Heights University Hospital

All Charges

Charge

Type

Setting

Price

XENMATRIX AB GRAFT 20CM X 25CM

Facility

$73,100.00

Service Code	HCPCS C1781
Hospital Charge Code	270686972
Hospital Revenue Code	278
Min. Negotiated Rate	$10,965.00
Max. Negotiated Rate	$36,550.00
Rate for Payer: Aetna Commercial	$21,930.00
Rate for Payer: Aetna Medicare Advantage	$21,930.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18,640.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18,640.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14,620.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18,640.50
Rate for Payer: Cigna Commercial	$36,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17,690.20
Rate for Payer: Qualcare PPO/HMO/WC	$10,965.00

XENMATRIX AB GRAFT 20CM X 25CM

Facility

$73,100.00

Service Code	HCPCS C1781
Hospital Charge Code	270686972
Hospital Revenue Code	278
Min. Negotiated Rate	$10,965.00
Max. Negotiated Rate	$17,690.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14,620.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17,690.20
Rate for Payer: Qualcare PPO/HMO/WC	$10,965.00

XENON 133 GAS 1.0 MCI VIAL

Facility

$315.58

Service Code	HCPCS A9558
Hospital Charge Code	4509095
Hospital Revenue Code	343
Min. Negotiated Rate	$41.03
Max. Negotiated Rate	$217.54
Rate for Payer: Aetna Commercial	$94.67
Rate for Payer: Aetna Medicare Advantage	$94.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.47
Rate for Payer: Cigna Commercial	$157.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.03
Rate for Payer: Qualcare PPO/HMO/WC	$47.34

XENON 133 GAS 1.0 MCI VIAL

Facility

$315.58

Service Code	HCPCS A9558
Hospital Charge Code	4509095
Hospital Revenue Code	343
Min. Negotiated Rate	$47.34
Max. Negotiated Rate	$47.34
Rate for Payer: Qualcare PPO/HMO/WC	$47.34

XI 8MM BLADELES OBDURATOR LONG

Facility

$150.00

Hospital Charge Code	270680253
Hospital Revenue Code	272
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$45.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.50
Rate for Payer: Oxford Commercial	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$75.00

XI 8MM BLADELES OBDURATOR LONG

Facility

$150.00

Hospital Charge Code	270680253
Hospital Revenue Code	272
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

XI 8MM BLADELES OBDURATOR OPTL

Facility

$150.00

Hospital Charge Code	270677942
Hospital Revenue Code	272
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

XI 8MM BLADELES OBDURATOR OPTL

Facility

$150.00

Hospital Charge Code	270677942
Hospital Revenue Code	272
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$45.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.50
Rate for Payer: Oxford Commercial	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$75.00

XIA 3 BLOCKER

Facility

$480.00

Hospital Charge Code	270332631
Hospital Revenue Code	272
Min. Negotiated Rate	$62.40
Max. Negotiated Rate	$240.00
Rate for Payer: Aetna Commercial	$144.00
Rate for Payer: Aetna Medicare Advantage	$144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.40
Rate for Payer: Cigna Commercial	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.40
Rate for Payer: Oxford Commercial	$240.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.00
Rate for Payer: UnitedHealthcare Commercial	$240.00

XIA 3 BLOCKER

Facility

$480.00

Hospital Charge Code	270332631
Hospital Revenue Code	272
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$72.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.00

XIENCE SKYPOINT DES 3.00 x 38

Facility

$3,500.00

Hospital Charge Code	270704383
Hospital Revenue Code	279
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

XIENCE SKYPOINT DES 3.00 x 38

Facility

$3,500.00

Hospital Charge Code	270704383
Hospital Revenue Code	279
Min. Negotiated Rate	$455.00
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,050.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$455.00
Rate for Payer: Oxford Commercial	$1,750.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Commercial	$1,750.00

XIENCE SKYPOINT DES 4.00 x 28

Facility

$3,500.00

Hospital Charge Code	270704408
Hospital Revenue Code	272
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

XIENCE SKYPOINT DES 4.00 x 28

Facility

$3,500.00

Hospital Charge Code	270704408
Hospital Revenue Code	272
Min. Negotiated Rate	$455.00
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,050.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$455.00
Rate for Payer: Oxford Commercial	$1,750.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Commercial	$1,750.00

