Heights University Hospital

All Charges

Charge

Type

Setting

Price

XANAX/0.5MG/TAB

Facility

$5.00

Hospital Charge Code	60634176
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

XANAX/1MG/TAB

Facility

$6.00

Hospital Charge Code	60634180
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

XANAX/1MG/TAB

Facility

$29.01

Service Code	NDC 9009001
Hospital Charge Code	60634177
Hospital Revenue Code	250
Min. Negotiated Rate	$4.35
Max. Negotiated Rate	$4.35
Rate for Payer: Qualcare PPO/HMO/WC	$4.35

XANAX/1MG/TAB

Facility

$29.01

Service Code	NDC 9009001
Hospital Charge Code	60634177
Hospital Revenue Code	250
Min. Negotiated Rate	$3.77
Max. Negotiated Rate	$14.51
Rate for Payer: Aetna Commercial	$8.70
Rate for Payer: Aetna Medicare Advantage	$8.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.40
Rate for Payer: Cigna Commercial	$14.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.77
Rate for Payer: Oxford Commercial	$14.51
Rate for Payer: Qualcare PPO/HMO/WC	$4.35
Rate for Payer: UnitedHealthcare Commercial	$14.51

XANAX/1MG/TAB

Facility

$6.00

Hospital Charge Code	60634180
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

XARELTO 10MG TAB

Facility

$84.35

Service Code	NDC 50458058030
Hospital Charge Code	60635799
Hospital Revenue Code	250
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$12.65
Rate for Payer: Qualcare PPO/HMO/WC	$12.65

XARELTO 10MG TAB

Facility

$84.35

Service Code	NDC 50458058030
Hospital Charge Code	60635799
Hospital Revenue Code	250
Min. Negotiated Rate	$10.97
Max. Negotiated Rate	$42.17
Rate for Payer: Aetna Commercial	$25.30
Rate for Payer: Aetna Medicare Advantage	$25.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.51
Rate for Payer: Cigna Commercial	$42.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.97
Rate for Payer: Oxford Commercial	$42.17
Rate for Payer: Qualcare PPO/HMO/WC	$12.65
Rate for Payer: UnitedHealthcare Commercial	$42.17

XARELTO 15MG TAB

Facility

$84.35

Service Code	NDC 50458057830
Hospital Charge Code	60635802
Hospital Revenue Code	250
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$12.65
Rate for Payer: Qualcare PPO/HMO/WC	$12.65

XARELTO 15MG TAB

Facility

$84.35

Service Code	NDC 50458057830
Hospital Charge Code	60635802
Hospital Revenue Code	250
Min. Negotiated Rate	$10.97
Max. Negotiated Rate	$42.17
Rate for Payer: Aetna Commercial	$25.30
Rate for Payer: Aetna Medicare Advantage	$25.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.51
Rate for Payer: Cigna Commercial	$42.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.97
Rate for Payer: Oxford Commercial	$42.17
Rate for Payer: Qualcare PPO/HMO/WC	$12.65
Rate for Payer: UnitedHealthcare Commercial	$42.17

XARELTO 20MG TAB

Facility

$84.35

Service Code	NDC 50458057930
Hospital Charge Code	60635800
Hospital Revenue Code	250
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$12.65
Rate for Payer: Qualcare PPO/HMO/WC	$12.65

XARELTO 20MG TAB

Facility

$84.35

Service Code	NDC 50458057930
Hospital Charge Code	60635800
Hospital Revenue Code	250
Min. Negotiated Rate	$10.97
Max. Negotiated Rate	$42.17
Rate for Payer: Aetna Commercial	$25.30
Rate for Payer: Aetna Medicare Advantage	$25.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.51
Rate for Payer: Cigna Commercial	$42.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.97
Rate for Payer: Oxford Commercial	$42.17
Rate for Payer: Qualcare PPO/HMO/WC	$12.65
Rate for Payer: UnitedHealthcare Commercial	$42.17

XBRAID SUTURE #2

Facility

$142.50

Hospital Charge Code	270697227
Hospital Revenue Code	272
Min. Negotiated Rate	$21.38
Max. Negotiated Rate	$21.38
Rate for Payer: Qualcare PPO/HMO/WC	$21.38

