Heights University Hospital

All Charges

Charge

Type

Setting

Price

HYDROMORPHONE 0.2 MG/ML PCA

Facility

$67.00

Service Code	HCPCS J1171
Hospital Charge Code	6063943360
Hospital Revenue Code	636
Min. Negotiated Rate	$10.05
Max. Negotiated Rate	$16.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.21
Rate for Payer: Qualcare PPO/HMO/WC	$10.05

HYDROMORPHONE 0.5MG/0.5ML

Facility

$18.49

Service Code	HCPCS J1171
Hospital Charge Code	60630189
Hospital Revenue Code	636
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$4.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.47
Rate for Payer: Qualcare PPO/HMO/WC	$2.77

HYDROMORPHONE 0.5MG/0.5ML

Facility

$18.49

Service Code	HCPCS J1171
Hospital Charge Code	60630189
Hospital Revenue Code	636
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$5.55
Rate for Payer: Aetna Commercial	$5.55
Rate for Payer: Aetna Medicare Advantage	$5.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.71
Rate for Payer: Cigna Commercial	$0.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.47
Rate for Payer: Qualcare PPO/HMO/WC	$2.77

HYDROMORPHONE 1 MG/ML SYRINGE

Facility

$7.95

Service Code	HCPCS J1171
Hospital Charge Code	60630072
Hospital Revenue Code	636
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$1.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.92
Rate for Payer: Qualcare PPO/HMO/WC	$1.19

HYDROMORPHONE 1 MG/ML SYRINGE

Facility

$7.95

Service Code	HCPCS J1171
Hospital Charge Code	60630072
Hospital Revenue Code	636
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.38
Rate for Payer: Aetna Commercial	$2.38
Rate for Payer: Aetna Medicare Advantage	$2.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.03
Rate for Payer: Cigna Commercial	$0.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.92
Rate for Payer: Qualcare PPO/HMO/WC	$1.19

HYDROMORPHONE/2MG/1ML

Facility

$7.00

Hospital Charge Code	60633123
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

HYDROMORPHONE/2MG/1ML

Facility

$7.00

Hospital Charge Code	60633123
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

HYDROMORPHONE 2 MG/ML SYRINGE

Facility

$18.09

Service Code	HCPCS J1171
Hospital Charge Code	6012017
Hospital Revenue Code	636
Min. Negotiated Rate	$2.71
Max. Negotiated Rate	$4.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.38
Rate for Payer: Qualcare PPO/HMO/WC	$2.71

HYDROMORPHONE 2 MG/ML SYRINGE

Facility

$18.09

Service Code	HCPCS J1171
Hospital Charge Code	6012017
Hospital Revenue Code	636
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$5.43
Rate for Payer: Aetna Commercial	$5.43
Rate for Payer: Aetna Medicare Advantage	$5.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.61
Rate for Payer: Cigna Commercial	$0.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.38
Rate for Payer: Qualcare PPO/HMO/WC	$2.71

HYDROMORPHONE 2 MG TAB

Facility

$13.74

Service Code	NDC 42858030125
Hospital Charge Code	6012116
Hospital Revenue Code	250
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$6.87
Rate for Payer: Aetna Commercial	$4.12
Rate for Payer: Aetna Medicare Advantage	$4.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.50
Rate for Payer: Cigna Commercial	$6.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.79
Rate for Payer: Oxford Commercial	$6.87
Rate for Payer: Qualcare PPO/HMO/WC	$2.06
Rate for Payer: UnitedHealthcare Commercial	$6.87

HYDROMORPHONE 2 MG TAB

Facility

$13.74

Service Code	NDC 42858030125
Hospital Charge Code	6012116
Hospital Revenue Code	250
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$2.06
Rate for Payer: Qualcare PPO/HMO/WC	$2.06

HYDROMORPHONE 30MG PCA

Facility

$85.00

Hospital Charge Code	60635704
Hospital Revenue Code	250
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$12.75
Rate for Payer: Qualcare PPO/HMO/WC	$12.75

