Heights University Hospital

All Charges

Charge

Type

Setting

Price

XYLOCAINE, MPF 2%

Facility

$15.00

Hospital Charge Code	60635444
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

XYLOCAINE, MPF 2%

Facility

$15.00

Hospital Charge Code	60635444
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$4.50
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.95
Rate for Payer: Oxford Commercial	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$7.50

XYLOCAINE-MPF 2% 10MLPLYM

Facility

$24.52

Service Code	NDC 409428202
Hospital Charge Code	60635347
Hospital Revenue Code	250
Min. Negotiated Rate	$3.68
Max. Negotiated Rate	$3.68
Rate for Payer: Qualcare PPO/HMO/WC	$3.68

XYLOCAINE-MPF 2% 10MLPLYM

Facility

$24.52

Service Code	NDC 409428202
Hospital Charge Code	60635347
Hospital Revenue Code	250
Min. Negotiated Rate	$3.19
Max. Negotiated Rate	$12.26
Rate for Payer: Aetna Commercial	$7.36
Rate for Payer: Aetna Medicare Advantage	$7.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.25
Rate for Payer: Cigna Commercial	$12.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.19
Rate for Payer: Oxford Commercial	$12.26
Rate for Payer: Qualcare PPO/HMO/WC	$3.68
Rate for Payer: UnitedHealthcare Commercial	$12.26

XYLOCAINE MPF 4% 5ML

Facility

$21.00

Hospital Charge Code	60635354
Hospital Revenue Code	250
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$6.30
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.73
Rate for Payer: Oxford Commercial	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$10.50

XYLOCAINE MPF 4% 5ML

Facility

$21.00

Hospital Charge Code	60635354
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

XYLOCAINE ORAL 10%/30ML

Facility

$190.00

Hospital Charge Code	60634181
Hospital Revenue Code	250
Min. Negotiated Rate	$28.50
Max. Negotiated Rate	$28.50
Rate for Payer: Qualcare PPO/HMO/WC	$28.50

XYLOCAINE ORAL 10%/30ML

Facility

$190.00

Hospital Charge Code	60634181
Hospital Revenue Code	250
Min. Negotiated Rate	$24.70
Max. Negotiated Rate	$95.00
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare Advantage	$57.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.45
Rate for Payer: Cigna Commercial	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.70
Rate for Payer: Oxford Commercial	$95.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.50
Rate for Payer: UnitedHealthcare Commercial	$95.00

XYLOCAINE TOPICAL 4%/50ML

Facility

$66.00

Hospital Charge Code	60634182
Hospital Revenue Code	250
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

XYLOCAINE TOPICAL 4%/50ML

Facility

$66.00

Hospital Charge Code	60634182
Hospital Revenue Code	250
Min. Negotiated Rate	$8.58
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$19.80
Rate for Payer: Aetna Medicare Advantage	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.83
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.58
Rate for Payer: Oxford Commercial	$33.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$33.00

XYLOSE ABSORPTION

Facility

$103.25

Service Code	HCPCS 84620
Hospital Charge Code	3002813
Hospital Revenue Code	301
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$15.49
Rate for Payer: Qualcare PPO/HMO/WC	$15.49

XYLOSE ABSORPTION

Facility

$103.25

Service Code	HCPCS 84620
Hospital Charge Code	3002813
Hospital Revenue Code	301
Min. Negotiated Rate	$6.46
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$41.83
Rate for Payer: Aetna Medicare Advantage	$12.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.30
Rate for Payer: Cigna Commercial	$12.91
Rate for Payer: Cigna Medicare Advantage	$6.46
Rate for Payer: Clover Medicare Advantage	$12.26
Rate for Payer: EmblemHealth Commercial	$38.73
Rate for Payer: Humana Medicare Advantage	$13.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.42
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.49
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.91
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.68
Rate for Payer: Wellcare Medicare Advantage	$12.91

XYLOSE ABSORPTION TEST

Facility

$180.00

Service Code	HCPCS 84620
Hospital Charge Code	38472704
Hospital Revenue Code	301
Min. Negotiated Rate	$6.46
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$41.83
Rate for Payer: Aetna Medicare Advantage	$12.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.30
Rate for Payer: Cigna Commercial	$12.91
Rate for Payer: Cigna Medicare Advantage	$6.46
Rate for Payer: Clover Medicare Advantage	$12.26
Rate for Payer: EmblemHealth Commercial	$38.73
Rate for Payer: Humana Medicare Advantage	$13.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.91
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.68
Rate for Payer: Wellcare Medicare Advantage	$12.91

