Heights University Hospital

All Charges

Charge

Type

Setting

Price

VIDEX/50MG/TAB

Facility

$3.00

Hospital Charge Code	60634755
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 EC 125 MG

Facility

$36.18

Service Code	NDC 87667117
Hospital Charge Code	60632244
Hospital Revenue Code	250
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$18.09
Rate for Payer: Aetna Commercial	$10.85
Rate for Payer: Aetna Medicare Advantage	$10.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.23
Rate for Payer: Cigna Commercial	$18.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.70
Rate for Payer: Oxford Commercial	$18.09
Rate for Payer: Qualcare PPO/HMO/WC	$5.43
Rate for Payer: UnitedHealthcare Commercial	$18.09

VIDEX EC 125 MG

Facility

$36.18

Service Code	NDC 87667117
Hospital Charge Code	60632244
Hospital Revenue Code	250
Min. Negotiated Rate	$5.43
Max. Negotiated Rate	$5.43
Rate for Payer: Qualcare PPO/HMO/WC	$5.43

VIDEX EC 200MG CAP

Facility

$57.89

Service Code	NDC 87667217
Hospital Charge Code	60632268
Hospital Revenue Code	250
Min. Negotiated Rate	$7.53
Max. Negotiated Rate	$28.95
Rate for Payer: Aetna Commercial	$17.37
Rate for Payer: Aetna Medicare Advantage	$17.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.76
Rate for Payer: Cigna Commercial	$28.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.53
Rate for Payer: Oxford Commercial	$28.95
Rate for Payer: Qualcare PPO/HMO/WC	$8.68
Rate for Payer: UnitedHealthcare Commercial	$28.95

VIDEX EC 200MG CAP

Facility

$57.89

Service Code	NDC 87667217
Hospital Charge Code	60632268
Hospital Revenue Code	250
Min. Negotiated Rate	$8.68
Max. Negotiated Rate	$8.68
Rate for Payer: Qualcare PPO/HMO/WC	$8.68

VIDEX EC 250 MG CAPS

Facility

$73.77

Service Code	NDC 87667317
Hospital Charge Code	60635345
Hospital Revenue Code	250
Min. Negotiated Rate	$11.07
Max. Negotiated Rate	$11.07
Rate for Payer: Qualcare PPO/HMO/WC	$11.07

VIDEX EC 250 MG CAPS

Facility

$73.77

Service Code	NDC 87667317
Hospital Charge Code	60635345
Hospital Revenue Code	250
Min. Negotiated Rate	$9.59
Max. Negotiated Rate	$36.88
Rate for Payer: Aetna Commercial	$22.13
Rate for Payer: Aetna Medicare Advantage	$22.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.81
Rate for Payer: Cigna Commercial	$36.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.59
Rate for Payer: Oxford Commercial	$36.88
Rate for Payer: Qualcare PPO/HMO/WC	$11.07
Rate for Payer: UnitedHealthcare Commercial	$36.88

VIDEX EC CAPS 400 MG

Facility

$115.17

Service Code	NDC 87667417
Hospital Charge Code	60635320
Hospital Revenue Code	250
Min. Negotiated Rate	$14.97
Max. Negotiated Rate	$57.59
Rate for Payer: Aetna Commercial	$34.55
Rate for Payer: Aetna Medicare Advantage	$34.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.37
Rate for Payer: Cigna Commercial	$57.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.97
Rate for Payer: Oxford Commercial	$57.59
Rate for Payer: Qualcare PPO/HMO/WC	$17.28
Rate for Payer: UnitedHealthcare Commercial	$57.59

VIDEX EC CAPS 400 MG

Facility

$115.17

Service Code	NDC 87667417
Hospital Charge Code	60635320
Hospital Revenue Code	250
Min. Negotiated Rate	$17.28
Max. Negotiated Rate	$17.28
Rate for Payer: Qualcare PPO/HMO/WC	$17.28

VID SMOKING/HUMAN PHYS GN-16

Facility

$450.00

Hospital Charge Code	270632335
Hospital Revenue Code	272
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

VID SMOKING/HUMAN PHYS GN-16

Facility

$450.00

Hospital Charge Code	270632335
Hospital Revenue Code	272
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$135.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.50
Rate for Payer: Oxford Commercial	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Commercial	$225.00

VI EMOBLIZATION (NON NEURO)

Facility

$40,990.35

Hospital Charge Code	5600002
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$20,495.17
Rate for Payer: Aetna Commercial	$12,297.10
Rate for Payer: Aetna Medicare Advantage	$12,297.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,452.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,452.54
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	$10,452.54
Rate for Payer: Cigna Commercial	$20,495.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,328.75
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.55

VI EMOBLIZATION (NON NEURO)

