Heights University Hospital

All Charges

Charge

Type

Setting

Price

HYDROXYCHLOROQUINE 200 MG TAB

Facility

$27.40

Service Code	NDC 66993005702
Hospital Charge Code	6016596
Hospital Revenue Code	251
Min. Negotiated Rate	$3.56
Max. Negotiated Rate	$13.70
Rate for Payer: Aetna Commercial	$8.22
Rate for Payer: Aetna Medicare Advantage	$8.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.99
Rate for Payer: Cigna Commercial	$13.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.56
Rate for Payer: Oxford Commercial	$13.70
Rate for Payer: Qualcare PPO/HMO/WC	$4.11
Rate for Payer: UnitedHealthcare Commercial	$13.70

HYDROXYPROLINE FREE

Facility

$566.00

Service Code	HCPCS 83500
Hospital Charge Code	38474101
Hospital Revenue Code	301
Min. Negotiated Rate	$84.90
Max. Negotiated Rate	$84.90
Rate for Payer: Qualcare PPO/HMO/WC	$84.90

HYDROXYPROLINE FREE

Facility

$566.00

Service Code	HCPCS 83500
Hospital Charge Code	38474101
Hospital Revenue Code	301
Min. Negotiated Rate	$11.32
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$73.39
Rate for Payer: Aetna Medicare Advantage	$22.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.99
Rate for Payer: Cigna Commercial	$22.65
Rate for Payer: Cigna Medicare Advantage	$11.32
Rate for Payer: Clover Medicare Advantage	$21.52
Rate for Payer: EmblemHealth Commercial	$67.95
Rate for Payer: Humana Medicare Advantage	$23.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.58
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$84.90
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.65
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$24.01
Rate for Payer: Wellcare Medicare Advantage	$22.65

HYDROXYPROLINE,FREE

Facility

$239.25

Service Code	HCPCS 83505
Hospital Charge Code	3001616
Hospital Revenue Code	301
Min. Negotiated Rate	$12.15
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$78.73
Rate for Payer: Aetna Medicare Advantage	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.04
Rate for Payer: Cigna Commercial	$24.30
Rate for Payer: Cigna Medicare Advantage	$12.15
Rate for Payer: Clover Medicare Advantage	$23.09
Rate for Payer: EmblemHealth Commercial	$72.90
Rate for Payer: Humana Medicare Advantage	$25.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.89
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.30
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.76
Rate for Payer: Wellcare Medicare Advantage	$24.30

HYDROXYPROLINE,FREE

Facility

$239.25

Service Code	HCPCS 83505
Hospital Charge Code	3001616
Hospital Revenue Code	301
Min. Negotiated Rate	$35.89
Max. Negotiated Rate	$35.89
Rate for Payer: Qualcare PPO/HMO/WC	$35.89

HYDROXYPROLINE,FREE 24HR URINE

Facility

$183.75

Service Code	HCPCS 83500
Hospital Charge Code	3001619
Hospital Revenue Code	301
Min. Negotiated Rate	$27.56
Max. Negotiated Rate	$27.56
Rate for Payer: Qualcare PPO/HMO/WC	$27.56

HYDROXYPROLINE,FREE 24HR URINE

Facility

$183.75

Service Code	HCPCS 83500
Hospital Charge Code	3001619
Hospital Revenue Code	301
Min. Negotiated Rate	$11.32
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$73.39
Rate for Payer: Aetna Medicare Advantage	$22.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.99
Rate for Payer: Cigna Commercial	$22.65
Rate for Payer: Cigna Medicare Advantage	$11.32
Rate for Payer: Clover Medicare Advantage	$21.52
Rate for Payer: EmblemHealth Commercial	$67.95
Rate for Payer: Humana Medicare Advantage	$23.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.89
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.56
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.65
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$24.01
Rate for Payer: Wellcare Medicare Advantage	$22.65

HYDROXYPROLINE, FREE, SERUM

Facility

$566.00

Service Code	HCPCS 83500
Hospital Charge Code	38474104
Hospital Revenue Code	301
Min. Negotiated Rate	$11.32
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$73.39
Rate for Payer: Aetna Medicare Advantage	$22.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.99
Rate for Payer: Cigna Commercial	$22.65
Rate for Payer: Cigna Medicare Advantage	$11.32
Rate for Payer: Clover Medicare Advantage	$21.52
Rate for Payer: EmblemHealth Commercial	$67.95
Rate for Payer: Humana Medicare Advantage	$23.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.58
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$84.90
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.65
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$24.01
Rate for Payer: Wellcare Medicare Advantage	$22.65

HYDROXYPROLINE, FREE, SERUM

Facility

$566.00

Service Code	HCPCS 83500
Hospital Charge Code	38474104
Hospital Revenue Code	301
Min. Negotiated Rate	$84.90
Max. Negotiated Rate	$84.90
Rate for Payer: Qualcare PPO/HMO/WC	$84.90

HYDROXYPROLINE TOTAL

Facility

$411.00

Service Code	HCPCS 83505
Hospital Charge Code	38474102
Hospital Revenue Code	301
Min. Negotiated Rate	$12.15
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$78.73
Rate for Payer: Aetna Medicare Advantage	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.04
Rate for Payer: Cigna Commercial	$24.30
Rate for Payer: Cigna Medicare Advantage	$12.15
Rate for Payer: Clover Medicare Advantage	$23.09
Rate for Payer: EmblemHealth Commercial	$72.90
Rate for Payer: Humana Medicare Advantage	$25.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.43
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$61.65
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.30
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.76
Rate for Payer: Wellcare Medicare Advantage	$24.30

