Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

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	$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	3039027
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	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 (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	$5.16
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$69.03
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	$47.23
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.96
Rate for Payer: Wellpoint Medicaid Managed Care	$5.16

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,SCREEN

Facility

$190.45

Service Code	HCPCS 80346
Hospital Charge Code	3000340
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, 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	$7.87
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$105.26
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	$72.02
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.55
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.96
Rate for Payer: Wellpoint Medicaid Managed Care	$7.87

BENZODIAZEPINES, SERUM 1-12

Facility

$181.65

Service Code	HCPCS 80346
Hospital Charge Code	3007192
Hospital Revenue Code	301
Min. Negotiated Rate	$5.16
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$69.03
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	$47.23
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.96
Rate for Payer: Wellpoint Medicaid Managed Care	$5.16

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

$130.00

Service Code	HCPCS 80346
Hospital Charge Code	38472137
Hospital Revenue Code	301
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$19.50
Rate for Payer: Qualcare PPO/HMO/WC	$19.50

BENZODIAZEPINES, URINE

Facility

$130.00

Service Code	HCPCS 80346
Hospital Charge Code	38472137
Hospital Revenue Code	301
Min. Negotiated Rate	$3.69
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$49.40
Rate for Payer: Aetna Medicare Advantage	$39.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.15
Rate for Payer: Cigna Commercial	$65.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.80
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.96
Rate for Payer: Wellpoint Medicaid Managed Care	$3.69

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

Facility

$37.12

Service Code	NDC 54162010002
Hospital Charge Code	60631132
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$18.56
Rate for Payer: Aetna Commercial	$14.11
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	$9.65
Rate for Payer: Oxford Commercial	$7.42
Rate for Payer: Qualcare PPO/HMO/WC	$5.57
Rate for Payer: UnitedHealthcare Commercial	$7.42
Rate for Payer: UnitedHealthcare Community & State	$1.17
Rate for Payer: Wellpoint Medicaid Managed Care	$1.05

BENZOIN COMPOUND TINCTURE 30ML

Facility

$24.72

Service Code	NDC 54162010001
Hospital Charge Code	6063943319
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$12.36
Rate for Payer: Aetna Commercial	$9.39
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	$6.43
Rate for Payer: Oxford Commercial	$4.94
Rate for Payer: Qualcare PPO/HMO/WC	$3.71
Rate for Payer: UnitedHealthcare Commercial	$4.94
Rate for Payer: UnitedHealthcare Community & State	$0.78
Rate for Payer: Wellpoint Medicaid Managed Care	$0.70

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 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-60ML

Facility

$85.96

Service Code	NDC 395024792
Hospital Charge Code	606390067
Hospital Revenue Code	250
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$42.98
Rate for Payer: Aetna Commercial	$32.66
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	$22.35
Rate for Payer: Oxford Commercial	$17.19
Rate for Payer: Qualcare PPO/HMO/WC	$12.89
Rate for Payer: UnitedHealthcare Commercial	$17.19
Rate for Payer: UnitedHealthcare Community & State	$2.72
Rate for Payer: Wellpoint Medicaid Managed Care	$2.44

BENZONATATE 100 MG CAP

Facility

$16.75

Service Code	NDC 67877057301
Hospital Charge Code	60627984
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$8.38
Rate for Payer: Aetna Commercial	$6.37
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	$4.36
Rate for Payer: Oxford Commercial	$3.35
Rate for Payer: Qualcare PPO/HMO/WC	$2.51
Rate for Payer: UnitedHealthcare Commercial	$3.35
Rate for Payer: UnitedHealthcare Community & State	$0.53
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

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

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 0.5 MG TAB

Facility

$4.00

Service Code	NDC 76385010301
Hospital Charge Code	60627417
Hospital Revenue Code	251
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
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	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

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

Know your out-of-pocket cost for care.

All Charges