XBRAID SUTURE #2

Facility

$142.50

Hospital Charge Code	270697227
Hospital Revenue Code	272
Min. Negotiated Rate	$18.52
Max. Negotiated Rate	$71.25
Rate for Payer: Aetna Commercial	$42.75
Rate for Payer: Aetna Medicare Advantage	$42.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.34
Rate for Payer: Cigna Commercial	$71.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.52
Rate for Payer: Oxford Commercial	$71.25
Rate for Payer: Qualcare PPO/HMO/WC	$21.38
Rate for Payer: UnitedHealthcare Commercial	$71.25

XBRAID TT 1.4 MM BLUE BLACK WH

Facility

$750.00

Service Code	HCPCS C1716
Hospital Charge Code	270701823
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$1,197.08
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$1,197.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

XBRAID TT 1.4 MM BLUE BLACK WH

Facility

$750.00

Service Code	HCPCS C1716
Hospital Charge Code	270701823
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

XCLIP IMPLANT X 7.5X25MM

Facility

$660.00

Service Code	HCPCS C1713
Hospital Charge Code	270698458
Hospital Revenue Code	278
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$330.00
Rate for Payer: Aetna Commercial	$198.00
Rate for Payer: Aetna Medicare Advantage	$198.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.30
Rate for Payer: Cigna Commercial	$330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.72
Rate for Payer: Qualcare PPO/HMO/WC	$99.00

XCLIP IMPLANT X 7.5X25MM

Facility

$660.00

Service Code	HCPCS C1713
Hospital Charge Code	270698458
Hospital Revenue Code	278
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$159.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.72
Rate for Payer: Qualcare PPO/HMO/WC	$99.00

X-CORE MINI, 15-20MM 12MM

Facility

$36,725.00

Hospital Charge Code	270666084
Hospital Revenue Code	278
Min. Negotiated Rate	$5,508.75
Max. Negotiated Rate	$18,362.50
Rate for Payer: Aetna Commercial	$11,017.50
Rate for Payer: Aetna Medicare Advantage	$11,017.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,364.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,364.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,345.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,364.88
Rate for Payer: Cigna Commercial	$18,362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,887.45
Rate for Payer: Qualcare PPO/HMO/WC	$5,508.75

X-CORE MINI, 15-20MM 12MM

Facility

$36,725.00

Hospital Charge Code	270666084
Hospital Revenue Code	278
Min. Negotiated Rate	$5,508.75
Max. Negotiated Rate	$8,887.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,345.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,887.45
Rate for Payer: Qualcare PPO/HMO/WC	$5,508.75

X-CORE MINI ENDCAP, 14 PAR

Facility

$9,425.00

Hospital Charge Code	270666085
Hospital Revenue Code	278
Min. Negotiated Rate	$1,413.75
Max. Negotiated Rate	$2,280.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,885.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,280.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,413.75

X-CORE MINI ENDCAP, 14 PAR

Facility

$9,425.00

Hospital Charge Code	270666085
Hospital Revenue Code	278
Min. Negotiated Rate	$1,413.75
Max. Negotiated Rate	$4,712.50
Rate for Payer: Aetna Commercial	$2,827.50
Rate for Payer: Aetna Medicare Advantage	$2,827.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,403.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,403.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,885.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,403.38
Rate for Payer: Cigna Commercial	$4,712.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,280.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,413.75

XELODA 500MG

Facility

$80.00

Hospital Charge Code	60635625
Hospital Revenue Code	636
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$19.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.36
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

XELODA 500MG

Facility

$80.00

Hospital Charge Code	60635625
Hospital Revenue Code	636
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna Commercial	$24.00
Rate for Payer: Aetna Medicare Advantage	$24.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.40
Rate for Payer: Cigna Commercial	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.36
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

XENADERM 60GM

Facility

$53.73

Service Code	NDC 51079062181
Hospital Charge Code	60635901
Hospital Revenue Code	250
Min. Negotiated Rate	$8.06
Max. Negotiated Rate	$8.06
Rate for Payer: Qualcare PPO/HMO/WC	$8.06

XENADERM 60GM

Facility

$53.73

Service Code	NDC 51079062181
Hospital Charge Code	60635901
Hospital Revenue Code	250
Min. Negotiated Rate	$6.98
Max. Negotiated Rate	$26.86
Rate for Payer: Aetna Commercial	$16.12
Rate for Payer: Aetna Medicare Advantage	$16.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.70
Rate for Payer: Cigna Commercial	$26.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.98
Rate for Payer: Oxford Commercial	$26.86
Rate for Payer: Qualcare PPO/HMO/WC	$8.06
Rate for Payer: UnitedHealthcare Commercial	$26.86

Know your out-of-pocket cost for care.

All Charges