Heights University Hospital

All Charges

Charge

Type

Setting

Price

HYDROCODONE PHENYLTO SUSP 480M

Facility

$534.40

Hospital Charge Code	6002828
Hospital Revenue Code	252
Min. Negotiated Rate	$80.16
Max. Negotiated Rate	$80.16
Rate for Payer: Qualcare PPO/HMO/WC	$80.16

HYDROCODONE PHENYLTO SUSP 480M

Facility

$534.40

Hospital Charge Code	6002828
Hospital Revenue Code	252
Min. Negotiated Rate	$69.47
Max. Negotiated Rate	$267.20
Rate for Payer: Aetna Commercial	$160.32
Rate for Payer: Aetna Medicare Advantage	$160.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$136.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$136.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$136.27
Rate for Payer: Cigna Commercial	$267.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.47
Rate for Payer: Oxford Commercial	$267.20
Rate for Payer: Qualcare PPO/HMO/WC	$80.16
Rate for Payer: UnitedHealthcare Commercial	$267.20

HYDROCODONE SYRP(HYCODAN)

Facility

$293.00

Hospital Charge Code	60634413
Hospital Revenue Code	250
Min. Negotiated Rate	$38.09
Max. Negotiated Rate	$146.50
Rate for Payer: Aetna Commercial	$87.90
Rate for Payer: Aetna Medicare Advantage	$87.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.72
Rate for Payer: Cigna Commercial	$146.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.09
Rate for Payer: Oxford Commercial	$146.50
Rate for Payer: Qualcare PPO/HMO/WC	$43.95
Rate for Payer: UnitedHealthcare Commercial	$146.50

HYDROCODONE SYRP(HYCODAN)

Facility

$293.00

Hospital Charge Code	60634413
Hospital Revenue Code	250
Min. Negotiated Rate	$43.95
Max. Negotiated Rate	$43.95
Rate for Payer: Qualcare PPO/HMO/WC	$43.95

HYDROCODONE, URINE

Facility

$164.00

Service Code	HCPCS 80361
Hospital Charge Code	38478099
Hospital Revenue Code	301
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$24.60
Rate for Payer: Qualcare PPO/HMO/WC	$24.60

HYDROCODONE, URINE

Facility

$164.00

Service Code	HCPCS 80361
Hospital Charge Code	38478099
Hospital Revenue Code	301
Min. Negotiated Rate	$21.32
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$49.20
Rate for Payer: Aetna Medicare Advantage	$49.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.82
Rate for Payer: Cigna Commercial	$82.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.32
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.60
Rate for Payer: UnitedHealthcare Commercial	$114.00

HYDROCOD PSEUDOEPH LIQ PT

Facility

$122.90

Hospital Charge Code	6002836
Hospital Revenue Code	251
Min. Negotiated Rate	$18.43
Max. Negotiated Rate	$18.43
Rate for Payer: Qualcare PPO/HMO/WC	$18.43

HYDROCOD PSEUDOEPH LIQ PT

Facility

$122.90

Hospital Charge Code	6002836
Hospital Revenue Code	251
Min. Negotiated Rate	$15.98
Max. Negotiated Rate	$61.45
Rate for Payer: Aetna Commercial	$36.87
Rate for Payer: Aetna Medicare Advantage	$36.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.34
Rate for Payer: Cigna Commercial	$61.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.98
Rate for Payer: Oxford Commercial	$61.45
Rate for Payer: Qualcare PPO/HMO/WC	$18.43
Rate for Payer: UnitedHealthcare Commercial	$61.45

HYDROCORT AUTIC ACID O.S

Facility

$19.85

Hospital Charge Code	6016240
Hospital Revenue Code	251
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$9.93
Rate for Payer: Aetna Commercial	$5.96
Rate for Payer: Aetna Medicare Advantage	$5.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.06
Rate for Payer: Cigna Commercial	$9.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.58
Rate for Payer: Oxford Commercial	$9.93
Rate for Payer: Qualcare PPO/HMO/WC	$2.98
Rate for Payer: UnitedHealthcare Commercial	$9.93

HYDROCORT AUTIC ACID O.S

Facility

$19.85

Hospital Charge Code	6016240
Hospital Revenue Code	251
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$2.98
Rate for Payer: Qualcare PPO/HMO/WC	$2.98

HYDROCORT CRM 0.2%

Facility

$276.00

Hospital Charge Code	60628398
Hospital Revenue Code	250
Min. Negotiated Rate	$35.88
Max. Negotiated Rate	$138.00
Rate for Payer: Aetna Commercial	$82.80
Rate for Payer: Aetna Medicare Advantage	$82.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.38
Rate for Payer: Cigna Commercial	$138.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.88
Rate for Payer: Oxford Commercial	$138.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.40
Rate for Payer: UnitedHealthcare Commercial	$138.00

HYDROCORT CRM 0.2%

Facility

$276.00

Hospital Charge Code	60628398
Hospital Revenue Code	250
Min. Negotiated Rate	$41.40
Max. Negotiated Rate	$41.40
Rate for Payer: Qualcare PPO/HMO/WC	$41.40

