Heights University Hospital

All Charges

Charge

Type

Setting

Price

HYDROXYZINE PAMOATE/25MG

Facility

$3.00

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

HYDROXYZINE PAMOATE 25 MG CAP

Facility

$4.00

Service Code	NDC 51079007701
Hospital Charge Code	6022545
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 PAMOATE 25 MG CAP

Facility

$4.00

Service Code	NDC 51079007701
Hospital Charge Code	6022545
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

HYDROXYZINE PAMOATE/50MG

Facility

$3.00

Hospital Charge Code	60633137
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

HYDROXYZINE PAMOATE/50MG

Facility

$3.00

Hospital Charge Code	60633137
Hospital Revenue Code	636
Min. Negotiated Rate	$0.45
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	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

HYDROXYZINE PAMOATE/50MG

Facility

$4.00

Hospital Charge Code	60633136
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
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	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

HYDROXYZINE PAMOATE/50MG

Facility

$4.00

Hospital Charge Code	60633136
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

HYDROXYZINE PAMOATE 50 MG CAP

Facility

$4.00

Service Code	HCPCS Q0177
Hospital Charge Code	60627231
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
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	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

HYDROXYZINE PAMOATE 50 MG CAP

Facility

$4.00

Service Code	HCPCS Q0177
Hospital Charge Code	60627231
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

HYDROXYZINE SYRG 25MG/1ML

Facility

$162.14

Service Code	HCPCS J3410
Hospital Charge Code	60627857
Hospital Revenue Code	636
Min. Negotiated Rate	$15.17
Max. Negotiated Rate	$48.64
Rate for Payer: Aetna Commercial	$48.64
Rate for Payer: Aetna Medicare Advantage	$48.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.35
Rate for Payer: Cigna Commercial	$15.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.24
Rate for Payer: Qualcare PPO/HMO/WC	$24.32

HYDROXYZINE SYRG 25MG/1ML

Facility

$162.14

Service Code	HCPCS J3410
Hospital Charge Code	60627857
Hospital Revenue Code	636
Min. Negotiated Rate	$24.32
Max. Negotiated Rate	$39.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.24
Rate for Payer: Qualcare PPO/HMO/WC	$24.32

HYDROXYZINE SYRG 50MG/1ML

Facility

$178.89

Service Code	HCPCS J3410
Hospital Charge Code	60627858
Hospital Revenue Code	636
Min. Negotiated Rate	$15.17
Max. Negotiated Rate	$53.67
Rate for Payer: Aetna Commercial	$53.67
Rate for Payer: Aetna Medicare Advantage	$53.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.62
Rate for Payer: Cigna Commercial	$15.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.29
Rate for Payer: Qualcare PPO/HMO/WC	$26.83

HYDROXYZINE SYRG 50MG/1ML

Facility

$178.89

Service Code	HCPCS J3410
Hospital Charge Code	60627858
Hospital Revenue Code	636
Min. Negotiated Rate	$26.83
Max. Negotiated Rate	$43.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.29
Rate for Payer: Qualcare PPO/HMO/WC	$26.83

HYDROXYZINE TUBEX

Facility

$4.50

Hospital Charge Code	6012645
Hospital Revenue Code	250
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$1.35
Rate for Payer: Aetna Medicare Advantage	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.15
Rate for Payer: Cigna Commercial	$2.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$0.68
Rate for Payer: UnitedHealthcare Commercial	$2.25

HYDROXYZINE TUBEX

Facility

$4.50

Hospital Charge Code	6012645
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

HYDROXYZINE TUBEX 50MG

Facility

$5.80

Hospital Charge Code	6012652
Hospital Revenue Code	250
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

HYDROXYZINE TUBEX 50MG

Facility

$5.80

Hospital Charge Code	6012652
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$0.87
Rate for Payer: Qualcare PPO/HMO/WC	$0.87

HYLAN POLYMERS A & B 16MG/2ML

Facility

$1,267.20

Hospital Charge Code	60629006
Hospital Revenue Code	636
Min. Negotiated Rate	$190.08
Max. Negotiated Rate	$306.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$306.66
Rate for Payer: Qualcare PPO/HMO/WC	$190.08

HYLAN POLYMERS A & B 16MG/2ML

Facility

$1,267.20

Hospital Charge Code	60629006
Hospital Revenue Code	636
Min. Negotiated Rate	$190.08
Max. Negotiated Rate	$633.60
Rate for Payer: Aetna Commercial	$380.16
Rate for Payer: Aetna Medicare Advantage	$380.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$323.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$323.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$323.14
Rate for Payer: Cigna Commercial	$633.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$306.66
Rate for Payer: Qualcare PPO/HMO/WC	$190.08

HYLENEX 150UNITS/1ML

Facility

$448.63

Service Code	HCPCS J3470
Hospital Charge Code	6000432
Hospital Revenue Code	636
Min. Negotiated Rate	$67.29
Max. Negotiated Rate	$108.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.57
Rate for Payer: Qualcare PPO/HMO/WC	$67.29

HYLENEX 150UNITS/1ML

Facility

$448.63

Service Code	HCPCS J3470
Hospital Charge Code	6000432
Hospital Revenue Code	636
Min. Negotiated Rate	$31.55
Max. Negotiated Rate	$134.59
Rate for Payer: Aetna Commercial	$134.59
Rate for Payer: Aetna Medicare Advantage	$134.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.40
Rate for Payer: Cigna Commercial	$31.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.57
Rate for Payer: Qualcare PPO/HMO/WC	$67.29

HYODCYAMINE SULFATE

Facility

$16.25

Hospital Charge Code	601032
Hospital Revenue Code	258
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$8.12
Rate for Payer: Aetna Commercial	$4.88
Rate for Payer: Aetna Medicare Advantage	$4.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.14
Rate for Payer: Cigna Commercial	$8.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.11
Rate for Payer: Oxford Commercial	$8.12
Rate for Payer: Qualcare PPO/HMO/WC	$2.44
Rate for Payer: UnitedHealthcare Commercial	$8.12

HYODCYAMINE SULFATE

Facility

$16.25

Hospital Charge Code	601032
Hospital Revenue Code	258
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$2.44
Rate for Payer: Qualcare PPO/HMO/WC	$2.44

HYOSCYAMINE 0.125MG/5ML

Facility

$7.50

Service Code	HCPCS J1980
Hospital Charge Code	6063943113
Hospital Revenue Code	636
Min. Negotiated Rate	$1.12
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	$1.81
Rate for Payer: Qualcare PPO/HMO/WC	$1.12

HYOSCYAMINE 0.125MG/5ML

Facility

$7.50

Service Code	HCPCS J1980
Hospital Charge Code	6063943113
Hospital Revenue Code	636
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.81
Rate for Payer: Qualcare PPO/HMO/WC	$1.12

Know your out-of-pocket cost for care.

All Charges