Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

BENZOIN SPRAY 105G CAN

Facility

$25.60

Hospital Charge Code	60628926
Hospital Revenue Code	250
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$12.80
Rate for Payer: Aetna Commercial	$7.68
Rate for Payer: Aetna Medicare Advantage	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.53
Rate for Payer: Cigna Commercial	$12.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.33
Rate for Payer: Oxford Commercial	$12.80
Rate for Payer: Qualcare PPO/HMO/WC	$3.84
Rate for Payer: UnitedHealthcare Commercial	$12.80

BENZOIN SPRAY 105G CAN

Facility

$25.60

Hospital Charge Code	60628926
Hospital Revenue Code	250
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$3.84
Rate for Payer: Qualcare PPO/HMO/WC	$3.84

BENZOIN TINCTURE 4OZ

Facility

$15.40

Hospital Charge Code	6012264
Hospital Revenue Code	251
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.31

BENZOIN TINCTURE 4OZ

Facility

$15.40

Hospital Charge Code	6012264
Hospital Revenue Code	251
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$7.70
Rate for Payer: Aetna Commercial	$4.62
Rate for Payer: Aetna Medicare Advantage	$4.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.93
Rate for Payer: Cigna Commercial	$7.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.00
Rate for Payer: Oxford Commercial	$7.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.31
Rate for Payer: UnitedHealthcare Commercial	$7.70

BENZOIN TINCTURE-60ML

Facility

$85.96

Service Code	NDC 395024792
Hospital Charge Code	606390067
Hospital Revenue Code	250
Min. Negotiated Rate	$11.17
Max. Negotiated Rate	$42.98
Rate for Payer: Aetna Commercial	$25.79
Rate for Payer: Aetna Medicare Advantage	$25.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.92
Rate for Payer: Cigna Commercial	$42.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.17
Rate for Payer: Oxford Commercial	$42.98
Rate for Payer: Qualcare PPO/HMO/WC	$12.89
Rate for Payer: UnitedHealthcare Commercial	$42.98

BENZOIN TINCTURE-60ML

Facility

$85.96

Service Code	NDC 395024792
Hospital Charge Code	606390067
Hospital Revenue Code	250
Min. Negotiated Rate	$12.89
Max. Negotiated Rate	$12.89
Rate for Payer: Qualcare PPO/HMO/WC	$12.89

BENZOIN TINCTURE SPRAY 142.5ML

Facility

$115.85

Hospital Charge Code	6009260
Hospital Revenue Code	251
Min. Negotiated Rate	$17.38
Max. Negotiated Rate	$17.38
Rate for Payer: Qualcare PPO/HMO/WC	$17.38

BENZOIN TINCTURE SPRAY 142.5ML

Facility

$115.85

Hospital Charge Code	6009260
Hospital Revenue Code	251
Min. Negotiated Rate	$15.06
Max. Negotiated Rate	$57.92
Rate for Payer: Aetna Commercial	$34.76
Rate for Payer: Aetna Medicare Advantage	$34.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.54
Rate for Payer: Cigna Commercial	$57.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.06
Rate for Payer: Oxford Commercial	$57.92
Rate for Payer: Qualcare PPO/HMO/WC	$17.38
Rate for Payer: UnitedHealthcare Commercial	$57.92

BENZOIN TOLU TINCTURE

Facility

$32.85

Hospital Charge Code	60628431
Hospital Revenue Code	250
Min. Negotiated Rate	$4.93
Max. Negotiated Rate	$4.93
Rate for Payer: Qualcare PPO/HMO/WC	$4.93

BENZOIN TOLU TINCTURE

Facility

$32.85

Hospital Charge Code	60628431
Hospital Revenue Code	250
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$16.43
Rate for Payer: Aetna Commercial	$9.86
Rate for Payer: Aetna Medicare Advantage	$9.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.38
Rate for Payer: Cigna Commercial	$16.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.27
Rate for Payer: Oxford Commercial	$16.43
Rate for Payer: Qualcare PPO/HMO/WC	$4.93
Rate for Payer: UnitedHealthcare Commercial	$16.43

