Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

HYDRALAZINE 10 MG TAB

Facility

$4.00

Service Code	NDC 51079007420
Hospital Charge Code	60627632
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

HYDRALAZINE 10 MG TAB

Facility

$4.00

Service Code	NDC 51079007420
Hospital Charge Code	60627632
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
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	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

HYDRALAZINE 12.5MG TAB

Facility

$4.00

Service Code	NDC 62584073301
Hospital Charge Code	60635654
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

HYDRALAZINE 12.5MG TAB

Facility

$4.00

Service Code	NDC 62584073301
Hospital Charge Code	60635654
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
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	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

HYDRALAZINE 20 MG/ML LNJ

Facility

$125.63

Service Code	HCPCS J0360
Hospital Charge Code	60628966
Hospital Revenue Code	636
Min. Negotiated Rate	$3.57
Max. Negotiated Rate	$62.81
Rate for Payer: Aetna Commercial	$47.74
Rate for Payer: Aetna Medicare Advantage	$37.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.04
Rate for Payer: Cigna Commercial	$62.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.40
Rate for Payer: Qualcare PPO/HMO/WC	$18.84
Rate for Payer: UnitedHealthcare Community & State	$3.97
Rate for Payer: Wellpoint Medicaid Managed Care	$3.57

HYDRALAZINE 20 MG/ML LNJ

Facility

$125.63

Service Code	HCPCS J0360
Hospital Charge Code	60628966
Hospital Revenue Code	636
Min. Negotiated Rate	$18.84
Max. Negotiated Rate	$30.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.40
Rate for Payer: Qualcare PPO/HMO/WC	$18.84

HYDRALAZINE 25 MG TAB

Facility

$4.15

Service Code	NDC 63739012610
Hospital Charge Code	60627633
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.08
Rate for Payer: Aetna Commercial	$1.58
Rate for Payer: Aetna Medicare Advantage	$1.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.06
Rate for Payer: Cigna Commercial	$2.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.08
Rate for Payer: Oxford Commercial	$0.83
Rate for Payer: Qualcare PPO/HMO/WC	$0.62
Rate for Payer: UnitedHealthcare Commercial	$0.83
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

HYDRALAZINE 25 MG TAB

Facility

$4.15

Service Code	NDC 63739012610
Hospital Charge Code	60627633
Hospital Revenue Code	250
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$0.62
Rate for Payer: Qualcare PPO/HMO/WC	$0.62

HYDRALAZINE 50 MG TAB

Facility

$4.00

Service Code	NDC 50111032801
Hospital Charge Code	60627634
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
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	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

HYDRALAZINE 50 MG TAB

Facility

$4.00

Service Code	NDC 50111032801
Hospital Charge Code	60627634
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

HYDRATION INF 1ST HR

Facility

$1,610.84

Service Code	HCPCS 96360
Hospital Charge Code	1600532
Hospital Revenue Code	260
Min. Negotiated Rate	$45.75
Max. Negotiated Rate	$1,235.00
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$916.67
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$418.82
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$241.63
Rate for Payer: UnitedHealthcare Commercial	$1,235.00
Rate for Payer: UnitedHealthcare Community & State	$50.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$45.75

HYDRATION INF 1ST HR

Facility

$1,610.84

Service Code	HCPCS 96360
Hospital Charge Code	73050901
Hospital Revenue Code	260
Min. Negotiated Rate	$45.75
Max. Negotiated Rate	$1,235.00
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$916.67
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$418.82
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$241.63
Rate for Payer: UnitedHealthcare Commercial	$1,235.00
Rate for Payer: UnitedHealthcare Community & State	$50.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$45.75

HYDRATION INF 1ST HR

Facility

$1,610.84

Service Code	HCPCS 96360
Hospital Charge Code	1001170
Hospital Revenue Code	260
Min. Negotiated Rate	$241.63
Max. Negotiated Rate	$241.63
Rate for Payer: Qualcare PPO/HMO/WC	$241.63

HYDRATION INF 1ST HR

Facility

$2,800.00

Service Code	HCPCS 96360
Hospital Charge Code	93500007
Hospital Revenue Code	260
Min. Negotiated Rate	$79.52
Max. Negotiated Rate	$1,235.00
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$916.67
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$728.00
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00
Rate for Payer: UnitedHealthcare Commercial	$1,235.00
Rate for Payer: UnitedHealthcare Community & State	$88.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$79.52

