Heights University Hospital

All Charges

Charge

Type

Setting

Price

XR ZYGOMATIC ARCHES MIN 3 VWS

Facility

$5,100.00

Service Code	HCPCS 70150
Hospital Charge Code	2000529
Hospital Revenue Code	320
Min. Negotiated Rate	$37.40
Max. Negotiated Rate	$1,530.00
Rate for Payer: Aetna Better Health Medicaid	$309.88
Rate for Payer: Aetna Commercial	$1,530.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$316.08

XSENSE(R),FRAGILE X W/RFL

Facility

$390.00

Service Code	HCPCS 81243
Hospital Charge Code	39900319
Hospital Revenue Code	310
Min. Negotiated Rate	$28.52
Max. Negotiated Rate	$208.99
Rate for Payer: Aetna Commercial	$184.81
Rate for Payer: Aetna Medicare Advantage	$57.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$208.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$208.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$57.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$208.99
Rate for Payer: Cigna Commercial	$57.04
Rate for Payer: Cigna Medicare Advantage	$28.52
Rate for Payer: Clover Medicare Advantage	$54.19
Rate for Payer: EmblemHealth Commercial	$171.12
Rate for Payer: Humana Medicare Advantage	$58.75
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
Rate for Payer: UnitedHealthcare Medicare Advantage	$57.04
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$60.46
Rate for Payer: Wellcare Medicare Advantage	$57.04

XSENSE(R),FRAGILE X W/RFL

Facility

$390.00

Service Code	HCPCS 81243
Hospital Charge Code	39900319
Hospital Revenue Code	310
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

XTRAFIX 11MM X 500MM CARBON FI

Facility

$1,925.00

Hospital Charge Code	270702690
Hospital Revenue Code	278
Min. Negotiated Rate	$288.75
Max. Negotiated Rate	$465.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$385.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$465.85
Rate for Payer: Qualcare PPO/HMO/WC	$288.75

XTRAFIX 11MM X 500MM CARBON FI

Facility

$1,925.00

Hospital Charge Code	270702690
Hospital Revenue Code	278
Min. Negotiated Rate	$288.75
Max. Negotiated Rate	$962.50
Rate for Payer: Aetna Commercial	$577.50
Rate for Payer: Aetna Medicare Advantage	$577.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$490.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$490.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$385.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$490.88
Rate for Payer: Cigna Commercial	$962.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$465.85
Rate for Payer: Qualcare PPO/HMO/WC	$288.75

XTRAFIX LARGE 5 X 200 X 65MM P

Facility

$1,045.00

Hospital Charge Code	270702687
Hospital Revenue Code	278
Min. Negotiated Rate	$156.75
Max. Negotiated Rate	$252.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$252.89
Rate for Payer: Qualcare PPO/HMO/WC	$156.75

XTRAFIX LARGE 5 X 200 X 65MM P

Facility

$1,045.00

Hospital Charge Code	270702687
Hospital Revenue Code	278
Min. Negotiated Rate	$156.75
Max. Negotiated Rate	$522.50
Rate for Payer: Aetna Commercial	$313.50
Rate for Payer: Aetna Medicare Advantage	$313.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$266.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$266.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$266.48
Rate for Payer: Cigna Commercial	$522.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$252.89
Rate for Payer: Qualcare PPO/HMO/WC	$156.75

XXL BALOON

Facility

$1,432.75

Hospital Charge Code	270685073
Hospital Revenue Code	272
Min. Negotiated Rate	$186.26
Max. Negotiated Rate	$716.38
Rate for Payer: Aetna Commercial	$429.82
Rate for Payer: Aetna Medicare Advantage	$429.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$365.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$365.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$365.35
Rate for Payer: Cigna Commercial	$716.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.26
Rate for Payer: Oxford Commercial	$716.38
Rate for Payer: Qualcare PPO/HMO/WC	$214.91
Rate for Payer: UnitedHealthcare Commercial	$716.38

XXL BALOON

Facility

$1,432.75

Hospital Charge Code	270685073
Hospital Revenue Code	272
Min. Negotiated Rate	$214.91
Max. Negotiated Rate	$214.91
Rate for Payer: Qualcare PPO/HMO/WC	$214.91

XYLOCAINE 0.5%/50ML

Facility

$49.00

Hospital Charge Code	60634183
Hospital Revenue Code	250
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$7.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.35

XYLOCAINE 0.5%/50ML

Facility

$49.00

Hospital Charge Code	60634183
Hospital Revenue Code	250
Min. Negotiated Rate	$6.37
Max. Negotiated Rate	$24.50
Rate for Payer: Aetna Commercial	$14.70
Rate for Payer: Aetna Medicare Advantage	$14.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.49
Rate for Payer: Cigna Commercial	$24.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.37
Rate for Payer: Oxford Commercial	$24.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.35
Rate for Payer: UnitedHealthcare Commercial	$24.50

XYLOCAINE 1.5%/20ML

Facility

$51.00

Hospital Charge Code	60634184
Hospital Revenue Code	250
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna Commercial	$15.30
Rate for Payer: Aetna Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.01
Rate for Payer: Cigna Commercial	$25.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.63
Rate for Payer: Oxford Commercial	$25.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.65
Rate for Payer: UnitedHealthcare Commercial	$25.50

XYLOCAINE 1.5%/20ML

Facility

$51.00

Hospital Charge Code	60634184
Hospital Revenue Code	250
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$7.65
Rate for Payer: Qualcare PPO/HMO/WC	$7.65

