Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

HYDROSCOPIC HUMIDIFIER ADULT

Facility

$9.50

Hospital Charge Code	270655463
Hospital Revenue Code	270
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$1.43
Rate for Payer: Qualcare PPO/HMO/WC	$1.43

HYDROSET

Facility

$15,002.35

Hospital Charge Code	270656509
Hospital Revenue Code	272
Min. Negotiated Rate	$426.07
Max. Negotiated Rate	$7,501.18
Rate for Payer: Aetna Commercial	$5,700.89
Rate for Payer: Aetna Medicare Advantage	$4,500.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.60
Rate for Payer: Cigna Commercial	$7,501.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,900.61
Rate for Payer: Oxford Commercial	$3,000.47
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.35
Rate for Payer: UnitedHealthcare Commercial	$3,000.47
Rate for Payer: UnitedHealthcare Community & State	$474.07
Rate for Payer: Wellpoint Medicaid Managed Care	$426.07

HYDROSET

Facility

$15,002.35

Hospital Charge Code	270656509
Hospital Revenue Code	272
Min. Negotiated Rate	$2,250.35
Max. Negotiated Rate	$2,250.35
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.35

HYDROSET

Facility

$18,000.00

Hospital Charge Code	270339468
Hospital Revenue Code	272
Min. Negotiated Rate	$511.20
Max. Negotiated Rate	$9,000.00
Rate for Payer: Aetna Commercial	$6,840.00
Rate for Payer: Aetna Medicare Advantage	$5,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,590.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,590.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,590.00
Rate for Payer: Cigna Commercial	$9,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,680.00
Rate for Payer: Oxford Commercial	$3,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,700.00
Rate for Payer: UnitedHealthcare Commercial	$3,600.00
Rate for Payer: UnitedHealthcare Community & State	$568.80
Rate for Payer: Wellpoint Medicaid Managed Care	$511.20

HYDROSET

Facility

$18,000.00

Hospital Charge Code	270339468
Hospital Revenue Code	272
Min. Negotiated Rate	$2,700.00
Max. Negotiated Rate	$2,700.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,700.00

HYDROSET 5cc 397005

Facility

$7,803.90

Hospital Charge Code	270647992
Hospital Revenue Code	278
Min. Negotiated Rate	$1,170.59
Max. Negotiated Rate	$1,888.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,560.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,888.54
Rate for Payer: Qualcare PPO/HMO/WC	$1,170.59

HYDROSET 5cc 397005

Facility

$7,803.90

Hospital Charge Code	270647992
Hospital Revenue Code	278
Min. Negotiated Rate	$221.63
Max. Negotiated Rate	$3,901.95
Rate for Payer: Aetna Commercial	$2,965.48
Rate for Payer: Aetna Medicare Advantage	$2,341.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,989.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,989.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,560.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,989.99
Rate for Payer: Cigna Commercial	$3,901.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,888.54
Rate for Payer: Qualcare PPO/HMO/WC	$1,170.59
Rate for Payer: UnitedHealthcare Community & State	$246.60
Rate for Payer: Wellpoint Medicaid Managed Care	$221.63

HYDROSET XT 5CC

Facility

$13,030.00

Service Code	HCPCS C1713
Hospital Charge Code	270687945
Hospital Revenue Code	278
Min. Negotiated Rate	$370.05
Max. Negotiated Rate	$6,515.00
Rate for Payer: Aetna Commercial	$4,951.40
Rate for Payer: Aetna Medicare Advantage	$3,909.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,322.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,322.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,606.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,322.65
Rate for Payer: Cigna Commercial	$6,515.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,153.26
Rate for Payer: Qualcare PPO/HMO/WC	$1,954.50
Rate for Payer: UnitedHealthcare Community & State	$411.75
Rate for Payer: Wellpoint Medicaid Managed Care	$370.05

HYDROSET XT 5CC

Facility

$13,030.00

Service Code	HCPCS C1713
Hospital Charge Code	270687945
Hospital Revenue Code	278
Min. Negotiated Rate	$1,954.50
Max. Negotiated Rate	$3,153.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,606.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,153.26
Rate for Payer: Qualcare PPO/HMO/WC	$1,954.50

