Heights University Hospital

All Charges

Charge

Type

Setting

Price

HYDROXYZINE 25MG TAB

Facility

$4.00

Service Code	NDC 68084025401
Hospital Charge Code	60630180
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

HYDROXYZINE 25MG TAB

Facility

$4.00

Service Code	NDC 68084025401
Hospital Charge Code	60630180
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/25MG/TAB

Facility

$3.00

Hospital Charge Code	60633132
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/25MG/TAB

Facility

$3.00

Hospital Charge Code	60633131
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

HYDROXYZINE/25MG/TAB

Facility

$3.00

Hospital Charge Code	60633134
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

HYDROXYZINE/25MG/TAB

Facility

$3.00

Hospital Charge Code	60633134
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/25MG/TAB

Facility

$3.00

Hospital Charge Code	60633132
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

HYDROXYZINE/25MG/TAB

Facility

$3.00

Hospital Charge Code	60633131
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/25MG/TAB

Facility

$3.00

Hospital Charge Code	60633127
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

HYDROXYZINE/25MG/TAB

Facility

$3.00

Hospital Charge Code	60633127
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/50MG/1ML

Facility

$3.00

Hospital Charge Code	60633129
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/50MG/1ML

Facility

$4.00

Hospital Charge Code	60633133
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/50MG/1ML

Facility

$4.00

Hospital Charge Code	60633133
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

HYDROXYZINE/50MG/1ML

Facility

$3.00

Hospital Charge Code	60633129
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

HYDROXYZINE/50MG/TAB

Facility

$3.00

Hospital Charge Code	60633128
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

HYDROXYZINE/50MG/TAB

Facility

$7.50

Service Code	NDC 51079081601
Hospital Charge Code	60633135
Hospital Revenue Code	250
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.12

HYDROXYZINE/50MG/TAB

Facility

$7.50

Service Code	NDC 51079081601
Hospital Charge Code	60633135
Hospital Revenue Code	250
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Commercial	$2.25
Rate for Payer: Aetna Medicare Advantage	$2.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.91
Rate for Payer: Cigna Commercial	$3.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.98
Rate for Payer: Oxford Commercial	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$1.12
Rate for Payer: UnitedHealthcare Commercial	$3.75

HYDROXYZINE/50MG/TAB

Facility

$3.00

Hospital Charge Code	60633128
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 ELX 10MG/5ML 60ML

Facility

$5.63

Service Code	NDC 60432015004
Hospital Charge Code	6002810
Hospital Revenue Code	251
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$0.84
Rate for Payer: Qualcare PPO/HMO/WC	$0.84

HYDROXYZINE ELX 10MG/5ML 60ML

Facility

$5.63

Service Code	NDC 60432015004
Hospital Charge Code	6002810
Hospital Revenue Code	251
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$2.81
Rate for Payer: Aetna Commercial	$1.69
Rate for Payer: Aetna Medicare Advantage	$1.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.73
Rate for Payer: Oxford Commercial	$2.81
Rate for Payer: Qualcare PPO/HMO/WC	$0.84
Rate for Payer: UnitedHealthcare Commercial	$2.81

HYDROXYZINE HCL 100MG/2ML INJ

Facility

$724.15

Hospital Charge Code	606350919
Hospital Revenue Code	636
Min. Negotiated Rate	$108.62
Max. Negotiated Rate	$362.07
Rate for Payer: Aetna Commercial	$217.25
Rate for Payer: Aetna Medicare Advantage	$217.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.66
Rate for Payer: Cigna Commercial	$362.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.24
Rate for Payer: Qualcare PPO/HMO/WC	$108.62

HYDROXYZINE HCL 100MG/2ML INJ

Facility

$724.15

Hospital Charge Code	606350919
Hospital Revenue Code	636
Min. Negotiated Rate	$108.62
Max. Negotiated Rate	$175.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.24
Rate for Payer: Qualcare PPO/HMO/WC	$108.62

HYDROXYZINE INJ 100MG/2ML

Facility

$8.90

Hospital Charge Code	60627855
Hospital Revenue Code	636
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$4.45
Rate for Payer: Aetna Commercial	$2.67
Rate for Payer: Aetna Medicare Advantage	$2.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.27
Rate for Payer: Cigna Commercial	$4.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.15
Rate for Payer: Qualcare PPO/HMO/WC	$1.33

HYDROXYZINE INJ 100MG/2ML

Facility

$8.90

Hospital Charge Code	60627855
Hospital Revenue Code	636
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$2.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.15
Rate for Payer: Qualcare PPO/HMO/WC	$1.33

HYDROXYZINE PAMOATE/25MG

Facility

$3.00

Hospital Charge Code	60633138
Hospital Revenue Code	636
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

Know your out-of-pocket cost for care.

All Charges