XYLOCAINE 2% 10ML VIAL NPF

Facility

$24.12

Service Code	NDC 63323048617
Hospital Charge Code	606390176
Hospital Revenue Code	250
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$3.62
Rate for Payer: Qualcare PPO/HMO/WC	$3.62

XYLOCAINE 2% 10ML VIAL NPF

Facility

$24.12

Service Code	NDC 63323048617
Hospital Charge Code	606390176
Hospital Revenue Code	250
Min. Negotiated Rate	$3.14
Max. Negotiated Rate	$12.06
Rate for Payer: Aetna Commercial	$7.24
Rate for Payer: Aetna Medicare Advantage	$7.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.15
Rate for Payer: Cigna Commercial	$12.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.14
Rate for Payer: Oxford Commercial	$12.06
Rate for Payer: Qualcare PPO/HMO/WC	$3.62
Rate for Payer: UnitedHealthcare Commercial	$12.06

XYLOCAINE 2% MPF 5 ML VIAL

Facility

$22.91

Service Code	NDC 63323049507
Hospital Charge Code	606350967
Hospital Revenue Code	250
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$11.46
Rate for Payer: Aetna Commercial	$6.87
Rate for Payer: Aetna Medicare Advantage	$6.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.84
Rate for Payer: Cigna Commercial	$11.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.98
Rate for Payer: Oxford Commercial	$11.46
Rate for Payer: Qualcare PPO/HMO/WC	$3.44
Rate for Payer: UnitedHealthcare Commercial	$11.46

XYLOCAINE 2% MPF 5 ML VIAL

Facility

$22.91

Service Code	NDC 63323049507
Hospital Charge Code	606350967
Hospital Revenue Code	250
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$3.44
Rate for Payer: Qualcare PPO/HMO/WC	$3.44

XYLOCAINE 5%/35GM

Facility

$56.00

Hospital Charge Code	60634185
Hospital Revenue Code	250
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$8.40
Rate for Payer: Qualcare PPO/HMO/WC	$8.40

XYLOCAINE 5%/35GM

Facility

$56.00

Hospital Charge Code	60634185
Hospital Revenue Code	250
Min. Negotiated Rate	$7.28
Max. Negotiated Rate	$28.00
Rate for Payer: Aetna Commercial	$16.80
Rate for Payer: Aetna Medicare Advantage	$16.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.28
Rate for Payer: Cigna Commercial	$28.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.28
Rate for Payer: Oxford Commercial	$28.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.40
Rate for Payer: UnitedHealthcare Commercial	$28.00

XYLOCAINE MPF 0.5% VIAL

Facility

$24.92

Service Code	NDC 409427801
Hospital Charge Code	60634763
Hospital Revenue Code	250
Min. Negotiated Rate	$3.74
Max. Negotiated Rate	$3.74
Rate for Payer: Qualcare PPO/HMO/WC	$3.74

XYLOCAINE MPF 0.5% VIAL

Facility

$24.92

Service Code	NDC 409427801
Hospital Charge Code	60634763
Hospital Revenue Code	250
Min. Negotiated Rate	$3.24
Max. Negotiated Rate	$12.46
Rate for Payer: Aetna Commercial	$7.48
Rate for Payer: Aetna Medicare Advantage	$7.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.35
Rate for Payer: Cigna Commercial	$12.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.24
Rate for Payer: Oxford Commercial	$12.46
Rate for Payer: Qualcare PPO/HMO/WC	$3.74
Rate for Payer: UnitedHealthcare Commercial	$12.46

XYLOCAINE MPF 1% 10MG/ML 10 ML

Facility

$41.54

Service Code	NDC 63323049297
Hospital Charge Code	606390183
Hospital Revenue Code	250
Min. Negotiated Rate	$6.23
Max. Negotiated Rate	$6.23
Rate for Payer: Qualcare PPO/HMO/WC	$6.23

XYLOCAINE MPF 1% 10MG/ML 10 ML

Facility

$41.54

Service Code	NDC 63323049297
Hospital Charge Code	606390183
Hospital Revenue Code	250
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$20.77
Rate for Payer: Aetna Commercial	$12.46
Rate for Payer: Aetna Medicare Advantage	$12.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.59
Rate for Payer: Cigna Commercial	$20.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.40
Rate for Payer: Oxford Commercial	$20.77
Rate for Payer: Qualcare PPO/HMO/WC	$6.23
Rate for Payer: UnitedHealthcare Commercial	$20.77

XYLOCAINE MPF 1% AMP

Facility

$82.41

Service Code	NDC 63323049237
Hospital Charge Code	60634762
Hospital Revenue Code	250
Min. Negotiated Rate	$10.71
Max. Negotiated Rate	$41.20
Rate for Payer: Aetna Commercial	$24.72
Rate for Payer: Aetna Medicare Advantage	$24.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.01
Rate for Payer: Cigna Commercial	$41.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.71
Rate for Payer: Oxford Commercial	$41.20
Rate for Payer: Qualcare PPO/HMO/WC	$12.36
Rate for Payer: UnitedHealthcare Commercial	$41.20

XYLOCAINE MPF 1% AMP

Facility

$82.41

Service Code	NDC 63323049237
Hospital Charge Code	60634762
Hospital Revenue Code	250
Min. Negotiated Rate	$12.36
Max. Negotiated Rate	$12.36
Rate for Payer: Qualcare PPO/HMO/WC	$12.36

Know your out-of-pocket cost for care.

All Charges