Heights University Hospital

All Charges

Charge

Type

Setting

Price

VISCOAT INJ 0.5ML

Facility

$1,228.80

Hospital Charge Code	6006811
Hospital Revenue Code	250
Min. Negotiated Rate	$184.32
Max. Negotiated Rate	$184.32
Rate for Payer: Qualcare PPO/HMO/WC	$184.32

VISCOAT PROVISC OPH

Facility

$1,328.00

Hospital Charge Code	60628086
Hospital Revenue Code	250
Min. Negotiated Rate	$172.64
Max. Negotiated Rate	$664.00
Rate for Payer: Aetna Commercial	$398.40
Rate for Payer: Aetna Medicare Advantage	$398.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$338.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$338.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$338.64
Rate for Payer: Cigna Commercial	$664.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$172.64
Rate for Payer: Oxford Commercial	$664.00
Rate for Payer: Qualcare PPO/HMO/WC	$199.20
Rate for Payer: UnitedHealthcare Commercial	$664.00

VISCOAT PROVISC OPH

Facility

$1,328.00

Hospital Charge Code	60628086
Hospital Revenue Code	250
Min. Negotiated Rate	$199.20
Max. Negotiated Rate	$199.20
Rate for Payer: Qualcare PPO/HMO/WC	$199.20

VISCOSITY

Facility

$57.65

Service Code	HCPCS 85810
Hospital Charge Code	3007739
Hospital Revenue Code	305
Min. Negotiated Rate	$5.83
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$37.81
Rate for Payer: Aetna Medicare Advantage	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.76
Rate for Payer: Cigna Commercial	$11.67
Rate for Payer: Cigna Medicare Advantage	$5.83
Rate for Payer: Clover Medicare Advantage	$11.09
Rate for Payer: EmblemHealth Commercial	$35.01
Rate for Payer: Humana Medicare Advantage	$12.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.65
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.67
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.37
Rate for Payer: Wellcare Medicare Advantage	$11.67

VISCOSITY

Facility

$57.65

Service Code	HCPCS 85810
Hospital Charge Code	3007739
Hospital Revenue Code	305
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$8.65
Rate for Payer: Qualcare PPO/HMO/WC	$8.65

VISCOSITY, FLUID

Facility

$418.00

Service Code	HCPCS 85810
Hospital Charge Code	38473059
Hospital Revenue Code	305
Min. Negotiated Rate	$62.70
Max. Negotiated Rate	$62.70
Rate for Payer: Qualcare PPO/HMO/WC	$62.70

VISCOSITY, FLUID

Facility

$418.00

Service Code	HCPCS 85810
Hospital Charge Code	38473059
Hospital Revenue Code	305
Min. Negotiated Rate	$5.83
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$37.81
Rate for Payer: Aetna Medicare Advantage	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.76
Rate for Payer: Cigna Commercial	$11.67
Rate for Payer: Cigna Medicare Advantage	$5.83
Rate for Payer: Clover Medicare Advantage	$11.09
Rate for Payer: EmblemHealth Commercial	$35.01
Rate for Payer: Humana Medicare Advantage	$12.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.34
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.70
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.67
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.37
Rate for Payer: Wellcare Medicare Advantage	$11.67

VISCOSITY,SERUM

Facility

$418.00

Service Code	HCPCS 85810
Hospital Charge Code	38479123
Hospital Revenue Code	305
Min. Negotiated Rate	$5.83
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$37.81
Rate for Payer: Aetna Medicare Advantage	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.76
Rate for Payer: Cigna Commercial	$11.67
Rate for Payer: Cigna Medicare Advantage	$5.83
Rate for Payer: Clover Medicare Advantage	$11.09
Rate for Payer: EmblemHealth Commercial	$35.01
Rate for Payer: Humana Medicare Advantage	$12.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.34
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.70
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.67
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.37
Rate for Payer: Wellcare Medicare Advantage	$11.67

VISCOSITY,SERUM

Facility

$80.20

Service Code	HCPCS 85810
Hospital Charge Code	39900186
Hospital Revenue Code	305
Min. Negotiated Rate	$12.03
Max. Negotiated Rate	$12.03
Rate for Payer: Qualcare PPO/HMO/WC	$12.03