HYDROCORT CRM 0.2% 15GM

Facility

$287.97

Service Code	NDC 45802045535
Hospital Charge Code	60628625
Hospital Revenue Code	250
Min. Negotiated Rate	$37.44
Max. Negotiated Rate	$143.99
Rate for Payer: Aetna Commercial	$86.39
Rate for Payer: Aetna Medicare Advantage	$86.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.43
Rate for Payer: Cigna Commercial	$143.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.44
Rate for Payer: Oxford Commercial	$143.99
Rate for Payer: Qualcare PPO/HMO/WC	$43.20
Rate for Payer: UnitedHealthcare Commercial	$143.99

HYDROCORT CRM 0.2% 15GM

Facility

$287.97

Service Code	NDC 45802045535
Hospital Charge Code	60628625
Hospital Revenue Code	250
Min. Negotiated Rate	$43.20
Max. Negotiated Rate	$43.20
Rate for Payer: Qualcare PPO/HMO/WC	$43.20

HYDROCORT CRM 0.5% 28GM

Facility

$36.85

Service Code	NDC 168001431
Hospital Charge Code	6002935
Hospital Revenue Code	251
Min. Negotiated Rate	$4.79
Max. Negotiated Rate	$18.43
Rate for Payer: Aetna Commercial	$11.05
Rate for Payer: Aetna Medicare Advantage	$11.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.40
Rate for Payer: Cigna Commercial	$18.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.79
Rate for Payer: Oxford Commercial	$18.43
Rate for Payer: Qualcare PPO/HMO/WC	$5.53
Rate for Payer: UnitedHealthcare Commercial	$18.43

HYDROCORT CRM 0.5% 28GM

Facility

$36.85

Service Code	NDC 168001431
Hospital Charge Code	6002935
Hospital Revenue Code	251
Min. Negotiated Rate	$5.53
Max. Negotiated Rate	$5.53
Rate for Payer: Qualcare PPO/HMO/WC	$5.53

HYDROCORT CRM 1% 28GM

Facility

$10.90

Hospital Charge Code	6002943
Hospital Revenue Code	251
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$3.27
Rate for Payer: Aetna Medicare Advantage	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.42
Rate for Payer: Oxford Commercial	$5.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$5.45

HYDROCORT CRM 1% 28GM

Facility

$10.90

Hospital Charge Code	6002943
Hospital Revenue Code	251
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

HYDROCORT CRM 2.5%

Facility

$67.20

Hospital Charge Code	60628394
Hospital Revenue Code	250
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$10.08
Rate for Payer: Qualcare PPO/HMO/WC	$10.08

HYDROCORT CRM 2.5%

Facility

$67.20

Hospital Charge Code	60628394
Hospital Revenue Code	250
Min. Negotiated Rate	$8.74
Max. Negotiated Rate	$33.60
Rate for Payer: Aetna Commercial	$20.16
Rate for Payer: Aetna Medicare Advantage	$20.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.14
Rate for Payer: Cigna Commercial	$33.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.74
Rate for Payer: Oxford Commercial	$33.60
Rate for Payer: Qualcare PPO/HMO/WC	$10.08
Rate for Payer: UnitedHealthcare Commercial	$33.60

HYDROCORT CRM 2.5%

Facility

$585.11

Service Code	NDC 64980030130
Hospital Charge Code	60628395
Hospital Revenue Code	250
Min. Negotiated Rate	$76.06
Max. Negotiated Rate	$292.56
Rate for Payer: Aetna Commercial	$175.53
Rate for Payer: Aetna Medicare Advantage	$175.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$149.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$149.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$149.20
Rate for Payer: Cigna Commercial	$292.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.06
Rate for Payer: Oxford Commercial	$292.56
Rate for Payer: Qualcare PPO/HMO/WC	$87.77
Rate for Payer: UnitedHealthcare Commercial	$292.56

HYDROCORT CRM 2.5%

Facility

$585.11

Service Code	NDC 64980030130
Hospital Charge Code	60628395
Hospital Revenue Code	250
Min. Negotiated Rate	$87.77
Max. Negotiated Rate	$87.77
Rate for Payer: Qualcare PPO/HMO/WC	$87.77

HYDROCORT CRM 2.5% 28GM

Facility

$5.80

Hospital Charge Code	6002950
Hospital Revenue Code	251
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$0.87
Rate for Payer: Qualcare PPO/HMO/WC	$0.87

HYDROCORT CRM 2.5% 28GM

Facility

$5.80

Hospital Charge Code	6002950
Hospital Revenue Code	251
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$2.90
Rate for Payer: Aetna Commercial	$1.74
Rate for Payer: Aetna Medicare Advantage	$1.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.48
Rate for Payer: Cigna Commercial	$2.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.75
Rate for Payer: Oxford Commercial	$2.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.87
Rate for Payer: UnitedHealthcare Commercial	$2.90

HYDROCORT DIBUCNE REC CRM 28GM

Facility

$53.80

Hospital Charge Code	6002968
Hospital Revenue Code	251
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$26.90
Rate for Payer: Aetna Commercial	$16.14
Rate for Payer: Aetna Medicare Advantage	$16.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.72
Rate for Payer: Cigna Commercial	$26.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.99
Rate for Payer: Oxford Commercial	$26.90
Rate for Payer: Qualcare PPO/HMO/WC	$8.07
Rate for Payer: UnitedHealthcare Commercial	$26.90

Know your out-of-pocket cost for care.

All Charges