Hoboken 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	$33.00
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$86.94
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$316.08
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

XSENSE(R),FRAGILE X W/RFL

Facility

$390.00

Service Code	HCPCS 81243
Hospital Charge Code	39900319
Hospital Revenue Code	310
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$206.91
Rate for Payer: Aetna Commercial	$155.15
Rate for Payer: Aetna Medicare Advantage	$184.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$206.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$206.91
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	$206.91
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$57.04
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: Longevity Health Plan of New Jersey Medicare Advantage	$57.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$45.63
Rate for Payer: UnitedHealthcare Medicare Advantage	$57.04
Rate for Payer: Wellcare Medicare Advantage	$57.04
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

XSENSE(R),FRAGILE X W/RFL

Facility

$390.00

Service Code	HCPCS 81243
Hospital Charge Code	39900319
Hospital Revenue Code	310
Min. Negotiated Rate	$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	$54.67
Max. Negotiated Rate	$962.50
Rate for Payer: Aetna Commercial	$731.50
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
Rate for Payer: UnitedHealthcare Community & State	$60.83
Rate for Payer: Wellpoint Medicaid Managed Care	$54.67

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	$29.68
Max. Negotiated Rate	$522.50
Rate for Payer: Aetna Commercial	$397.10
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
Rate for Payer: UnitedHealthcare Community & State	$33.02
Rate for Payer: Wellpoint Medicaid Managed Care	$29.68

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

XXL BALOON

Facility

$1,432.75

Hospital Charge Code	270685073
Hospital Revenue Code	272
Min. Negotiated Rate	$40.69
Max. Negotiated Rate	$716.38
Rate for Payer: Aetna Commercial	$544.45
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	$372.51
Rate for Payer: Oxford Commercial	$286.55
Rate for Payer: Qualcare PPO/HMO/WC	$214.91
Rate for Payer: UnitedHealthcare Commercial	$286.55
Rate for Payer: UnitedHealthcare Community & State	$45.27
Rate for Payer: Wellpoint Medicaid Managed Care	$40.69

XYLOCAINE 2% 10ML VIAL NPF

Facility

$24.12

Service Code	NDC 63323048617
Hospital Charge Code	606390176
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$12.06
Rate for Payer: Aetna Commercial	$9.17
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	$6.27
Rate for Payer: Oxford Commercial	$4.82
Rate for Payer: Qualcare PPO/HMO/WC	$3.62
Rate for Payer: UnitedHealthcare Commercial	$4.82
Rate for Payer: UnitedHealthcare Community & State	$0.76
Rate for Payer: Wellpoint Medicaid Managed Care	$0.69

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% MPF 5 ML VIAL

Facility

$22.91

Service Code	NDC 63323049507
Hospital Charge Code	606350967
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$11.46
Rate for Payer: Aetna Commercial	$8.71
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	$5.96
Rate for Payer: Oxford Commercial	$4.58
Rate for Payer: Qualcare PPO/HMO/WC	$3.44
Rate for Payer: UnitedHealthcare Commercial	$4.58
Rate for Payer: UnitedHealthcare Community & State	$0.72
Rate for Payer: Wellpoint Medicaid Managed Care	$0.65

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 MPF 0.5% VIAL

Facility

$24.92

Service Code	NDC 409427801
Hospital Charge Code	60634763
Hospital Revenue Code	250
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$12.46
Rate for Payer: Aetna Commercial	$9.47
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	$6.48
Rate for Payer: Oxford Commercial	$4.98
Rate for Payer: Qualcare PPO/HMO/WC	$3.74
Rate for Payer: UnitedHealthcare Commercial	$4.98
Rate for Payer: UnitedHealthcare Community & State	$0.79
Rate for Payer: Wellpoint Medicaid Managed Care	$0.71

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 1% 10MG/ML 10 ML

Facility

$41.54

Service Code	NDC 63323049297
Hospital Charge Code	606390183
Hospital Revenue Code	250
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$20.77
Rate for Payer: Aetna Commercial	$15.79
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	$10.80
Rate for Payer: Oxford Commercial	$8.31
Rate for Payer: Qualcare PPO/HMO/WC	$6.23
Rate for Payer: UnitedHealthcare Commercial	$8.31
Rate for Payer: UnitedHealthcare Community & State	$1.31
Rate for Payer: Wellpoint Medicaid Managed Care	$1.18

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% AMP

Facility

$82.41

Service Code	NDC 63323049237
Hospital Charge Code	60634762
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$41.20
Rate for Payer: Aetna Commercial	$31.32
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	$21.43
Rate for Payer: Oxford Commercial	$16.48
Rate for Payer: Qualcare PPO/HMO/WC	$12.36
Rate for Payer: UnitedHealthcare Commercial	$16.48
Rate for Payer: UnitedHealthcare Community & State	$2.60
Rate for Payer: Wellpoint Medicaid Managed Care	$2.34

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

XYLOCAINE-MPF 2% 10MLPLYM

Facility

$24.52

Service Code	NDC 409428202
Hospital Charge Code	60635347
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$12.26
Rate for Payer: Aetna Commercial	$9.32
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	$6.38
Rate for Payer: Oxford Commercial	$4.90
Rate for Payer: Qualcare PPO/HMO/WC	$3.68
Rate for Payer: UnitedHealthcare Commercial	$4.90
Rate for Payer: UnitedHealthcare Community & State	$0.77
Rate for Payer: Wellpoint Medicaid Managed Care	$0.70

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

XYLOSE ABSORPTION TEST

Facility

$180.00

Service Code	HCPCS 84620
Hospital Charge Code	38472704
Hospital Revenue Code	301
Min. Negotiated Rate	$5.11
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$35.12
Rate for Payer: Aetna Medicare Advantage	$41.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.83
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	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.83
Rate for Payer: Cigna Commercial	$90.00
Rate for Payer: Cigna Medicare Advantage	$12.91
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: Longevity Health Plan of New Jersey Medicare Advantage	$12.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.80
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.91
Rate for Payer: Wellcare Medicare Advantage	$12.91
Rate for Payer: Wellpoint Medicaid Managed Care	$5.11

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	$5.94
Max. Negotiated Rate	$104.50
Rate for Payer: Aetna Commercial	$79.42
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	$54.34
Rate for Payer: Oxford Commercial	$41.80
Rate for Payer: Qualcare PPO/HMO/WC	$31.35
Rate for Payer: UnitedHealthcare Commercial	$41.80
Rate for Payer: UnitedHealthcare Community & State	$6.60
Rate for Payer: Wellpoint Medicaid Managed Care	$5.94

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

Know your out-of-pocket cost for care.

All Charges