Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

Benicar 5mg

Facility

$156.04

Service Code	NDC 35356028720
Hospital Charge Code	6063943277
Hospital Revenue Code	250
Min. Negotiated Rate	$23.41
Max. Negotiated Rate	$23.41
Rate for Payer: Qualcare PPO/HMO/WC	$23.41

BENIGN PROSTATIC HYPERTROPHY WITH MCC

Facility

$56,435.43

Service Code	MSDRG 725
Min. Negotiated Rate	$17,183.87
Max. Negotiated Rate	$56,435.43
Rate for Payer: Aetna Commercial	$42,052.47
Rate for Payer: Aetna Medicare Advantage	$56,435.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34,354.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34,354.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18,088.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34,354.20
Rate for Payer: Cigna Commercial	$26,087.27
Rate for Payer: Cigna Medicare Advantage	$18,088.28
Rate for Payer: Clover Medicare Advantage	$17,183.87
Rate for Payer: EmblemHealth Commercial	$54,264.84
Rate for Payer: Humana Medicare Advantage	$18,630.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18,088.28
Rate for Payer: Oxford Commercial	$20,618.92
Rate for Payer: UnitedHealthcare Commercial	$27,599.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$18,088.28
Rate for Payer: Wellcare Medicare Advantage	$18,088.28

BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC

Facility

$42,275.25

Service Code	MSDRG 726
Min. Negotiated Rate	$12,721.64
Max. Negotiated Rate	$42,275.25
Rate for Payer: Aetna Commercial	$31,967.41
Rate for Payer: Aetna Medicare Advantage	$42,275.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20,224.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20,224.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,549.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20,224.65
Rate for Payer: Cigna Commercial	$16,095.55
Rate for Payer: Cigna Medicare Advantage	$13,549.76
Rate for Payer: Clover Medicare Advantage	$12,872.27
Rate for Payer: EmblemHealth Commercial	$40,649.28
Rate for Payer: Humana Medicare Advantage	$13,956.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,549.76
Rate for Payer: Oxford Commercial	$12,721.64
Rate for Payer: UnitedHealthcare Commercial	$17,028.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,549.76
Rate for Payer: Wellcare Medicare Advantage	$13,549.76

BENTSON WIRE 180

Facility

$650.00

Hospital Charge Code	270683079N
Hospital Revenue Code	272
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

BENTSON WIRE 180

Facility

$650.00

Hospital Charge Code	270683079N
Hospital Revenue Code	272
Min. Negotiated Rate	$18.46
Max. Negotiated Rate	$325.00
Rate for Payer: Aetna Commercial	$247.00
Rate for Payer: Aetna Medicare Advantage	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.75
Rate for Payer: Cigna Commercial	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.00
Rate for Payer: Oxford Commercial	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.50
Rate for Payer: UnitedHealthcare Commercial	$130.00
Rate for Payer: UnitedHealthcare Community & State	$20.54
Rate for Payer: Wellpoint Medicaid Managed Care	$18.46

BENTSON WIRE 180

Facility

$650.00

Hospital Charge Code	270683079S
Hospital Revenue Code	272
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

BENTSON WIRE 180

Facility

$650.00

Hospital Charge Code	270683079
Hospital Revenue Code	272
Min. Negotiated Rate	$18.46
Max. Negotiated Rate	$325.00
Rate for Payer: Aetna Commercial	$247.00
Rate for Payer: Aetna Medicare Advantage	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.75
Rate for Payer: Cigna Commercial	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.00
Rate for Payer: Oxford Commercial	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.50
Rate for Payer: UnitedHealthcare Commercial	$130.00
Rate for Payer: UnitedHealthcare Community & State	$20.54
Rate for Payer: Wellpoint Medicaid Managed Care	$18.46

BENTSON WIRE 180

Facility

$650.00

Hospital Charge Code	270683079
Hospital Revenue Code	272
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

BENTSON WIRE 180

Facility

$650.00

Hospital Charge Code	270683079S
Hospital Revenue Code	272
Min. Negotiated Rate	$18.46
Max. Negotiated Rate	$325.00
Rate for Payer: Aetna Commercial	$247.00
Rate for Payer: Aetna Medicare Advantage	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.75
Rate for Payer: Cigna Commercial	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.00
Rate for Payer: Oxford Commercial	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.50
Rate for Payer: UnitedHealthcare Commercial	$130.00
Rate for Payer: UnitedHealthcare Community & State	$20.54
Rate for Payer: Wellpoint Medicaid Managed Care	$18.46

BENTSON WIRE GUIGE 80CM

Facility

$132.45

Hospital Charge Code	270704889
Hospital Revenue Code	279
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$66.22
Rate for Payer: Aetna Commercial	$50.33
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	$34.44
Rate for Payer: Oxford Commercial	$26.49
Rate for Payer: Qualcare PPO/HMO/WC	$19.87
Rate for Payer: UnitedHealthcare Commercial	$26.49
Rate for Payer: UnitedHealthcare Community & State	$4.19
Rate for Payer: Wellpoint Medicaid Managed Care	$3.76

BENTSON WIRE GUIGE 80CM

Facility

$132.45

Hospital Charge Code	270704889
Hospital Revenue Code	279
Min. Negotiated Rate	$19.87
Max. Negotiated Rate	$19.87
Rate for Payer: Qualcare PPO/HMO/WC	$19.87

BENZOCAINE GEL

Facility

$4.89

Service Code	NDC 10310031840
Hospital Charge Code	606390415
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.44
Rate for Payer: Aetna Commercial	$1.86
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	$1.27
Rate for Payer: Oxford Commercial	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.73
Rate for Payer: UnitedHealthcare Commercial	$0.98
Rate for Payer: UnitedHealthcare Community & State	$0.15
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

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 7.5% INFANT

Facility

$25.39

Service Code	NDC 11917007948
Hospital Charge Code	60628572
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$12.70
Rate for Payer: Aetna Commercial	$9.65
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	$6.60
Rate for Payer: Oxford Commercial	$5.08
Rate for Payer: Qualcare PPO/HMO/WC	$3.81
Rate for Payer: UnitedHealthcare Commercial	$5.08
Rate for Payer: UnitedHealthcare Community & State	$0.80
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

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

BENZODIAZEPINES1-12

Facility

$190.45

Service Code	HCPCS 80346
Hospital Charge Code	39990226
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	3039026
Hospital Revenue Code	301
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$72.37
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	$49.52
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.96
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

BENZODIAZEPINES1-12

Facility

$190.45

Service Code	HCPCS 80346
Hospital Charge Code	39990226
Hospital Revenue Code	301
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$72.37
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	$49.52
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.96
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

BENZODIAZEPINES1-12

Facility

$190.45

Service Code	HCPCS 80346
Hospital Charge Code	38430026
Hospital Revenue Code	301
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$72.37
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	$49.52
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.96
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

BENZODIAZEPINES1-12

Facility

$390.00

Service Code	HCPCS 80346
Hospital Charge Code	401180346
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
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	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.96
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

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

$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

BENZODIAZEPINES1-12

Facility

$190.45

Service Code	HCPCS 80346
Hospital Charge Code	38430026
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	38430027
Hospital Revenue Code	301
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$72.37
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	$49.52
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.96
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

BENZODIAZEPINES 13 OR MORE

Facility

$190.45

Service Code	HCPCS 80347
Hospital Charge Code	39990227
Hospital Revenue Code	301
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$72.37
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	$49.52
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.96
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

Know your out-of-pocket cost for care.

All Charges