HYDROXYCHLOROQUINE 200 MG TAB

Facility

$27.40

Service Code	NDC 66993005702
Hospital Charge Code	6016596
Hospital Revenue Code	251
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$13.70
Rate for Payer: Aetna Commercial	$10.41
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	$7.12
Rate for Payer: Oxford Commercial	$5.48
Rate for Payer: Qualcare PPO/HMO/WC	$4.11
Rate for Payer: UnitedHealthcare Commercial	$5.48
Rate for Payer: UnitedHealthcare Community & State	$0.87
Rate for Payer: Wellpoint Medicaid Managed Care	$0.78

HYDROXYCHLOROQUINE 200 MG TAB

Facility

$27.40

Service Code	NDC 66993005702
Hospital Charge Code	6016596
Hospital Revenue Code	251
Min. Negotiated Rate	$4.11
Max. Negotiated Rate	$4.11
Rate for Payer: Qualcare PPO/HMO/WC	$4.11

HYDROXYPROLINE FREE

Facility

$566.00

Service Code	HCPCS 83500
Hospital Charge Code	38474101
Hospital Revenue Code	301
Min. Negotiated Rate	$16.07
Max. Negotiated Rate	$283.00
Rate for Payer: Aetna Commercial	$61.61
Rate for Payer: Aetna Medicare Advantage	$73.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.16
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	$61.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.16
Rate for Payer: Cigna Commercial	$283.00
Rate for Payer: Cigna Medicare Advantage	$22.65
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: Longevity Health Plan of New Jersey Medicare Advantage	$22.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.16
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$84.90
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$18.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.65
Rate for Payer: Wellcare Medicare Advantage	$22.65
Rate for Payer: Wellpoint Medicaid Managed Care	$16.07

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, 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, FREE, SERUM

Facility

$566.00

Service Code	HCPCS 83500
Hospital Charge Code	38474104
Hospital Revenue Code	301
Min. Negotiated Rate	$16.07
Max. Negotiated Rate	$283.00
Rate for Payer: Aetna Commercial	$61.61
Rate for Payer: Aetna Medicare Advantage	$73.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.16
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	$61.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.16
Rate for Payer: Cigna Commercial	$283.00
Rate for Payer: Cigna Medicare Advantage	$22.65
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: Longevity Health Plan of New Jersey Medicare Advantage	$22.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.16
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$84.90
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$18.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.65
Rate for Payer: Wellcare Medicare Advantage	$22.65
Rate for Payer: Wellpoint Medicaid Managed Care	$16.07

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

Facility

$411.00

Service Code	HCPCS 83505
Hospital Charge Code	38474102
Hospital Revenue Code	301
Min. Negotiated Rate	$11.67
Max. Negotiated Rate	$205.50
Rate for Payer: Aetna Commercial	$66.10
Rate for Payer: Aetna Medicare Advantage	$78.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.15
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	$72.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.15
Rate for Payer: Cigna Commercial	$205.50
Rate for Payer: Cigna Medicare Advantage	$24.30
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: Longevity Health Plan of New Jersey Medicare Advantage	$24.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.86
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$61.65
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$19.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.30
Rate for Payer: Wellcare Medicare Advantage	$24.30
Rate for Payer: Wellpoint Medicaid Managed Care	$11.67

HYDROXYUREA 500 MG CAP

Facility

$10.99

Service Code	NDC 3083050
Hospital Charge Code	6009658
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$5.50
Rate for Payer: Aetna Commercial	$4.18
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	$2.86
Rate for Payer: Oxford Commercial	$2.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.65
Rate for Payer: UnitedHealthcare Commercial	$2.20
Rate for Payer: UnitedHealthcare Community & State	$0.35
Rate for Payer: Wellpoint Medicaid Managed Care	$0.31

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

HYDROXYZINE 25 MG ORAL TAB

Facility

$4.36

Service Code	HCPCS Q0177
Hospital Charge Code	60627856
Hospital Revenue Code	636
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.18
Rate for Payer: Aetna Commercial	$1.66
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
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

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

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	$0.11
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

HYDROXYZINE/50MG/TAB

Facility

$7.50

Service Code	NDC 51079081601
Hospital Charge Code	60633135
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Commercial	$2.85
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	$1.95
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.12
Rate for Payer: UnitedHealthcare Commercial	$1.50
Rate for Payer: UnitedHealthcare Community & State	$0.24
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

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

Know your out-of-pocket cost for care.

All Charges