Heights University Hospital

All Charges

Charge

Type

Setting

Price

VISIPAQUE 320 MG/ML 100ML

Facility

$35.91

Hospital Charge Code	270653788
Hospital Revenue Code	272
Min. Negotiated Rate	$4.67
Max. Negotiated Rate	$17.95
Rate for Payer: Aetna Commercial	$10.77
Rate for Payer: Aetna Medicare Advantage	$10.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.16
Rate for Payer: Cigna Commercial	$17.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.67
Rate for Payer: Oxford Commercial	$17.95
Rate for Payer: Qualcare PPO/HMO/WC	$5.39
Rate for Payer: UnitedHealthcare Commercial	$17.95

VISIPAQUE 320 MG/ML 100ML V-56

Facility

$184.33

Hospital Charge Code	270CH0133
Hospital Revenue Code	636
Min. Negotiated Rate	$27.65
Max. Negotiated Rate	$92.17
Rate for Payer: Aetna Commercial	$55.30
Rate for Payer: Aetna Medicare Advantage	$55.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.00
Rate for Payer: Cigna Commercial	$92.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.61
Rate for Payer: Qualcare PPO/HMO/WC	$27.65

VISIPAQUE 320 MG/ML 100ML V-56

Facility

$184.33

Hospital Charge Code	270CH0133
Hospital Revenue Code	636
Min. Negotiated Rate	$27.65
Max. Negotiated Rate	$44.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.61
Rate for Payer: Qualcare PPO/HMO/WC	$27.65

VISIPAQUE 320MG/ML 100ML V-562

Facility

$184.33

Hospital Charge Code	2707500024
Hospital Revenue Code	272
Min. Negotiated Rate	$23.96
Max. Negotiated Rate	$92.17
Rate for Payer: Aetna Commercial	$55.30
Rate for Payer: Aetna Medicare Advantage	$55.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.00
Rate for Payer: Cigna Commercial	$92.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.96
Rate for Payer: Oxford Commercial	$92.17
Rate for Payer: Qualcare PPO/HMO/WC	$27.65
Rate for Payer: UnitedHealthcare Commercial	$92.17

VISIPAQUE 320MG/ML 100ML V-562

Facility

$184.33

Hospital Charge Code	2707500024
Hospital Revenue Code	272
Min. Negotiated Rate	$27.65
Max. Negotiated Rate	$27.65
Rate for Payer: Qualcare PPO/HMO/WC	$27.65

VISIPAQUE 320MG/ML VIAL(100ML

Facility

$261.30

Service Code	NDC 407222317
Hospital Charge Code	60631593
Hospital Revenue Code	255
Min. Negotiated Rate	$33.97
Max. Negotiated Rate	$130.65
Rate for Payer: Aetna Commercial	$78.39
Rate for Payer: Aetna Medicare Advantage	$78.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.63
Rate for Payer: Cigna Commercial	$130.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.97
Rate for Payer: Oxford Commercial	$130.65
Rate for Payer: Qualcare PPO/HMO/WC	$39.20
Rate for Payer: UnitedHealthcare Commercial	$130.65

VISIPAQUE 320MG/ML VIAL(100ML

Facility

$261.30

Service Code	NDC 407222317
Hospital Charge Code	60631593
Hospital Revenue Code	255
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$39.20
Rate for Payer: Qualcare PPO/HMO/WC	$39.20

VISIPAQUE 350 TO 399ML

Facility

$4,000.00

Hospital Charge Code	7411319
Hospital Revenue Code	255
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$600.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

VISIPAQUE 350 TO 399ML

Facility

$4,000.00

Hospital Charge Code	7411317
Hospital Revenue Code	255
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$600.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

VISIPAQUE 350 TO 399ML

Facility

$4,000.00

Hospital Charge Code	7411317
Hospital Revenue Code	255
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,200.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$520.00
Rate for Payer: Oxford Commercial	$2,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Commercial	$2,000.00

VISIPAQUE 350 TO 399ML

Facility

$4,000.00

Hospital Charge Code	7411319
Hospital Revenue Code	255
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,200.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$520.00
Rate for Payer: Oxford Commercial	$2,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Commercial	$2,000.00

VISIPAQUE=>400ML

Facility

$4,500.00

Hospital Charge Code	7411297
Hospital Revenue Code	636
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

VISIPAQUE=>400ML

Facility

$4,500.00

Hospital Charge Code	7411297
Hospital Revenue Code	636
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

VISIPAQUE=>400ML

Facility

$4,500.00

Hospital Charge Code	7411299
Hospital Revenue Code	636
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