Facility

$40,990.35

Hospital Charge Code	5600002
Hospital Revenue Code	361
Min. Negotiated Rate	$6,148.55
Max. Negotiated Rate	$6,148.55
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.55

VI ILIAC ANGIOSPLASTY

Facility

$21,962.30

Hospital Charge Code	5600005
Hospital Revenue Code	361
Min. Negotiated Rate	$3,294.34
Max. Negotiated Rate	$3,294.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

VI ILIAC ANGIOSPLASTY

Facility

$21,962.30

Hospital Charge Code	5600005
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$10,981.15
Rate for Payer: Aetna Commercial	$6,588.69
Rate for Payer: Aetna Medicare Advantage	$6,588.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,600.39
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	$5,600.39
Rate for Payer: Cigna Commercial	$10,981.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.10
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

VI INT EXT BILIARY DRAINAGE

Facility

$2,687.25

Service Code	HCPCS 75982
Hospital Charge Code	5600015
Hospital Revenue Code	323
Min. Negotiated Rate	$349.34
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$806.17
Rate for Payer: Aetna Medicare Advantage	$806.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$685.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$685.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$685.25
Rate for Payer: Cigna Commercial	$1,343.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$349.34
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$403.09
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

VI INT EXT BILIARY DRAINAGE

Facility

$2,687.25

Service Code	HCPCS 75982
Hospital Charge Code	5600015
Hospital Revenue Code	323
Min. Negotiated Rate	$403.09
Max. Negotiated Rate	$403.09
Rate for Payer: Qualcare PPO/HMO/WC	$403.09

VI IVC FILTER

Facility

$7,400.85

Service Code	HCPCS 37191
Hospital Charge Code	5600003
Hospital Revenue Code	361
Min. Negotiated Rate	$1,110.13
Max. Negotiated Rate	$1,110.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,110.13

VI IVC FILTER

Facility

$7,400.85

Service Code	HCPCS 37191
Hospital Charge Code	5600003
Hospital Revenue Code	361
Min. Negotiated Rate	$962.11
Max. Negotiated Rate	$13,251.23
Rate for Payer: Aetna Commercial	$2,220.26
Rate for Payer: Aetna Medicare Advantage	$2,220.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,887.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,887.22
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	$1,887.22
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$962.11
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,110.13
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

VILEX GUIDEWIRE 100MM.09

Facility

$29.75

Hospital Charge Code	270656330
Hospital Revenue Code	278
Min. Negotiated Rate	$4.46
Max. Negotiated Rate	$7.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.46

VILEX GUIDEWIRE 100MM.09

Facility

$29.75

Hospital Charge Code	270656330
Hospital Revenue Code	278
Min. Negotiated Rate	$4.46
Max. Negotiated Rate	$14.88
Rate for Payer: Aetna Commercial	$8.93
Rate for Payer: Aetna Medicare Advantage	$8.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.59
Rate for Payer: Cigna Commercial	$14.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.46

VILEX HOMI IMPLANT 17X15MM

Facility

$7,125.00

Hospital Charge Code	270656769
Hospital Revenue Code	278
Min. Negotiated Rate	$1,068.75
Max. Negotiated Rate	$1,724.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,724.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,068.75

VILEX HOMI IMPLANT 17X15MM

Facility

$7,125.00

Hospital Charge Code	270656769
Hospital Revenue Code	278
Min. Negotiated Rate	$1,068.75
Max. Negotiated Rate	$3,562.50
Rate for Payer: Aetna Commercial	$2,137.50
Rate for Payer: Aetna Medicare Advantage	$2,137.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,816.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,816.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,816.88
Rate for Payer: Cigna Commercial	$3,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,724.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,068.75

VIMAX BONE MATRIX CARTRIDGE 10

Facility

$23,400.00

Service Code	HCPCS C1763
Hospital Charge Code	270697258
Hospital Revenue Code	278
Min. Negotiated Rate	$3,510.00
Max. Negotiated Rate	$11,700.00
Rate for Payer: Aetna Commercial	$7,020.00
Rate for Payer: Aetna Medicare Advantage	$7,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,967.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,967.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,680.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,967.00
Rate for Payer: Cigna Commercial	$11,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,662.80
Rate for Payer: Qualcare PPO/HMO/WC	$3,510.00

VIMAX BONE MATRIX CARTRIDGE 10

Facility

$23,400.00

Service Code	HCPCS C1763
Hospital Charge Code	270697258
Hospital Revenue Code	278
Min. Negotiated Rate	$3,510.00
Max. Negotiated Rate	$5,662.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,680.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,662.80
Rate for Payer: Qualcare PPO/HMO/WC	$3,510.00

Know your out-of-pocket cost for care.

All Charges