Heights University Hospital

All Charges

Charge

Type

Setting

Price

HYDRALAZINE/10MG/TAB

Facility

$3.00

Hospital Charge Code	60633106
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

HYDRALAZINE/10MG/TAB

Facility

$3.00

Hospital Charge Code	60633106
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

HYDRALAZINE 12.5MG TAB

Facility

$4.00

Service Code	NDC 62584073301
Hospital Charge Code	60635654
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

HYDRALAZINE 12.5MG TAB

Facility

$4.00

Service Code	NDC 62584073301
Hospital Charge Code	60635654
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 20 MG/ML LNJ

Facility

$125.63

Service Code	HCPCS J0360
Hospital Charge Code	60628966
Hospital Revenue Code	636
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$37.69
Rate for Payer: Aetna Commercial	$37.69
Rate for Payer: Aetna Medicare Advantage	$37.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.04
Rate for Payer: Cigna Commercial	$4.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.40
Rate for Payer: Qualcare PPO/HMO/WC	$18.84

HYDRALAZINE 20 MG/ML LNJ

Facility

$125.63

Service Code	HCPCS J0360
Hospital Charge Code	60628966
Hospital Revenue Code	636
Min. Negotiated Rate	$18.84
Max. Negotiated Rate	$30.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.40
Rate for Payer: Qualcare PPO/HMO/WC	$18.84

HYDRALAZINE 25 MG TAB

Facility

$4.15

Service Code	NDC 63739012610
Hospital Charge Code	60627633
Hospital Revenue Code	250
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$0.62
Rate for Payer: Qualcare PPO/HMO/WC	$0.62

HYDRALAZINE 25 MG TAB

Facility

$4.15

Service Code	NDC 63739012610
Hospital Charge Code	60627633
Hospital Revenue Code	250
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$2.08
Rate for Payer: Aetna Commercial	$1.25
Rate for Payer: Aetna Medicare Advantage	$1.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.06
Rate for Payer: Cigna Commercial	$2.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.54
Rate for Payer: Oxford Commercial	$2.08
Rate for Payer: Qualcare PPO/HMO/WC	$0.62
Rate for Payer: UnitedHealthcare Commercial	$2.08

HYDRALAZINE/25MG/TAB

Facility

$3.00

Hospital Charge Code	60633105
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

HYDRALAZINE/25MG/TAB

Facility

$3.00

Hospital Charge Code	60633107
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

HYDRALAZINE/25MG/TAB

Facility

$3.00

Hospital Charge Code	60633105
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

HYDRALAZINE/25MG/TAB

Facility

$3.00

Hospital Charge Code	60633107
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

HYDRALAZINE 50 MG TAB

Facility

$4.00

Service Code	NDC 50111032801
Hospital Charge Code	60627634
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 50 MG TAB

Facility

$4.00

Service Code	NDC 50111032801
Hospital Charge Code	60627634
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

HYDRALAZINE/50MG/TAB

Facility

$3.00

Hospital Charge Code	60633108
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

HYDRALAZINE/50MG/TAB

Facility

$3.00

Hospital Charge Code	60633108
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

HYDRALAZINE INJ 20MG

Facility

$115.85

Hospital Charge Code	6009252
Hospital Revenue Code	250
Min. Negotiated Rate	$17.38
Max. Negotiated Rate	$17.38
Rate for Payer: Qualcare PPO/HMO/WC	$17.38

HYDRALAZINE INJ 20MG

Facility

$115.85

Hospital Charge Code	6009252
Hospital Revenue Code	250
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

HYDRATION INF 1ST HR

Facility

$1,334.09

Service Code	HCPCS 96360
Hospital Charge Code	4501037
Hospital Revenue Code	260
Min. Negotiated Rate	$200.11
Max. Negotiated Rate	$200.11
Rate for Payer: Qualcare PPO/HMO/WC	$200.11

HYDRATION INF 1ST HR

Facility

$1,326.52

Service Code	HCPCS 96360
Hospital Charge Code	3409015
Hospital Revenue Code	260
Min. Negotiated Rate	$198.98
Max. Negotiated Rate	$198.98
Rate for Payer: Qualcare PPO/HMO/WC	$198.98

HYDRATION INF 1ST HR

Facility

$2,800.00

Service Code	HCPCS 96360
Hospital Charge Code	366896360
Hospital Revenue Code	260
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

HYDRATION INF 1ST HR

Facility

$1,334.09

Service Code	HCPCS 96360
Hospital Charge Code	2301097
Hospital Revenue Code	260
Min. Negotiated Rate	$162.15
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$400.23
Rate for Payer: Aetna Medicare Advantage	$400.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$340.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$340.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$162.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$340.19
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.43
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$200.11
Rate for Payer: UnitedHealthcare Commercial	$802.00

HYDRATION INF 1ST HR

Facility

$1,334.09

Service Code	HCPCS 96360
Hospital Charge Code	1001170
Hospital Revenue Code	260
Min. Negotiated Rate	$200.11
Max. Negotiated Rate	$200.11
Rate for Payer: Qualcare PPO/HMO/WC	$200.11

HYDRATION INF 1ST HR

Facility

$1,334.09

Service Code	HCPCS 96360
Hospital Charge Code	2301097
Hospital Revenue Code	260
Min. Negotiated Rate	$200.11
Max. Negotiated Rate	$200.11
Rate for Payer: Qualcare PPO/HMO/WC	$200.11

HYDRATION INF 1ST HR

Facility

$1,326.52

Service Code	HCPCS 96360
Hospital Charge Code	73050965
Hospital Revenue Code	260
Min. Negotiated Rate	$198.98
Max. Negotiated Rate	$198.98
Rate for Payer: Qualcare PPO/HMO/WC	$198.98

Know your out-of-pocket cost for care.

All Charges