BENZONATATE 100 MG CAP

Facility

$16.75

Service Code	NDC 67877057301
Hospital Charge Code	60627984
Hospital Revenue Code	250
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$2.51
Rate for Payer: Qualcare PPO/HMO/WC	$2.51

BENZONATATE 100 MG CAP

Facility

$16.75

Service Code	NDC 67877057301
Hospital Charge Code	60627984
Hospital Revenue Code	250
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$8.38
Rate for Payer: Aetna Commercial	$5.03
Rate for Payer: Aetna Medicare Advantage	$5.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.27
Rate for Payer: Cigna Commercial	$8.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.18
Rate for Payer: Oxford Commercial	$8.38
Rate for Payer: Qualcare PPO/HMO/WC	$2.51
Rate for Payer: UnitedHealthcare Commercial	$8.38

BENZOYL PEROX TOP 10%

Facility

$64.00

Hospital Charge Code	6000608
Hospital Revenue Code	251
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.60

BENZOYL PEROX TOP 10%

Facility

$64.00

Hospital Charge Code	6000608
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

BENZQUINAMIDE HC INJ 50MG VIAL

Facility

$82.00

Service Code	HCPCS J0510
Hospital Charge Code	6008742
Hospital Revenue Code	250
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$41.00
Rate for Payer: Aetna Commercial	$24.60
Rate for Payer: Aetna Medicare Advantage	$24.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.91
Rate for Payer: Cigna Commercial	$41.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.66
Rate for Payer: Oxford Commercial	$41.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.30
Rate for Payer: UnitedHealthcare Commercial	$41.00

BENZQUINAMIDE HC INJ 50MG VIAL

Facility

$82.00

Service Code	HCPCS J0510
Hospital Charge Code	6008742
Hospital Revenue Code	250
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$12.30
Rate for Payer: Qualcare PPO/HMO/WC	$12.30

BENZTROPINE 0.5 MG TAB

Facility

$4.00

Service Code	NDC 76385010301
Hospital Charge Code	60627417
Hospital Revenue Code	251
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

BENZTROPINE 0.5 MG TAB

Facility

$4.00

Service Code	NDC 76385010301
Hospital Charge Code	60627417
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

BENZTROPINE 1 MG TAB

Facility

$4.00

Service Code	NDC 832108100
Hospital Charge Code	6022198
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

BENZTROPINE 1 MG TAB

Facility

$4.00

Service Code	NDC 832108100
Hospital Charge Code	6022198
Hospital Revenue Code	251
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

BENZTROPINE 2 MG/2 ML INJ

Facility

$393.63

Service Code	HCPCS J0515
Hospital Charge Code	60627418
Hospital Revenue Code	636
Min. Negotiated Rate	$13.52
Max. Negotiated Rate	$118.09
Rate for Payer: Aetna Commercial	$118.09
Rate for Payer: Aetna Medicare Advantage	$118.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.38
Rate for Payer: Cigna Commercial	$13.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.26
Rate for Payer: Qualcare PPO/HMO/WC	$59.04

BENZTROPINE 2 MG/2 ML INJ

Facility

$393.63

Service Code	HCPCS J0515
Hospital Charge Code	60627418
Hospital Revenue Code	636
Min. Negotiated Rate	$59.04
Max. Negotiated Rate	$95.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.26
Rate for Payer: Qualcare PPO/HMO/WC	$59.04

BENZTROPINE 2 MG TAB

Facility

$4.00

Service Code	NDC 603243921
Hospital Charge Code	60627419
Hospital Revenue Code	251
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

BENZTROPINE 2 MG TAB

Facility

$4.00

Service Code	NDC 603243921
Hospital Charge Code	60627419
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

Know your out-of-pocket cost for care.

All Charges