HYDRATION INF 1ST HR

Facility

$1,610.84

Service Code	HCPCS 96360
Hospital Charge Code	8200519
Hospital Revenue Code	260
Min. Negotiated Rate	$241.63
Max. Negotiated Rate	$241.63
Rate for Payer: Qualcare PPO/HMO/WC	$241.63

HYDRATION INF 1ST HR

Facility

$1,610.84

Service Code	HCPCS 96360
Hospital Charge Code	1500110
Hospital Revenue Code	260
Min. Negotiated Rate	$45.75
Max. Negotiated Rate	$1,235.00
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$916.67
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$418.82
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$241.63
Rate for Payer: UnitedHealthcare Commercial	$1,235.00
Rate for Payer: UnitedHealthcare Community & State	$50.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$45.75

HYDRATION INF 1ST HR

Facility

$1,610.84

Service Code	HCPCS 96360
Hospital Charge Code	5100784
Hospital Revenue Code	260
Min. Negotiated Rate	$241.63
Max. Negotiated Rate	$241.63
Rate for Payer: Qualcare PPO/HMO/WC	$241.63

HYDRATION INF 1ST HR

Facility

$1,610.84

Service Code	HCPCS 96360
Hospital Charge Code	5100784
Hospital Revenue Code	260
Min. Negotiated Rate	$45.75
Max. Negotiated Rate	$1,235.00
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$916.67
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$418.82
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$241.63
Rate for Payer: UnitedHealthcare Commercial	$1,235.00
Rate for Payer: UnitedHealthcare Community & State	$50.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$45.75

HYDRATION INF 1ST HR

Facility

$1,610.84

Service Code	HCPCS 96360
Hospital Charge Code	74308225
Hospital Revenue Code	260
Min. Negotiated Rate	$241.63
Max. Negotiated Rate	$241.63
Rate for Payer: Qualcare PPO/HMO/WC	$241.63

HYDRATION INF 1ST HR

Facility

$2,408.78

Service Code	HCPCS 96360
Hospital Charge Code	5700385
Hospital Revenue Code	450
Min. Negotiated Rate	$361.32
Max. Negotiated Rate	$361.32
Rate for Payer: Qualcare PPO/HMO/WC	$361.32

HYDRATION INF 1ST HR

Facility

$2,408.78

Service Code	HCPCS 96360
Hospital Charge Code	5700385
Hospital Revenue Code	450
Min. Negotiated Rate	$68.41
Max. Negotiated Rate	$916.67
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$916.67
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$626.28
Rate for Payer: Qualcare PPO/HMO/WC	$361.32
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$68.41

HYDRATION INF 1ST HR

Facility

$1,610.84

Service Code	HCPCS 96360
Hospital Charge Code	1500110
Hospital Revenue Code	260
Min. Negotiated Rate	$241.63
Max. Negotiated Rate	$241.63
Rate for Payer: Qualcare PPO/HMO/WC	$241.63

HYDRATION INF 1ST HR

Facility

$2,800.00

Service Code	HCPCS 96360
Hospital Charge Code	83653125
Hospital Revenue Code	260
Min. Negotiated Rate	$79.52
Max. Negotiated Rate	$1,235.00
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$916.67
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$728.00
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00
Rate for Payer: UnitedHealthcare Commercial	$1,235.00
Rate for Payer: UnitedHealthcare Community & State	$88.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$79.52

HYDRATION INF 1ST HR

Facility

$1,610.84

Service Code	HCPCS 96360
Hospital Charge Code	2400617
Hospital Revenue Code	260
Min. Negotiated Rate	$45.75
Max. Negotiated Rate	$1,235.00
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$916.67
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$418.82
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$241.63
Rate for Payer: UnitedHealthcare Commercial	$1,235.00
Rate for Payer: UnitedHealthcare Community & State	$50.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$45.75

HYDRATION INF 1ST HR

Facility

$2,800.00

Service Code	HCPCS 96360
Hospital Charge Code	5700262
Hospital Revenue Code	260
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

Know your out-of-pocket cost for care.

All Charges