XYLOSE ABSORPTION TEST

Facility

$180.00

Service Code	HCPCS 84620
Hospital Charge Code	38472704
Hospital Revenue Code	301
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$27.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00

Y-ADAPTER

Facility

$209.00

Hospital Charge Code	2008170
Hospital Revenue Code	272
Min. Negotiated Rate	$31.35
Max. Negotiated Rate	$31.35
Rate for Payer: Qualcare PPO/HMO/WC	$31.35

Y-ADAPTER

Facility

$209.00

Hospital Charge Code	2008170
Hospital Revenue Code	272
Min. Negotiated Rate	$27.17
Max. Negotiated Rate	$104.50
Rate for Payer: Aetna Commercial	$62.70
Rate for Payer: Aetna Medicare Advantage	$62.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.30
Rate for Payer: Cigna Commercial	$104.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.17
Rate for Payer: Oxford Commercial	$104.50
Rate for Payer: Qualcare PPO/HMO/WC	$31.35
Rate for Payer: UnitedHealthcare Commercial	$104.50

YAG LASER*****

Facility

$765.00

Service Code	HCPCS 66821
Hospital Charge Code	5600010
Hospital Revenue Code	369
Min. Negotiated Rate	$99.45
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$229.50
Rate for Payer: Aetna Medicare Advantage	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$195.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$195.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$173.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$195.07
Rate for Payer: Cigna Commercial	$1,309.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.45
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$114.75
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

YAG LASER*****

Facility

$765.00

Service Code	HCPCS 66821
Hospital Charge Code	5600010
Hospital Revenue Code	369
Min. Negotiated Rate	$114.75
Max. Negotiated Rate	$114.75
Rate for Payer: Qualcare PPO/HMO/WC	$114.75

YANKAUER SUCTION TIP W/O TUBE

Facility

$1.60

Hospital Charge Code	270654175S
Hospital Revenue Code	270
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.80
Rate for Payer: Aetna Commercial	$0.48
Rate for Payer: Aetna Medicare Advantage	$0.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.41
Rate for Payer: Cigna Commercial	$0.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.21
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.24
Rate for Payer: UnitedHealthcare Commercial	$0.80

YANKAUER SUCTION TIP W/O TUBE

Facility

$1.60

Hospital Charge Code	270654175N
Hospital Revenue Code	270
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.80
Rate for Payer: Aetna Commercial	$0.48
Rate for Payer: Aetna Medicare Advantage	$0.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.41
Rate for Payer: Cigna Commercial	$0.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.21
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.24
Rate for Payer: UnitedHealthcare Commercial	$0.80

YANKAUER SUCTION TIP W/O TUBE

Facility

$1.60

Hospital Charge Code	270654175N
Hospital Revenue Code	270
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.24
Rate for Payer: Qualcare PPO/HMO/WC	$0.24

YANKAUER SUCTION TIP W/O TUBE

Facility

$1.60

Hospital Charge Code	270654175
Hospital Revenue Code	272
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.80
Rate for Payer: Aetna Commercial	$0.48
Rate for Payer: Aetna Medicare Advantage	$0.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.41
Rate for Payer: Cigna Commercial	$0.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.21
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.24
Rate for Payer: UnitedHealthcare Commercial	$0.80

YANKAUER SUCTION TIP W/O TUBE

Facility

$1.60

Hospital Charge Code	270654175S
Hospital Revenue Code	270
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.24
Rate for Payer: Qualcare PPO/HMO/WC	$0.24

YANKAUER SUCTION TIP W/O TUBE

Facility

$1.60

Hospital Charge Code	270654175
Hospital Revenue Code	272
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.24
Rate for Payer: Qualcare PPO/HMO/WC	$0.24

Y CHROMOSOME MICRODELETN

Facility

$2,375.00

Service Code	HCPCS 81403
Hospital Charge Code	39900029
Hospital Revenue Code	310
Min. Negotiated Rate	$92.60
Max. Negotiated Rate	$678.57
Rate for Payer: Aetna Commercial	$600.05
Rate for Payer: Aetna Medicare Advantage	$185.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$678.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$678.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$185.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$678.57
Rate for Payer: Cigna Commercial	$185.20
Rate for Payer: Cigna Medicare Advantage	$92.60
Rate for Payer: Clover Medicare Advantage	$175.94
Rate for Payer: EmblemHealth Commercial	$555.60
Rate for Payer: Humana Medicare Advantage	$190.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.75
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$356.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$185.20
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$196.31
Rate for Payer: Wellcare Medicare Advantage	$185.20

Know your out-of-pocket cost for care.

All Charges