Heights University Hospital

All Charges

Charge

Type

Setting

Price

VENLAFAXINE 25 MG TAB

Facility

$9.65

Hospital Charge Code	60627785
Hospital Revenue Code	250
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$2.90
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.25
Rate for Payer: Oxford Commercial	$4.83
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$4.83

VENLAFAXINE 25 MG TAB

Facility

$9.65

Hospital Charge Code	60627785
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

VENLAFAXINE 37.5 MG ER CAP

Facility

$58.76

Service Code	NDC 8083703
Hospital Charge Code	60629122
Hospital Revenue Code	250
Min. Negotiated Rate	$8.81
Max. Negotiated Rate	$8.81
Rate for Payer: Qualcare PPO/HMO/WC	$8.81

VENLAFAXINE 37.5 MG ER CAP

Facility

$58.76

Service Code	NDC 8083703
Hospital Charge Code	60629122
Hospital Revenue Code	250
Min. Negotiated Rate	$7.64
Max. Negotiated Rate	$29.38
Rate for Payer: Aetna Commercial	$17.63
Rate for Payer: Aetna Medicare Advantage	$17.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.98
Rate for Payer: Cigna Commercial	$29.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.64
Rate for Payer: Oxford Commercial	$29.38
Rate for Payer: Qualcare PPO/HMO/WC	$8.81
Rate for Payer: UnitedHealthcare Commercial	$29.38

VENLAFAXINE 37.5 MG TAB

Facility

$13.40

Service Code	NDC 51079048001
Hospital Charge Code	60627786
Hospital Revenue Code	250
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$2.01
Rate for Payer: Qualcare PPO/HMO/WC	$2.01

VENLAFAXINE 37.5 MG TAB

Facility

$13.40

Service Code	NDC 51079048001
Hospital Charge Code	60627786
Hospital Revenue Code	250
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$6.70
Rate for Payer: Aetna Commercial	$4.02
Rate for Payer: Aetna Medicare Advantage	$4.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.42
Rate for Payer: Cigna Commercial	$6.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.74
Rate for Payer: Oxford Commercial	$6.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.01
Rate for Payer: UnitedHealthcare Commercial	$6.70

VENLAFAXINE 50MG TAB

Facility

$13.80

Service Code	NDC 65162030609
Hospital Charge Code	6063943175
Hospital Revenue Code	250
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$2.07
Rate for Payer: Qualcare PPO/HMO/WC	$2.07

VENLAFAXINE 50MG TAB

Facility

$13.80

Service Code	NDC 65162030609
Hospital Charge Code	6063943175
Hospital Revenue Code	250
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$6.90
Rate for Payer: Aetna Commercial	$4.14
Rate for Payer: Aetna Medicare Advantage	$4.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.52
Rate for Payer: Cigna Commercial	$6.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.79
Rate for Payer: Oxford Commercial	$6.90
Rate for Payer: Qualcare PPO/HMO/WC	$2.07
Rate for Payer: UnitedHealthcare Commercial	$6.90

VENLAFAXINE 75 MG ER CAP

Facility

$65.86

Service Code	NDC 8083303
Hospital Charge Code	60629114
Hospital Revenue Code	250
Min. Negotiated Rate	$9.88
Max. Negotiated Rate	$9.88
Rate for Payer: Qualcare PPO/HMO/WC	$9.88

VENLAFAXINE 75 MG ER CAP

Facility

$65.86

Service Code	NDC 8083303
Hospital Charge Code	60629114
Hospital Revenue Code	250
Min. Negotiated Rate	$8.56
Max. Negotiated Rate	$32.93
Rate for Payer: Aetna Commercial	$19.76
Rate for Payer: Aetna Medicare Advantage	$19.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.79
Rate for Payer: Cigna Commercial	$32.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.56
Rate for Payer: Oxford Commercial	$32.93
Rate for Payer: Qualcare PPO/HMO/WC	$9.88
Rate for Payer: UnitedHealthcare Commercial	$32.93

VENLAFAXINE 75 MG TAB

Facility

$14.61

Service Code	NDC 51079048201
Hospital Charge Code	60629917
Hospital Revenue Code	250
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$7.30
Rate for Payer: Aetna Commercial	$4.38
Rate for Payer: Aetna Medicare Advantage	$4.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.73
Rate for Payer: Cigna Commercial	$7.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.90
Rate for Payer: Oxford Commercial	$7.30
Rate for Payer: Qualcare PPO/HMO/WC	$2.19
Rate for Payer: UnitedHealthcare Commercial	$7.30

VENLAFAXINE 75 MG TAB

Facility

$14.61

Service Code	NDC 51079048201
Hospital Charge Code	60629917
Hospital Revenue Code	250
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$2.19
Rate for Payer: Qualcare PPO/HMO/WC	$2.19