HYDROXYPROLINE TOTAL

Facility

$411.00

Service Code	HCPCS 83505
Hospital Charge Code	38474102
Hospital Revenue Code	301
Min. Negotiated Rate	$61.65
Max. Negotiated Rate	$61.65
Rate for Payer: Qualcare PPO/HMO/WC	$61.65

HYDROXYPROLINE (TOTAL URINE)

Facility

$239.25

Service Code	HCPCS 83505
Hospital Charge Code	3001617
Hospital Revenue Code	301
Min. Negotiated Rate	$35.89
Max. Negotiated Rate	$35.89
Rate for Payer: Qualcare PPO/HMO/WC	$35.89

HYDROXYPROLINE (TOTAL URINE)

Facility

$239.25

Service Code	HCPCS 83505
Hospital Charge Code	3001617
Hospital Revenue Code	301
Min. Negotiated Rate	$12.15
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$78.73
Rate for Payer: Aetna Medicare Advantage	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.04
Rate for Payer: Cigna Commercial	$24.30
Rate for Payer: Cigna Medicare Advantage	$12.15
Rate for Payer: Clover Medicare Advantage	$23.09
Rate for Payer: EmblemHealth Commercial	$72.90
Rate for Payer: Humana Medicare Advantage	$25.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.89
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.30
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.76
Rate for Payer: Wellcare Medicare Advantage	$24.30

HYDROXYPROPYMTHLCEL OPH 2.5%

Facility

$131.85

Hospital Charge Code	6002992
Hospital Revenue Code	251
Min. Negotiated Rate	$17.14
Max. Negotiated Rate	$65.92
Rate for Payer: Aetna Commercial	$39.55
Rate for Payer: Aetna Medicare Advantage	$39.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.62
Rate for Payer: Cigna Commercial	$65.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.14
Rate for Payer: Oxford Commercial	$65.92
Rate for Payer: Qualcare PPO/HMO/WC	$19.78
Rate for Payer: UnitedHealthcare Commercial	$65.92

HYDROXYPROPYMTHLCEL OPH 2.5%

Facility

$131.85

Hospital Charge Code	6002992
Hospital Revenue Code	251
Min. Negotiated Rate	$19.78
Max. Negotiated Rate	$19.78
Rate for Payer: Qualcare PPO/HMO/WC	$19.78

HYDROXYUREA 500 MG CAP

Facility

$10.99

Service Code	NDC 3083050
Hospital Charge Code	6009658
Hospital Revenue Code	250
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$1.65
Rate for Payer: Qualcare PPO/HMO/WC	$1.65

HYDROXYUREA 500 MG CAP

Facility

$10.99

Service Code	NDC 3083050
Hospital Charge Code	6009658
Hospital Revenue Code	250
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$5.50
Rate for Payer: Aetna Commercial	$3.30
Rate for Payer: Aetna Medicare Advantage	$3.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.80
Rate for Payer: Cigna Commercial	$5.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.43
Rate for Payer: Oxford Commercial	$5.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.65
Rate for Payer: UnitedHealthcare Commercial	$5.50

HYDROXYZINE/10MG/5ML

Facility

$45.00

Hospital Charge Code	60633125
Hospital Revenue Code	250
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$6.75
Rate for Payer: Qualcare PPO/HMO/WC	$6.75

HYDROXYZINE/10MG/5ML

Facility

$45.00

Hospital Charge Code	60633125
Hospital Revenue Code	250
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna Commercial	$13.50
Rate for Payer: Aetna Medicare Advantage	$13.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.47
Rate for Payer: Cigna Commercial	$22.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.85
Rate for Payer: Oxford Commercial	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$6.75
Rate for Payer: UnitedHealthcare Commercial	$22.50

HYDROXYZINE/10MG/TAB

Facility

$3.00

Hospital Charge Code	60633126
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

HYDROXYZINE/10MG/TAB

Facility

$4.00

Hospital Charge Code	60633130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

HYDROXYZINE/10MG/TAB

Facility

$3.00

Hospital Charge Code	60633126
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

HYDROXYZINE/10MG/TAB

Facility

$4.00

Hospital Charge Code	60633130
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

HYDROXYZINE 25 MG ORAL TAB

Facility

$4.36

Service Code	HCPCS Q0177
Hospital Charge Code	60627856
Hospital Revenue Code	636
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.18
Rate for Payer: Aetna Commercial	$1.31
Rate for Payer: Aetna Medicare Advantage	$1.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.11
Rate for Payer: Cigna Commercial	$2.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.06
Rate for Payer: Qualcare PPO/HMO/WC	$0.65

HYDROXYZINE 25 MG ORAL TAB

Facility

$4.36

Service Code	HCPCS Q0177
Hospital Charge Code	60627856
Hospital Revenue Code	636
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$1.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.06
Rate for Payer: Qualcare PPO/HMO/WC	$0.65

Know your out-of-pocket cost for care.

All Charges