Heights University Hospital

All Charges

Charge

Type

Setting

Price

VIATORR ENDOPRT 10x8 PTB108275

Facility

$19,500.00

Hospital Charge Code	270635474V
Hospital Revenue Code	278
Min. Negotiated Rate	$2,925.00
Max. Negotiated Rate	$9,750.00
Rate for Payer: Aetna Commercial	$5,850.00
Rate for Payer: Aetna Medicare Advantage	$5,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,972.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,972.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,972.50
Rate for Payer: Cigna Commercial	$9,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,719.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,925.00

VI BILIARY TUBE CHANGE

Facility

$775.25

Hospital Charge Code	5600013
Hospital Revenue Code	320
Min. Negotiated Rate	$116.29
Max. Negotiated Rate	$116.29
Rate for Payer: Qualcare PPO/HMO/WC	$116.29

VI BILIARY TUBE CHANGE

Facility

$775.25

Hospital Charge Code	5600013
Hospital Revenue Code	320
Min. Negotiated Rate	$100.78
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$232.57
Rate for Payer: Aetna Medicare Advantage	$232.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.69
Rate for Payer: Cigna Commercial	$387.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.78
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$116.29
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

VIBRAMYCIN 50MG/50ML SYRP

Facility

$4.00

Service Code	NDC 69097065
Hospital Charge Code	60634794
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

VIBRAMYCIN 50MG/50ML SYRP

Facility

$4.00

Service Code	NDC 69097065
Hospital Charge Code	60634794
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

VIBRAMYCIN 50MG/5ML SYR

Facility

$82.50

Hospital Charge Code	6063943176
Hospital Revenue Code	250
Min. Negotiated Rate	$12.38
Max. Negotiated Rate	$12.38
Rate for Payer: Qualcare PPO/HMO/WC	$12.38

VIBRAMYCIN 50MG/5ML SYR

Facility

$82.50

Hospital Charge Code	6063943176
Hospital Revenue Code	250
Min. Negotiated Rate	$10.72
Max. Negotiated Rate	$41.25
Rate for Payer: Aetna Commercial	$24.75
Rate for Payer: Aetna Medicare Advantage	$24.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.04
Rate for Payer: Cigna Commercial	$41.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.72
Rate for Payer: Oxford Commercial	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$12.38
Rate for Payer: UnitedHealthcare Commercial	$41.25

VI BRANCHIOCEPHAZIL

Facility

$5,659.55

Service Code	HCPCS 35475
Hospital Charge Code	5600008
Hospital Revenue Code	361
Min. Negotiated Rate	$735.74
Max. Negotiated Rate	$2,829.78
Rate for Payer: Aetna Commercial	$1,697.87
Rate for Payer: Aetna Medicare Advantage	$1,697.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,443.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,443.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,443.19
Rate for Payer: Cigna Commercial	$2,829.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$735.74
Rate for Payer: Qualcare PPO/HMO/WC	$848.93

VI BRANCHIOCEPHAZIL

Facility

$5,659.55

Service Code	HCPCS 35475
Hospital Charge Code	5600008
Hospital Revenue Code	361
Min. Negotiated Rate	$848.93
Max. Negotiated Rate	$848.93
Rate for Payer: Qualcare PPO/HMO/WC	$848.93

VICI Stent 14x120

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270687299
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$3,225.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

VICI Stent 14x120

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270687299
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

VICI VENOUS STENT SYS 14X60MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686699S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

VICI VENOUS STENT SYS 14X60MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686699N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$5,375.00
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: Aetna Commercial	$3,225.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

VICI VENOUS STENT SYS 14X60MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686699N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

VICI VENOUS STENT SYS 14X60MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686699S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$3,225.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

VICI VENOUS STENT SYS 14X90MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686696N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

VICI VENOUS STENT SYS 14X90MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686696N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$3,225.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

VICI VENOUS STENT SYS 14X90MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686696S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

VICI VENOUS STENT SYS 14X90MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686696S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$3,225.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

VICI VENOUS STENT SYS 16X120MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686697S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

VICI VENOUS STENT SYS 16X120MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686697N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$3,225.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

VICI VENOUS STENT SYS 16X120MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686697S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$3,225.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

VICI VENOUS STENT SYS 16X120MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686697N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

VICI VENOUS STENT SYS 16X90MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686698S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$3,225.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

VICI VENOUS STENT SYS 16X90MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686698S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

Know your out-of-pocket cost for care.

All Charges