VENLAFAXINE HCL TAB 37.5MG

Facility

$7.70

Hospital Charge Code	6017958
Hospital Revenue Code	252
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

VENLAFAXINE HCL TAB 37.5MG

Facility

$7.70

Hospital Charge Code	6017958
Hospital Revenue Code	252
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna Commercial	$2.31
Rate for Payer: Aetna Medicare Advantage	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.96
Rate for Payer: Cigna Commercial	$3.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.00
Rate for Payer: Oxford Commercial	$3.85
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$3.85

VENOGRAM EXT LT

Facility

$3,054.00

Service Code	HCPCS 75820LT
Hospital Charge Code	7411153
Hospital Revenue Code	320
Min. Negotiated Rate	$397.02
Max. Negotiated Rate	$1,527.00
Rate for Payer: Aetna Medicare Advantage	$916.20
Rate for Payer: Aetna Commercial	$916.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$778.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$778.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$778.77
Rate for Payer: Cigna Commercial	$1,527.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$397.02
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$458.10
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

VENOGRAM EXT LT

Facility

$3,054.00

Service Code	HCPCS 75820LT
Hospital Charge Code	7411153
Hospital Revenue Code	320
Min. Negotiated Rate	$458.10
Max. Negotiated Rate	$458.10
Rate for Payer: Qualcare PPO/HMO/WC	$458.10

VENOGRAM EXT RT

Facility

$3,054.00

Service Code	HCPCS 75820RT
Hospital Charge Code	7411155
Hospital Revenue Code	320
Min. Negotiated Rate	$397.02
Max. Negotiated Rate	$1,527.00
Rate for Payer: Aetna Commercial	$916.20
Rate for Payer: Aetna Medicare Advantage	$916.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$778.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$778.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$778.77
Rate for Payer: Cigna Commercial	$1,527.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$397.02
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$458.10
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

VENOGRAM EXT RT

Facility

$3,054.00

Service Code	HCPCS 75820RT
Hospital Charge Code	7411155
Hospital Revenue Code	320
Min. Negotiated Rate	$458.10
Max. Negotiated Rate	$458.10
Rate for Payer: Qualcare PPO/HMO/WC	$458.10

VENOGRAM IVC

Facility

$1,263.40

Service Code	HCPCS 75825
Hospital Charge Code	5100563
Hospital Revenue Code	320
Min. Negotiated Rate	$189.51
Max. Negotiated Rate	$189.51
Rate for Payer: Qualcare PPO/HMO/WC	$189.51

VENOGRAM IVC

Facility

$1,263.40

Service Code	HCPCS 75825
Hospital Charge Code	5100563
Hospital Revenue Code	320
Min. Negotiated Rate	$164.24
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Commercial	$379.02
Rate for Payer: Aetna Medicare Advantage	$379.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$322.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$322.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$219.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$322.17
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.24
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$189.51
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

VENOGRAM LEFT UPPER EXTREMITY

Facility

$593.30

Service Code	HCPCS 75820
Hospital Charge Code	5100564
Hospital Revenue Code	320
Min. Negotiated Rate	$89.00
Max. Negotiated Rate	$89.00
Rate for Payer: Qualcare PPO/HMO/WC	$89.00

VENOGRAM LEFT UPPER EXTREMITY

Facility

$593.30

Service Code	HCPCS 75820
Hospital Charge Code	5100564
Hospital Revenue Code	320
Min. Negotiated Rate	$77.13
Max. Negotiated Rate	$3,748.67
Rate for Payer: Aetna Commercial	$177.99
Rate for Payer: Aetna Medicare Advantage	$177.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$117.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.29
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.13
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$89.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

VENOGRAM ULTRASOUND GUIDED

Facility

$1,097.60

Service Code	HCPCS 76942
Hospital Charge Code	5100570
Hospital Revenue Code	320
Min. Negotiated Rate	$164.64
Max. Negotiated Rate	$164.64
Rate for Payer: Qualcare PPO/HMO/WC	$164.64

VENOGRAM ULTRASOUND GUIDED

Facility

$1,097.60

Service Code	HCPCS 76942
Hospital Charge Code	5100570
Hospital Revenue Code	320
Min. Negotiated Rate	$69.19
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$329.28
Rate for Payer: Aetna Medicare Advantage	$329.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$279.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$279.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$279.89
Rate for Payer: Cigna Commercial	$72.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.69
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$164.64
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

VENOGRAM UPPER EXTREMITY

Facility

$4,693.75

Service Code	HCPCS 75822
Hospital Charge Code	5100565
Hospital Revenue Code	320
Min. Negotiated Rate	$704.06
Max. Negotiated Rate	$704.06
Rate for Payer: Qualcare PPO/HMO/WC	$704.06

Know your out-of-pocket cost for care.

All Charges