code	606390415
Hospital Revenue Code	250
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$2.44
Rate for Payer: Aetna Commercial	$1.47
Rate for Payer: Aetna Medicare Advantage	$1.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.25
Rate for Payer: Cigna Commercial	$2.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.64
Rate for Payer: Oxford Commercial	$2.44
Rate for Payer: Qualcare PPO/HMO/WC	$0.73
Rate for Payer: UnitedHealthcare Commercial	$2.44

BENZOCAINE GEL 7.5% INFANT

Facility

$25.39

Service Code	NDC 11917007948
Hospital Charge Code	60628572
Hospital Revenue Code	250
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$12.70
Rate for Payer: Aetna Commercial	$7.62
Rate for Payer: Aetna Medicare Advantage	$7.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.47
Rate for Payer: Cigna Commercial	$12.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.30
Rate for Payer: Oxford Commercial	$12.70
Rate for Payer: Qualcare PPO/HMO/WC	$3.81
Rate for Payer: UnitedHealthcare Commercial	$12.70

BENZOCAINE GEL 7.5% INFANT

Facility

$25.39

Service Code	NDC 11917007948
Hospital Charge Code	60628572
Hospital Revenue Code	250
Min. Negotiated Rate	$3.81
Max. Negotiated Rate	$3.81
Rate for Payer: Qualcare PPO/HMO/WC	$3.81

BENZOCAINE PHENOL GEL

Facility

$4.50

Hospital Charge Code	60628573
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

BENZOCAINE PHENOL GEL

Facility

$4.50

Hospital Charge Code	60628573
Hospital Revenue Code	250
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$1.35
Rate for Payer: Aetna Medicare Advantage	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.15
Rate for Payer: Cigna Commercial	$2.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$0.68
Rate for Payer: UnitedHealthcare Commercial	$2.25

BENZOCAINE TETRACN BUTMBN AERO

Facility

$388.85

Hospital Charge Code	60628409
Hospital Revenue Code	250
Min. Negotiated Rate	$58.33
Max. Negotiated Rate	$58.33
Rate for Payer: Qualcare PPO/HMO/WC	$58.33

BENZOCAINE TETRACN BUTMBN AERO

Facility

$388.85

Hospital Charge Code	60628409
Hospital Revenue Code	250
Min. Negotiated Rate	$50.55
Max. Negotiated Rate	$194.43
Rate for Payer: Aetna Commercial	$116.66
Rate for Payer: Aetna Medicare Advantage	$116.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.16
Rate for Payer: Cigna Commercial	$194.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.55
Rate for Payer: Oxford Commercial	$194.43
Rate for Payer: Qualcare PPO/HMO/WC	$58.33
Rate for Payer: UnitedHealthcare Commercial	$194.43

BENZODIAZEPINES1-12

Facility

$190.45

Service Code	HCPCS 80346
Hospital Charge Code	3039026
Hospital Revenue Code	301
Min. Negotiated Rate	$24.76
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$57.13
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.76
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$114.00

BENZODIAZEPINES1-12

Facility

$190.45

Service Code	HCPCS 80346
Hospital Charge Code	3039026
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

BENZODIAZEPINES1-12

Facility

$190.45

Service Code	HCPCS 80346
Hospital Charge Code	38430026
Hospital Revenue Code	301
Min. Negotiated Rate	$24.76
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$57.13
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.76
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$114.00

BENZODIAZEPINES1-12

Facility

$390.00

Service Code	HCPCS 80346
Hospital Charge Code	401180346
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

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