VISCOSITY,SERUM

Facility

$418.00

Service Code	HCPCS 85810
Hospital Charge Code	38479123
Hospital Revenue Code	305
Min. Negotiated Rate	$62.70
Max. Negotiated Rate	$62.70
Rate for Payer: Qualcare PPO/HMO/WC	$62.70

VISCOSITY,SERUM

Facility

$80.20

Service Code	HCPCS 85810
Hospital Charge Code	39900186
Hospital Revenue Code	305
Min. Negotiated Rate	$5.83
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$37.81
Rate for Payer: Aetna Medicare Advantage	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.76
Rate for Payer: Cigna Commercial	$11.67
Rate for Payer: Cigna Medicare Advantage	$5.83
Rate for Payer: Clover Medicare Advantage	$11.09
Rate for Payer: EmblemHealth Commercial	$35.01
Rate for Payer: Humana Medicare Advantage	$12.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.43
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.03
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.67
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.37
Rate for Payer: Wellcare Medicare Advantage	$11.67

VISIDRAIN EYE FLUID FLUIDEWICK

Facility

$7.50

Hospital Charge Code	270664106
Hospital Revenue Code	270
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.12

VISIDRAIN EYE FLUID FLUIDEWICK

Facility

$7.50

Hospital Charge Code	270664106
Hospital Revenue Code	270
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Commercial	$2.25
Rate for Payer: Aetna Medicare Advantage	$2.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.91
Rate for Payer: Cigna Commercial	$3.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.98
Rate for Payer: Oxford Commercial	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$1.12
Rate for Payer: UnitedHealthcare Commercial	$3.75

VISINE AC/30ML

Facility

$28.00

Hospital Charge Code	60634547
Hospital Revenue Code	250
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$8.40
Rate for Payer: Aetna Medicare Advantage	$8.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.14
Rate for Payer: Cigna Commercial	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.64
Rate for Payer: Oxford Commercial	$14.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Commercial	$14.00

VISINE AC/30ML

Facility

$28.00

Hospital Charge Code	60634547
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

VISINE EYE DROPS

Facility

$5.00

Hospital Charge Code	60634830
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

VISINE EYE DROPS

Facility

$5.00

Hospital Charge Code	60634830
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

VISION BLUE .06%

Facility

$383.33

Hospital Charge Code	270659775
Hospital Revenue Code	270
Min. Negotiated Rate	$49.83
Max. Negotiated Rate	$191.66
Rate for Payer: Aetna Commercial	$115.00
Rate for Payer: Aetna Medicare Advantage	$115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.75
Rate for Payer: Cigna Commercial	$191.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.83
Rate for Payer: Oxford Commercial	$191.66
Rate for Payer: Qualcare PPO/HMO/WC	$57.50
Rate for Payer: UnitedHealthcare Commercial	$191.66

VISION BLUE .06%

Facility

$383.33

Hospital Charge Code	270659775
Hospital Revenue Code	270
Min. Negotiated Rate	$57.50
Max. Negotiated Rate	$57.50
Rate for Payer: Qualcare PPO/HMO/WC	$57.50

VISIPAQUE 150 TO 199ML

Facility

$2,000.00

Hospital Charge Code	7411303
Hospital Revenue Code	255
Min. Negotiated Rate	$260.00
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$600.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.00
Rate for Payer: Oxford Commercial	$1,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Commercial	$1,000.00

VISIPAQUE 150 TO 199ML

Facility

$2,000.00

Hospital Charge Code	7411301
Hospital Revenue Code	255
Min. Negotiated Rate	$260.00
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$600.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.00
Rate for Payer: Oxford Commercial	$1,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Commercial	$1,000.00

VISIPAQUE 150 TO 199ML

Facility

$2,000.00

Hospital Charge Code	7411301
Hospital Revenue Code	255
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

VISIPAQUE 150 TO 199ML

Facility

$2,000.00

Hospital Charge Code	7411303
Hospital Revenue Code	255
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

VISIPAQUE 1 TO 149ML

Facility

$1,500.00

Hospital Charge Code	7411307
Hospital Revenue Code	255
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Oxford Commercial	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Commercial	$750.00

VISIPAQUE 1 TO 149ML

Facility

$1,500.00

Hospital Charge Code	7411305
Hospital Revenue Code	255
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

Know your out-of-pocket cost for care.

All Charges