Heights University Hospital

All Charges

Charge

Type

Setting

Price

VICI VENOUS STENT SYS 16X90MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686698N
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	270686698N
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

VICODIN 5/300 MG TAB

Facility

$10.94

Hospital Charge Code	606380011
Hospital Revenue Code	250
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$5.47
Rate for Payer: Aetna Commercial	$3.28
Rate for Payer: Aetna Medicare Advantage	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.79
Rate for Payer: Cigna Commercial	$5.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.42
Rate for Payer: Oxford Commercial	$5.47
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$5.47

VICODIN 5/300 MG TAB

Facility

$10.94

Hospital Charge Code	606380011
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

VICODIN/TAB

Facility

$3.00

Hospital Charge Code	60634154
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

VICODIN/TAB

Facility

$3.00

Hospital Charge Code	60634154
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

VICODIN/TAB

Facility

$4.00

Hospital Charge Code	60634155
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

VICODIN/TAB

Facility

$4.00

Hospital Charge Code	60634155
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

VICON C/TAB

Facility

$3.00

Hospital Charge Code	60634309
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

VICON C/TAB

Facility

$3.00

Hospital Charge Code	60634309
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

VICON FORTE/TAB

Facility

$3.00

Hospital Charge Code	60634308
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

VICON FORTE/TAB

Facility

$3.00

Hospital Charge Code	60634308
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

VICRYL MESH KNITTED 6X6

Facility

$527.00

Hospital Charge Code	270334718
Hospital Revenue Code	278
Min. Negotiated Rate	$79.05
Max. Negotiated Rate	$127.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.53
Rate for Payer: Qualcare PPO/HMO/WC	$79.05

VICRYL MESH KNITTED 6X6

Facility

$527.00

Hospital Charge Code	270334718
Hospital Revenue Code	278
Min. Negotiated Rate	$79.05
Max. Negotiated Rate	$263.50
Rate for Payer: Aetna Commercial	$158.10
Rate for Payer: Aetna Medicare Advantage	$158.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$134.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$134.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$134.38
Rate for Payer: Cigna Commercial	$263.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.53
Rate for Payer: Qualcare PPO/HMO/WC	$79.05

VICRYL PLUS UNDYED 8X27CT-1 CR

Facility

$62.35

Hospital Charge Code	270690394
Hospital Revenue Code	272
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$9.35
Rate for Payer: Qualcare PPO/HMO/WC	$9.35

VICRYL PLUS UNDYED 8X27CT-1 CR

Facility

$62.35

Hospital Charge Code	270690394
Hospital Revenue Code	272
Min. Negotiated Rate	$8.11
Max. Negotiated Rate	$31.18
Rate for Payer: Aetna Commercial	$18.70
Rate for Payer: Aetna Medicare Advantage	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.90
Rate for Payer: Cigna Commercial	$31.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.11
Rate for Payer: Oxford Commercial	$31.18
Rate for Payer: Qualcare PPO/HMO/WC	$9.35
Rate for Payer: UnitedHealthcare Commercial	$31.18

VIDARABINE OPH OINT 3%

Facility

$212.85

Hospital Charge Code	60628027
Hospital Revenue Code	250
Min. Negotiated Rate	$27.67
Max. Negotiated Rate	$106.42
Rate for Payer: Aetna Commercial	$63.85
Rate for Payer: Aetna Medicare Advantage	$63.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.28
Rate for Payer: Cigna Commercial	$106.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.67
Rate for Payer: Oxford Commercial	$106.42
Rate for Payer: Qualcare PPO/HMO/WC	$31.93
Rate for Payer: UnitedHealthcare Commercial	$106.42

VIDARABINE OPH OINT 3%

Facility

$212.85

Hospital Charge Code	60628027
Hospital Revenue Code	250
Min. Negotiated Rate	$31.93
Max. Negotiated Rate	$31.93
Rate for Payer: Qualcare PPO/HMO/WC	$31.93

VIDARABINE OPH OINT 3% 3.5GM

Facility

$122.25

Hospital Charge Code	6005656
Hospital Revenue Code	252
Min. Negotiated Rate	$15.89
Max. Negotiated Rate	$61.12
Rate for Payer: Aetna Commercial	$36.67
Rate for Payer: Aetna Medicare Advantage	$36.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.17
Rate for Payer: Cigna Commercial	$61.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.89
Rate for Payer: Oxford Commercial	$61.12
Rate for Payer: Qualcare PPO/HMO/WC	$18.34
Rate for Payer: UnitedHealthcare Commercial	$61.12

VIDARABINE OPH OINT 3% 3.5GM

Facility

$122.25

Hospital Charge Code	6005656
Hospital Revenue Code	252
Min. Negotiated Rate	$18.34
Max. Negotiated Rate	$18.34
Rate for Payer: Qualcare PPO/HMO/WC	$18.34

VIDEX/100MG/TAB

Facility

$12.00

Hospital Charge Code	60634756
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

VIDEX/100MG/TAB

Facility

$12.00

Hospital Charge Code	60634756
Hospital Revenue Code	250
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Commercial	$3.60
Rate for Payer: Aetna Medicare Advantage	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.06
Rate for Payer: Cigna Commercial	$6.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.56
Rate for Payer: Oxford Commercial	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.80
Rate for Payer: UnitedHealthcare Commercial	$6.00

VIDEX/25MG/TAB

Facility

$3.00

Hospital Charge Code	60634754
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

VIDEX/25MG/TAB

Facility

$3.00

Hospital Charge Code	60634754
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

VIDEX/50MG/TAB

Facility

$3.00

Hospital Charge Code	60634755
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

Know your out-of-pocket cost for care.

All Charges