VISIPAQUE=>400ML

Facility

$4,500.00

Hospital Charge Code	7411299
Hospital Revenue Code	636
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

VISIPAQUE IV CONTRAST 150ML

Facility

$22.10

Hospital Charge Code	270653922
Hospital Revenue Code	272
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$11.05
Rate for Payer: Aetna Commercial	$6.63
Rate for Payer: Aetna Medicare Advantage	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.64
Rate for Payer: Cigna Commercial	$11.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.87
Rate for Payer: Oxford Commercial	$11.05
Rate for Payer: Qualcare PPO/HMO/WC	$3.31
Rate for Payer: UnitedHealthcare Commercial	$11.05

VISIPAQUE IV CONTRAST 150ML

Facility

$22.10

Hospital Charge Code	270653922
Hospital Revenue Code	272
Min. Negotiated Rate	$3.31
Max. Negotiated Rate	$3.31
Rate for Payer: Qualcare PPO/HMO/WC	$3.31

VISIPORT 10.5MM

Facility

$222.17

Hospital Charge Code	270658732
Hospital Revenue Code	270
Min. Negotiated Rate	$28.88
Max. Negotiated Rate	$111.08
Rate for Payer: Aetna Commercial	$66.65
Rate for Payer: Aetna Medicare Advantage	$66.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.65
Rate for Payer: Cigna Commercial	$111.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.88
Rate for Payer: Oxford Commercial	$111.08
Rate for Payer: Qualcare PPO/HMO/WC	$33.33
Rate for Payer: UnitedHealthcare Commercial	$111.08

VISIPORT 10.5MM

Facility

$222.17

Hospital Charge Code	270658732
Hospital Revenue Code	270
Min. Negotiated Rate	$33.33
Max. Negotiated Rate	$33.33
Rate for Payer: Qualcare PPO/HMO/WC	$33.33

VISIPORT OPTICAL TROCAR 5-12MM

Facility

$306.00

Hospital Charge Code	270651839
Hospital Revenue Code	272
Min. Negotiated Rate	$45.90
Max. Negotiated Rate	$45.90
Rate for Payer: Qualcare PPO/HMO/WC	$45.90

VISIPORT OPTICAL TROCAR 5-12MM

Facility

$306.00

Hospital Charge Code	270651839
Hospital Revenue Code	272
Min. Negotiated Rate	$39.78
Max. Negotiated Rate	$153.00
Rate for Payer: Aetna Commercial	$91.80
Rate for Payer: Aetna Medicare Advantage	$91.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.03
Rate for Payer: Cigna Commercial	$153.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.78
Rate for Payer: Oxford Commercial	$153.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.90
Rate for Payer: UnitedHealthcare Commercial	$153.00

VISI PRO 7X27 STENT

Facility

$5,198.90

Service Code	HCPCS C1876
Hospital Charge Code	270686949S
Hospital Revenue Code	278
Min. Negotiated Rate	$779.84
Max. Negotiated Rate	$2,599.45
Rate for Payer: Aetna Commercial	$1,559.67
Rate for Payer: Aetna Medicare Advantage	$1,559.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,325.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,325.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,039.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,325.72
Rate for Payer: Cigna Commercial	$2,599.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,258.13
Rate for Payer: Qualcare PPO/HMO/WC	$779.84

VISI PRO 7X27 STENT

Facility

$5,198.90

Service Code	HCPCS C1876
Hospital Charge Code	270686949S
Hospital Revenue Code	278
Min. Negotiated Rate	$779.84
Max. Negotiated Rate	$1,258.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,039.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,258.13
Rate for Payer: Qualcare PPO/HMO/WC	$779.84

VISI-PRO BALLOON EXPANDABLE

Facility

$6,475.00

Service Code	HCPCS C1876
Hospital Charge Code	270659829N
Hospital Revenue Code	278
Min. Negotiated Rate	$971.25
Max. Negotiated Rate	$1,566.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,566.95
Rate for Payer: Qualcare PPO/HMO/WC	$971.25

VISI-PRO BALLOON EXPANDABLE

Facility

$6,475.00

Service Code	HCPCS C1876
Hospital Charge Code	270659829
Hospital Revenue Code	278
Min. Negotiated Rate	$971.25
Max. Negotiated Rate	$3,237.50
Rate for Payer: Aetna Commercial	$1,942.50
Rate for Payer: Aetna Medicare Advantage	$1,942.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,651.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,651.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,651.12
Rate for Payer: Cigna Commercial	$3,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,566.95
Rate for Payer: Qualcare PPO/HMO/WC	$971.25

Know your out-of-pocket cost for care.

All Charges