Heights University Hospital

All Charges

Charge

Type

Setting

Price

BENZODIAZEPINES1-12

Facility

$390.00

Service Code	HCPCS 80346
Hospital Charge Code	401180346
Hospital Revenue Code	301
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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

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

$190.45

Service Code	HCPCS 80346
Hospital Charge Code	39990226
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

BENZODIAZEPINES 13 OR MORE

Facility

$190.45

Service Code	HCPCS 80347
Hospital Charge Code	39990227
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

BENZODIAZEPINES 13 OR MORE

Facility

$190.45

Service Code	HCPCS 80347
Hospital Charge Code	39990227
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

BENZODIAZEPINES 13 OR MORE

Facility

$190.45

Service Code	HCPCS 80347
Hospital Charge Code	38430027
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

BENZODIAZEPINES 13 OR MORE

Facility

$190.45

Service Code	HCPCS 80347
Hospital Charge Code	3039027
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

BENZODIAZEPINES 13 OR MORE

Facility

$190.45

Service Code	HCPCS 80347
Hospital Charge Code	38430027
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

BENZODIAZEPINES 13 OR MORE

Facility

$190.45

Service Code	HCPCS 80347
Hospital Charge Code	3039027
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

BENZODIAZEPINES (QUANT UR)1-12

Facility

$181.65

Service Code	HCPCS 80346
Hospital Charge Code	3007184
Hospital Revenue Code	301
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

BENZODIAZEPINES (QUANT UR)1-12

Facility

$181.65

Service Code	HCPCS 80346
Hospital Charge Code	3007184
Hospital Revenue Code	301
Min. Negotiated Rate	$23.61
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$54.49
Rate for Payer: Aetna Medicare Advantage	$54.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.32
Rate for Payer: Cigna Commercial	$90.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
Rate for Payer: UnitedHealthcare Commercial	$114.00

BENZODIAZEPINES,SCREEN

Facility

$190.45

Service Code	HCPCS 80346
Hospital Charge Code	3000340
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

BENZODIAZEPINES,SCREEN

Facility

$190.45

Service Code	HCPCS 80346
Hospital Charge Code	3000340
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

BENZODIAZEPINES, SERUM

Facility

$277.00

Service Code	HCPCS 80346
Hospital Charge Code	38472134
Hospital Revenue Code	301
Min. Negotiated Rate	$41.55
Max. Negotiated Rate	$41.55
Rate for Payer: Qualcare PPO/HMO/WC	$41.55

BENZODIAZEPINES, SERUM

Facility

$277.00

Service Code	HCPCS 80346
Hospital Charge Code	38472134
Hospital Revenue Code	301
Min. Negotiated Rate	$36.01
Max. Negotiated Rate	$138.50
Rate for Payer: Aetna Commercial	$83.10
Rate for Payer: Aetna Medicare Advantage	$83.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.64
Rate for Payer: Cigna Commercial	$138.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.01
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.55
Rate for Payer: UnitedHealthcare Commercial	$114.00

BENZODIAZEPINES, SERUM 1-12

Facility

$181.65

Service Code	HCPCS 80346
Hospital Charge Code	3007192
Hospital Revenue Code	301
Min. Negotiated Rate	$23.61
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$54.49
Rate for Payer: Aetna Medicare Advantage	$54.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.32
Rate for Payer: Cigna Commercial	$90.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
Rate for Payer: UnitedHealthcare Commercial	$114.00

BENZODIAZEPINES, SERUM 1-12

Facility

$181.65

Service Code	HCPCS 80346
Hospital Charge Code	3007192
Hospital Revenue Code	301
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

BENZODIAZEPINES, URINE

Facility

$131.38

Service Code	HCPCS 80346
Hospital Charge Code	38472137
Hospital Revenue Code	301
Min. Negotiated Rate	$17.08
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$39.41
Rate for Payer: Aetna Medicare Advantage	$39.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.50
Rate for Payer: Cigna Commercial	$65.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.08
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.71
Rate for Payer: UnitedHealthcare Commercial	$114.00

BENZODIAZEPINES, URINE

Facility

$131.38

Service Code	HCPCS 80346
Hospital Charge Code	38472137
Hospital Revenue Code	301
Min. Negotiated Rate	$19.71
Max. Negotiated Rate	$19.71
Rate for Payer: Qualcare PPO/HMO/WC	$19.71

BENZOIN COMPOUND TINCTURE

Facility

$37.12

Service Code	NDC 54162010002
Hospital Charge Code	60631132
Hospital Revenue Code	250
Min. Negotiated Rate	$4.83
Max. Negotiated Rate	$18.56
Rate for Payer: Aetna Commercial	$11.14
Rate for Payer: Aetna Medicare Advantage	$11.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.47
Rate for Payer: Cigna Commercial	$18.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.83
Rate for Payer: Oxford Commercial	$18.56
Rate for Payer: Qualcare PPO/HMO/WC	$5.57
Rate for Payer: UnitedHealthcare Commercial	$18.56

BENZOIN COMPOUND TINCTURE

Facility

$37.12

Service Code	NDC 54162010002
Hospital Charge Code	60631132
Hospital Revenue Code	250
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$5.57
Rate for Payer: Qualcare PPO/HMO/WC	$5.57

BENZOIN COMPOUND TINCTURE 30ML

Facility

$24.72

Service Code	NDC 54162010001
Hospital Charge Code	6063943319
Hospital Revenue Code	250
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$3.71
Rate for Payer: Qualcare PPO/HMO/WC	$3.71

BENZOIN COMPOUND TINCTURE 30ML

Facility

$24.72

Service Code	NDC 54162010001
Hospital Charge Code	6063943319
Hospital Revenue Code	250
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$12.36
Rate for Payer: Aetna Commercial	$7.42
Rate for Payer: Aetna Medicare Advantage	$7.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.30
Rate for Payer: Cigna Commercial	$12.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.21
Rate for Payer: Oxford Commercial	$12.36
Rate for Payer: Qualcare PPO/HMO/WC	$3.71
Rate for Payer: UnitedHealthcare Commercial	$12.36

BENZOIN SPRAY****

Facility

$98.00

Hospital Charge Code	8000127
Hospital Revenue Code	279
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$14.70
Rate for Payer: Qualcare PPO/HMO/WC	$14.70

Know your out-of-pocket cost for care.

All Charges