Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

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	$0.16
Max. Negotiated Rate	$2.81
Rate for Payer: Aetna Commercial	$2.14
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	$1.46
Rate for Payer: Oxford Commercial	$1.13
Rate for Payer: Qualcare PPO/HMO/WC	$0.84
Rate for Payer: UnitedHealthcare Commercial	$1.13
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

HYDROXYZINE PAMOATE 25 MG CAP

Facility

$4.00

Service Code	NDC 51079007701
Hospital Charge Code	6022545
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 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 50 MG CAP

Facility

$4.00

Service Code	HCPCS Q0177
Hospital Charge Code	60627231
Hospital Revenue Code	636
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	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

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	$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 25MG/1ML

Facility

$162.14

Service Code	HCPCS J3410
Hospital Charge Code	60627857
Hospital Revenue Code	636
Min. Negotiated Rate	$4.60
Max. Negotiated Rate	$81.07
Rate for Payer: Aetna Commercial	$61.61
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	$81.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.24
Rate for Payer: Qualcare PPO/HMO/WC	$24.32
Rate for Payer: UnitedHealthcare Community & State	$5.12
Rate for Payer: Wellpoint Medicaid Managed Care	$4.60

HYDROXYZINE SYRG 50MG/1ML

Facility

$178.89

Service Code	HCPCS J3410
Hospital Charge Code	60627858
Hospital Revenue Code	636
Min. Negotiated Rate	$5.08
Max. Negotiated Rate	$89.44
Rate for Payer: Aetna Commercial	$67.98
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	$89.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.29
Rate for Payer: Qualcare PPO/HMO/WC	$26.83
Rate for Payer: UnitedHealthcare Community & State	$5.65
Rate for Payer: Wellpoint Medicaid Managed Care	$5.08

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

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	$12.74
Max. Negotiated Rate	$224.31
Rate for Payer: Aetna Commercial	$170.48
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	$224.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.57
Rate for Payer: Qualcare PPO/HMO/WC	$67.29
Rate for Payer: UnitedHealthcare Community & State	$14.18
Rate for Payer: Wellpoint Medicaid Managed Care	$12.74

HYOSCYAMINE 0.125MG/5ML

Facility

$7.50

Service Code	HCPCS J1980
Hospital Charge Code	6063943113
Hospital Revenue Code	636
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	$1.81
Rate for Payer: Qualcare PPO/HMO/WC	$1.12
Rate for Payer: UnitedHealthcare Community & State	$0.24
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

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

HYOSCYAMINE TAB 0.125MG

Facility

$5.70

Service Code	NDC 47781001301
Hospital Charge Code	60627433
Hospital Revenue Code	251
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$0.86
Rate for Payer: Qualcare PPO/HMO/WC	$0.86

HYOSCYAMINE TAB 0.125MG

Facility

$5.70

Service Code	NDC 47781001301
Hospital Charge Code	60627433
Hospital Revenue Code	251
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$2.85
Rate for Payer: Aetna Commercial	$2.17
Rate for Payer: Aetna Medicare Advantage	$1.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.45
Rate for Payer: Cigna Commercial	$2.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.48
Rate for Payer: Oxford Commercial	$1.14
Rate for Payer: Qualcare PPO/HMO/WC	$0.86
Rate for Payer: UnitedHealthcare Commercial	$1.14
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

HYP-08

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270666721
Hospital Revenue Code	278
Min. Negotiated Rate	$205.90
Max. Negotiated Rate	$3,625.00
Rate for Payer: Aetna Commercial	$2,755.00
Rate for Payer: Aetna Medicare Advantage	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,848.75
Rate for Payer: Cigna Commercial	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50
Rate for Payer: UnitedHealthcare Community & State	$229.10
Rate for Payer: Wellpoint Medicaid Managed Care	$205.90

HYP-08

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270666721
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$1,754.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

HYPERBARIC CHAMBER SUPERVISION

Facility

$300.00

Service Code	HCPCS 99183
Hospital Charge Code	9808275
Hospital Revenue Code	413
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

HYPERBARIC CHAMBER SUPERVISION

Facility

$300.00

Service Code	HCPCS 99183
Hospital Charge Code	9808275
Hospital Revenue Code	413
Min. Negotiated Rate	$8.52
Max. Negotiated Rate	$3,553.00
Rate for Payer: Aetna Commercial	$114.00
Rate for Payer: Aetna Medicare Advantage	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.50
Rate for Payer: Cigna Commercial	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.00
Rate for Payer: Oxford Commercial	$3,131.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00
Rate for Payer: UnitedHealthcare Commercial	$3,553.00
Rate for Payer: UnitedHealthcare Community & State	$9.48
Rate for Payer: Wellpoint Medicaid Managed Care	$8.52

HYPERHEP

Facility

$711.14

Service Code	NDC 13533063603
Hospital Charge Code	6063943285
Hospital Revenue Code	250
Min. Negotiated Rate	$20.20
Max. Negotiated Rate	$355.57
Rate for Payer: Aetna Commercial	$270.23
Rate for Payer: Aetna Medicare Advantage	$213.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$181.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$181.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$181.34
Rate for Payer: Cigna Commercial	$355.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$184.90
Rate for Payer: Oxford Commercial	$142.23
Rate for Payer: Qualcare PPO/HMO/WC	$106.67
Rate for Payer: UnitedHealthcare Commercial	$142.23
Rate for Payer: UnitedHealthcare Community & State	$22.47
Rate for Payer: Wellpoint Medicaid Managed Care	$20.20

HYPERHEP

Facility

$711.14

Service Code	NDC 13533063603
Hospital Charge Code	6063943285
Hospital Revenue Code	250
Min. Negotiated Rate	$106.67
Max. Negotiated Rate	$106.67
Rate for Payer: Qualcare PPO/HMO/WC	$106.67

HYPERTENSION

Facility

$6,905.36

Service Code	APR-DRG 1991
Min. Negotiated Rate	$6,769.96
Max. Negotiated Rate	$6,905.36
Rate for Payer: UnitedHealthcare Community & State	$6,769.96
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$6,905.36
Rate for Payer: Wellpoint Medicaid Managed Care	$6,769.96

HYPERTENSION

Facility

$8,426.29

Service Code	APR-DRG 1992
Min. Negotiated Rate	$8,261.07
Max. Negotiated Rate	$8,426.29
Rate for Payer: UnitedHealthcare Community & State	$8,261.07
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,426.29
Rate for Payer: Wellpoint Medicaid Managed Care	$8,261.07

HYPERTENSION

Facility

$11,663.38

Service Code	APR-DRG 1993
Min. Negotiated Rate	$11,434.69
Max. Negotiated Rate	$11,663.38
Rate for Payer: UnitedHealthcare Community & State	$11,434.69
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$11,663.38
Rate for Payer: Wellpoint Medicaid Managed Care	$11,434.69

Know your out-of-pocket cost for care.

All Charges