XIGRIS 5MG VIAL

Facility

$462.00

Hospital Charge Code	60635377
Hospital Revenue Code	250
Min. Negotiated Rate	$60.06
Max. Negotiated Rate	$231.00
Rate for Payer: Aetna Commercial	$138.60
Rate for Payer: Aetna Medicare Advantage	$138.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$117.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$117.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$117.81
Rate for Payer: Cigna Commercial	$231.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.06
Rate for Payer: Oxford Commercial	$231.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.30
Rate for Payer: UnitedHealthcare Commercial	$231.00

XIGRIS 5MG VIAL

Facility

$462.00

Hospital Charge Code	60635377
Hospital Revenue Code	250
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$69.30
Rate for Payer: Qualcare PPO/HMO/WC	$69.30

XLIF KIT

Facility

$5,980.00

Hospital Charge Code	270657325
Hospital Revenue Code	272
Min. Negotiated Rate	$897.00
Max. Negotiated Rate	$897.00
Rate for Payer: Qualcare PPO/HMO/WC	$897.00

XLIF KIT

Facility

$5,980.00

Hospital Charge Code	270657325
Hospital Revenue Code	272
Min. Negotiated Rate	$777.40
Max. Negotiated Rate	$2,990.00
Rate for Payer: Aetna Commercial	$1,794.00
Rate for Payer: Aetna Medicare Advantage	$1,794.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,524.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,524.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,524.90
Rate for Payer: Cigna Commercial	$2,990.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$777.40
Rate for Payer: Oxford Commercial	$2,990.00
Rate for Payer: Qualcare PPO/HMO/WC	$897.00
Rate for Payer: UnitedHealthcare Commercial	$2,990.00

X LONG ANGLED ATTACHMENT

Facility

$8,106.10

Hospital Charge Code	270657079
Hospital Revenue Code	278
Min. Negotiated Rate	$1,215.91
Max. Negotiated Rate	$4,053.05
Rate for Payer: Aetna Commercial	$2,431.83
Rate for Payer: Aetna Medicare Advantage	$2,431.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,067.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,067.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,621.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,067.06
Rate for Payer: Cigna Commercial	$4,053.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,961.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,215.91

X LONG ANGLED ATTACHMENT

Facility

$8,106.10

Hospital Charge Code	270657079
Hospital Revenue Code	278
Min. Negotiated Rate	$1,215.91
Max. Negotiated Rate	$1,961.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,621.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,961.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,215.91

X-LORDOTIC PLATE 12MM

Facility

$13,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270688732
Hospital Revenue Code	278
Min. Negotiated Rate	$1,987.50
Max. Negotiated Rate	$3,206.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,206.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,987.50

X-LORDOTIC PLATE 12MM

Facility

$13,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270688732
Hospital Revenue Code	278
Min. Negotiated Rate	$1,987.50
Max. Negotiated Rate	$6,625.00
Rate for Payer: Aetna Commercial	$3,975.00
Rate for Payer: Aetna Medicare Advantage	$3,975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,378.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,378.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,378.75
Rate for Payer: Cigna Commercial	$6,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,206.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,987.50

XM PREWARM

Facility

$390.00

Service Code	HCPCS 86921
Hospital Charge Code	3100544
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

XM PREWARM

Facility

$390.00

Service Code	HCPCS 86921
Hospital Charge Code	3100544
Hospital Revenue Code	309
Min. Negotiated Rate	$24.68
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00

XOMED TUBING

Facility

$87.00

Hospital Charge Code	270335206
Hospital Revenue Code	272
Min. Negotiated Rate	$11.31
Max. Negotiated Rate	$43.50
Rate for Payer: Aetna Commercial	$26.10
Rate for Payer: Aetna Medicare Advantage	$26.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.18
Rate for Payer: Cigna Commercial	$43.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.31
Rate for Payer: Oxford Commercial	$43.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.05
Rate for Payer: UnitedHealthcare Commercial	$43.50

Know your out-of-pocket cost for care.

All Charges