Heights University Hospital

All Charges

Charge

Type

Setting

Price

HYDRATION IV INFUSION ADDON H1

Facility

$116.48

Service Code	HCPCS 90761
Hospital Charge Code	3701115
Hospital Revenue Code	260
Min. Negotiated Rate	$15.14
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$34.94
Rate for Payer: Aetna Medicare Advantage	$34.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.70
Rate for Payer: Cigna Commercial	$58.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.14
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.47
Rate for Payer: UnitedHealthcare Commercial	$802.00

HYDRATION IV INFUSION ADDON H1

Facility

$116.48

Service Code	HCPCS 90761
Hospital Charge Code	3701115
Hospital Revenue Code	260
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$17.47
Rate for Payer: Qualcare PPO/HMO/WC	$17.47

HYDRATION IV INFUSION ADDON H5

Facility

$116.48

Service Code	HCPCS 90761
Hospital Charge Code	3401135
Hospital Revenue Code	260
Min. Negotiated Rate	$15.14
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$34.94
Rate for Payer: Aetna Medicare Advantage	$34.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.70
Rate for Payer: Cigna Commercial	$58.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.14
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.47
Rate for Payer: UnitedHealthcare Commercial	$802.00

HYDRATION IV INFUSION ADDON H5

Facility

$116.48

Service Code	HCPCS 90761
Hospital Charge Code	3401135
Hospital Revenue Code	260
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$17.47
Rate for Payer: Qualcare PPO/HMO/WC	$17.47

HYDRATOME RX 44

Facility

$2,029.75

Hospital Charge Code	270638446
Hospital Revenue Code	272
Min. Negotiated Rate	$263.87
Max. Negotiated Rate	$1,014.88
Rate for Payer: Aetna Commercial	$608.92
Rate for Payer: Aetna Medicare Advantage	$608.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$517.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$517.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$517.59
Rate for Payer: Cigna Commercial	$1,014.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$263.87
Rate for Payer: Oxford Commercial	$1,014.88
Rate for Payer: Qualcare PPO/HMO/WC	$304.46
Rate for Payer: UnitedHealthcare Commercial	$1,014.88

HYDRATOME RX 44

Facility

$2,029.75

Hospital Charge Code	270638446
Hospital Revenue Code	272
Min. Negotiated Rate	$304.46
Max. Negotiated Rate	$304.46
Rate for Payer: Qualcare PPO/HMO/WC	$304.46

HYDRATOME RX 44x20x 450cm

Facility

$2,257.50

Service Code	HCPCS C1769
Hospital Charge Code	270653660
Hospital Revenue Code	278
Min. Negotiated Rate	$338.62
Max. Negotiated Rate	$546.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$451.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$546.32
Rate for Payer: Qualcare PPO/HMO/WC	$338.62

HYDRATOME RX 44x20x 450cm

Facility

$2,257.50

Service Code	HCPCS C1769
Hospital Charge Code	270653660
Hospital Revenue Code	278
Min. Negotiated Rate	$338.62
Max. Negotiated Rate	$1,128.75
Rate for Payer: Aetna Commercial	$677.25
Rate for Payer: Aetna Medicare Advantage	$677.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$575.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$575.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$451.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$575.66
Rate for Payer: Cigna Commercial	$1,128.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$546.32
Rate for Payer: Qualcare PPO/HMO/WC	$338.62

HYDRAWIRE JAG SUPER STIFF

Facility

$2,945.00

Hospital Charge Code	270637106
Hospital Revenue Code	272
Min. Negotiated Rate	$382.85
Max. Negotiated Rate	$1,472.50
Rate for Payer: UnitedHealthcare Commercial	$1,472.50
Rate for Payer: Aetna Commercial	$883.50
Rate for Payer: Aetna Medicare Advantage	$883.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$750.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$750.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$750.98
Rate for Payer: Cigna Commercial	$1,472.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$382.85
Rate for Payer: Oxford Commercial	$1,472.50
Rate for Payer: Qualcare PPO/HMO/WC	$441.75

HYDRAWIRE JAG SUPER STIFF

Facility

$2,945.00

Hospital Charge Code	270637106
Hospital Revenue Code	272
Min. Negotiated Rate	$441.75
Max. Negotiated Rate	$441.75
Rate for Payer: Qualcare PPO/HMO/WC	$441.75

HYDRAWIRE ST TIP 0.035INX450CM

Facility

$862.50

Service Code	HCPCS C1769
Hospital Charge Code	270689958
Hospital Revenue Code	278
Min. Negotiated Rate	$129.38
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) NJ Health	$172.50
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	$208.72
Rate for Payer: Qualcare PPO/HMO/WC	$129.38

HYDRAWIRE ST TIP 0.035INX450CM

Facility

$862.50

Service Code	HCPCS C1769
Hospital Charge Code	270689958
Hospital Revenue Code	278
Min. Negotiated Rate	$129.38
Max. Negotiated Rate	$208.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$172.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.72
Rate for Payer: Qualcare PPO/HMO/WC	$129.38

HYDROCAM CANNULA SYSTEM DISP

Facility

$650.00

Service Code	HCPCS A4649
Hospital Charge Code	270698071
Hospital Revenue Code	272
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

HYDROCAM CANNULA SYSTEM DISP

Facility

$650.00

Service Code	HCPCS A4649
Hospital Charge Code	270698071
Hospital Revenue Code	272
Min. Negotiated Rate	$84.50
Max. Negotiated Rate	$325.00
Rate for Payer: Aetna Commercial	$195.00
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	$84.50
Rate for Payer: Oxford Commercial	$325.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.50
Rate for Payer: UnitedHealthcare Commercial	$325.00

HYDROCHLOROTHIAZIDE 12.5M

Facility

$1.00

Hospital Charge Code	60635468
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

HYDROCHLOROTHIAZIDE 12.5M

Facility

$1.00

Hospital Charge Code	60635468
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Oxford Commercial	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.50

HYDROCHLOROTHIAZIDE 12.5MG CAP

Facility

$5.49

Service Code	NDC 16729018201
Hospital Charge Code	60629943
Hospital Revenue Code	250
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$2.75
Rate for Payer: Aetna Commercial	$1.65
Rate for Payer: Aetna Medicare Advantage	$1.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.40
Rate for Payer: Cigna Commercial	$2.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.71
Rate for Payer: Oxford Commercial	$2.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.82
Rate for Payer: UnitedHealthcare Commercial	$2.75

HYDROCHLOROTHIAZIDE 12.5MG CAP

Facility

$5.49

Service Code	NDC 16729018201
Hospital Charge Code	60629943
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.82
Rate for Payer: Qualcare PPO/HMO/WC	$0.82

HYDROCHLOROTHIAZIDE/25MG

Facility

$4.00

Hospital Charge Code	60633110
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

HYDROCHLOROTHIAZIDE/25MG

Facility

$4.00

Hospital Charge Code	60633110
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

HYDROCHLOROTHIAZIDE 25 MG TAB

Facility

$4.00

Service Code	NDC 16729018301
Hospital Charge Code	60627968
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

HYDROCHLOROTHIAZIDE 25 MG TAB

Facility

$4.00

Service Code	NDC 16729018301
Hospital Charge Code	60627968
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

HYDROCHLOROTHIAZIDE/50MG

Facility

$3.00

Hospital Charge Code	60633114
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

HYDROCHLOROTHIAZIDE/50MG

Facility

$3.00

Hospital Charge Code	60633111
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

HYDROCHLOROTHIAZIDE/50MG

Facility

$4.00

Service Code	NDC 16729018401
Hospital Charge Code	60633112
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