Heights University Hospital

All Charges

Charge

Type

Setting

Price

HYBRID VASCULAR GRAFT 5 X 8 MM

Facility

$12,555.00

Service Code	HCPCS C1768
Hospital Charge Code	270659424
Hospital Revenue Code	278
Min. Negotiated Rate	$1,883.25
Max. Negotiated Rate	$3,038.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,511.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,038.31
Rate for Payer: Qualcare PPO/HMO/WC	$1,883.25

HYCAMTIN 4MG VIAL

Facility

$1,662.00

Hospital Charge Code	60635233
Hospital Revenue Code	636
Min. Negotiated Rate	$249.30
Max. Negotiated Rate	$402.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$402.20
Rate for Payer: Qualcare PPO/HMO/WC	$249.30

HYCAMTIN 4MG VIAL

Facility

$1,662.00

Hospital Charge Code	60635233
Hospital Revenue Code	636
Min. Negotiated Rate	$249.30
Max. Negotiated Rate	$831.00
Rate for Payer: Aetna Commercial	$498.60
Rate for Payer: Aetna Medicare Advantage	$498.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$423.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$423.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$423.81
Rate for Payer: Cigna Commercial	$831.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$402.20
Rate for Payer: Qualcare PPO/HMO/WC	$249.30

HYCODAN SYRUP/5ML/U/D

Facility

$3.00

Hospital Charge Code	60634973
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

HYCODAN SYRUP/5ML/U/D

Facility

$3.00

Hospital Charge Code	60634973
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

HYCOMINE 25-5/480ML

Facility

$290.00

Hospital Charge Code	60633101
Hospital Revenue Code	250
Min. Negotiated Rate	$37.70
Max. Negotiated Rate	$145.00
Rate for Payer: Aetna Commercial	$87.00
Rate for Payer: Aetna Medicare Advantage	$87.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.95
Rate for Payer: Cigna Commercial	$145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.70
Rate for Payer: Oxford Commercial	$145.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.50
Rate for Payer: UnitedHealthcare Commercial	$145.00

HYCOMINE 25-5/480ML

Facility

$290.00

Hospital Charge Code	60633101
Hospital Revenue Code	250
Min. Negotiated Rate	$43.50
Max. Negotiated Rate	$43.50
Rate for Payer: Qualcare PPO/HMO/WC	$43.50

HYCOMINE PEDIATRIC 12.5/2

Facility

$250.00

Hospital Charge Code	60633100
Hospital Revenue Code	250
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

HYCOMINE PEDIATRIC 12.5/2

Facility

$250.00

Hospital Charge Code	60633100
Hospital Revenue Code	250
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$125.00

HYDELTRA-T.B.A./20MG/1ML

Facility

$118.00

Hospital Charge Code	60633102
Hospital Revenue Code	250
Min. Negotiated Rate	$15.34
Max. Negotiated Rate	$59.00
Rate for Payer: Aetna Commercial	$35.40
Rate for Payer: Aetna Medicare Advantage	$35.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.09
Rate for Payer: Cigna Commercial	$59.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.34
Rate for Payer: Oxford Commercial	$59.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.70
Rate for Payer: UnitedHealthcare Commercial	$59.00

HYDELTRA-T.B.A./20MG/1ML

Facility

$118.00

Hospital Charge Code	60633102
Hospital Revenue Code	250
Min. Negotiated Rate	$17.70
Max. Negotiated Rate	$17.70
Rate for Payer: Qualcare PPO/HMO/WC	$17.70

HYDERGINE/1MG/1ML

Facility

$69.00

Hospital Charge Code	60633103
Hospital Revenue Code	250
Min. Negotiated Rate	$8.97
Max. Negotiated Rate	$34.50
Rate for Payer: Aetna Commercial	$20.70
Rate for Payer: Aetna Medicare Advantage	$20.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.59
Rate for Payer: Cigna Commercial	$34.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.97
Rate for Payer: Oxford Commercial	$34.50
Rate for Payer: Qualcare PPO/HMO/WC	$10.35
Rate for Payer: UnitedHealthcare Commercial	$34.50

HYDERGINE/1MG/1ML

Facility

$69.00

Hospital Charge Code	60633103
Hospital Revenue Code	250
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$10.35
Rate for Payer: Qualcare PPO/HMO/WC	$10.35

HYDERGINE LC/1MG/CAP

Facility

$3.00

Hospital Charge Code	60633104
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

HYDERGINE LC/1MG/CAP

Facility

$3.00

Hospital Charge Code	60633104
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

HYDERGINE SL/0.5MG/TAB

Facility

$3.00

Hospital Charge Code	60634642
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

HYDERGINE SL/0.5MG/TAB

Facility

$3.00

Hospital Charge Code	60634642
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

HYD-JAG.035/450cmSTR M00556041

Facility

$1,975.00

Hospital Charge Code	270639824
Hospital Revenue Code	272
Min. Negotiated Rate	$256.75
Max. Negotiated Rate	$987.50
Rate for Payer: Aetna Commercial	$592.50
Rate for Payer: Aetna Medicare Advantage	$592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$503.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$503.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$503.62
Rate for Payer: Cigna Commercial	$987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$256.75
Rate for Payer: Oxford Commercial	$987.50
Rate for Payer: Qualcare PPO/HMO/WC	$296.25
Rate for Payer: UnitedHealthcare Commercial	$987.50

HYD-JAG.035/450cmSTR M00556041

Facility

$1,975.00

Hospital Charge Code	270639824
Hospital Revenue Code	272
Min. Negotiated Rate	$296.25
Max. Negotiated Rate	$296.25
Rate for Payer: Qualcare PPO/HMO/WC	$296.25

HYDRA JAGWIRE 035260STRA 5600

Facility

$862.50

Hospital Charge Code	270634925
Hospital Revenue Code	270
Min. Negotiated Rate	$112.12
Max. Negotiated Rate	$431.25
Rate for Payer: Aetna Commercial	$258.75
Rate for Payer: Aetna Medicare Advantage	$258.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$219.94
Rate for Payer: Cigna Commercial	$431.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.12
Rate for Payer: Oxford Commercial	$431.25
Rate for Payer: Qualcare PPO/HMO/WC	$129.38
Rate for Payer: UnitedHealthcare Commercial	$431.25

HYDRA JAGWIRE 035260STRA 5600

Facility

$862.50

Hospital Charge Code	270634925
Hospital Revenue Code	270
Min. Negotiated Rate	$129.38
Max. Negotiated Rate	$129.38
Rate for Payer: Qualcare PPO/HMO/WC	$129.38

HYDRALAZINE/100MG/TAB

Facility

$4.00

Hospital Charge Code	60633109
Hospital Revenue Code	250
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

HYDRALAZINE/100MG/TAB

Facility

$4.00

Hospital Charge Code	60633109
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

HYDRALAZINE 10 MG TAB

Facility

$4.00

Service Code	NDC 51079007420
Hospital Charge Code	60627632
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

HYDRALAZINE 10 MG TAB

Facility

$4.00

Service Code	NDC 51079007420
Hospital Charge Code	60627632
Hospital Revenue Code	250
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

Know your out-of-pocket cost for care.

All Charges