HYDROMORPHONE 30MG PCA

Facility

$85.00

Hospital Charge Code	60635704
Hospital Revenue Code	250
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$42.50
Rate for Payer: Aetna Commercial	$25.50
Rate for Payer: Aetna Medicare Advantage	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.68
Rate for Payer: Cigna Commercial	$42.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.05
Rate for Payer: Oxford Commercial	$42.50
Rate for Payer: Qualcare PPO/HMO/WC	$12.75
Rate for Payer: UnitedHealthcare Commercial	$42.50

HYDROMORPHONE/4MG/1ML

Facility

$5.00

Hospital Charge Code	60633122
Hospital Revenue Code	636
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$1.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

HYDROMORPHONE/4MG/1ML

Facility

$5.00

Hospital Charge Code	60633122
Hospital Revenue Code	636
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

HYDROMORPHONE 4 MG/ML SYRINGE

Facility

$7.64

Service Code	HCPCS J1171
Hospital Charge Code	60629024
Hospital Revenue Code	636
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$1.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.85
Rate for Payer: Qualcare PPO/HMO/WC	$1.15

HYDROMORPHONE 4 MG/ML SYRINGE

Facility

$7.64

Service Code	HCPCS J1171
Hospital Charge Code	60629024
Hospital Revenue Code	636
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.29
Rate for Payer: Aetna Commercial	$2.29
Rate for Payer: Aetna Medicare Advantage	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.95
Rate for Payer: Cigna Commercial	$0.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.85
Rate for Payer: Qualcare PPO/HMO/WC	$1.15

HYDROMORPHONE 4 MG TAB

Facility

$4.00

Service Code	NDC 42858030225
Hospital Charge Code	60628872
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

HYDROMORPHONE 4 MG TAB

Facility

$4.00

Service Code	NDC 42858030225
Hospital Charge Code	60628872
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

HYDROMORPHONE 60MG/30 ML PCA I

Facility

$16.70

Hospital Charge Code	60629286
Hospital Revenue Code	250
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.50

HYDROMORPHONE 60MG/30 ML PCA I

Facility

$16.70

Hospital Charge Code	60629286
Hospital Revenue Code	250
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$8.35
Rate for Payer: Aetna Commercial	$5.01
Rate for Payer: Aetna Medicare Advantage	$5.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.26
Rate for Payer: Cigna Commercial	$8.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.17
Rate for Payer: Oxford Commercial	$8.35
Rate for Payer: Qualcare PPO/HMO/WC	$2.50
Rate for Payer: UnitedHealthcare Commercial	$8.35

HYDROMORPHONE INJ 50MG/5ML

Facility

$164.00

Hospital Charge Code	60627710
Hospital Revenue Code	250
Min. Negotiated Rate	$21.32
Max. Negotiated Rate	$82.00
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	$82.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.60
Rate for Payer: UnitedHealthcare Commercial	$82.00

HYDROMORPHONE INJ 50MG/5ML

Facility

$164.00

Hospital Charge Code	60627710
Hospital Revenue Code	250
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$24.60
Rate for Payer: Qualcare PPO/HMO/WC	$24.60

HYDROMORPHONE ISEC 1MG/ML

Facility

$8.58

Service Code	HCPCS J1171
Hospital Charge Code	60630220
Hospital Revenue Code	636
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$2.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.08
Rate for Payer: Qualcare PPO/HMO/WC	$1.29

HYDROMORPHONE ISEC 1MG/ML

Facility

$8.58

Service Code	HCPCS J1171
Hospital Charge Code	60630220
Hospital Revenue Code	636
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.57
Rate for Payer: Aetna Commercial	$2.57
Rate for Payer: Aetna Medicare Advantage	$2.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.19
Rate for Payer: Cigna Commercial	$0.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.08
Rate for Payer: Qualcare PPO/HMO/WC	$1.29

Know your out-of-pocket cost for care.

All Charges