Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$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	270659829N
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

VISISHOT 2 22G

Facility

$6,215.75

Hospital Charge Code	270703013
Hospital Revenue Code	278
Min. Negotiated Rate	$932.36
Max. Negotiated Rate	$3,107.88
Rate for Payer: Aetna Commercial	$1,864.72
Rate for Payer: Aetna Medicare Advantage	$1,864.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,585.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,585.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,243.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,585.02
Rate for Payer: Cigna Commercial	$3,107.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,504.21
Rate for Payer: Qualcare PPO/HMO/WC	$932.36

VISISHOT 2 22G

Facility

$6,215.75

Hospital Charge Code	270703013
Hospital Revenue Code	278
Min. Negotiated Rate	$932.36
Max. Negotiated Rate	$1,504.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,243.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,504.21
Rate for Payer: Qualcare PPO/HMO/WC	$932.36

VISISHOT 2 25G

Facility

$6,859.00

Hospital Charge Code	270703015
Hospital Revenue Code	278
Min. Negotiated Rate	$1,028.85
Max. Negotiated Rate	$1,659.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,371.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,659.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,028.85

VISISHOT 2 25G

Facility

$6,859.00

Hospital Charge Code	270703015
Hospital Revenue Code	278
Min. Negotiated Rate	$1,028.85
Max. Negotiated Rate	$3,429.50
Rate for Payer: Aetna Commercial	$2,057.70
Rate for Payer: Aetna Medicare Advantage	$2,057.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,749.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,749.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,371.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,749.05
Rate for Payer: Cigna Commercial	$3,429.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,659.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,028.85

VISKEN/10MG/TAB

Facility

$3.00

Hospital Charge Code	60634157
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

VISKEN/10MG/TAB

Facility

$3.00

Hospital Charge Code	60634157
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

VISKEN/5MG/TAB

Facility

$3.00

Hospital Charge Code	60634158
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

VISKEN/5MG/TAB

Facility

$3.00

Hospital Charge Code	60634158
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

VISTARIL/25MG/CAP

Facility

$6.00

Hospital Charge Code	60634334
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

VISTARIL/25MG/CAP

Facility

$6.00

Hospital Charge Code	60634334
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

VISTARIL/50MG/CAP

Facility

$6.00

Hospital Charge Code	60634335
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

VISTARIL/50MG/CAP

Facility

$6.00

Hospital Charge Code	60634335
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

VISTASEAL 2MM

Facility

$602.75

Hospital Charge Code	270688739
Hospital Revenue Code	272
Min. Negotiated Rate	$90.41
Max. Negotiated Rate	$90.41
Rate for Payer: Qualcare PPO/HMO/WC	$90.41

VISTASEAL 2MM

Facility

$602.75

Hospital Charge Code	270688739
Hospital Revenue Code	272
Min. Negotiated Rate	$78.36
Max. Negotiated Rate	$301.38
Rate for Payer: Aetna Commercial	$180.82
Rate for Payer: Aetna Medicare Advantage	$180.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.70
Rate for Payer: Cigna Commercial	$301.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.36
Rate for Payer: Oxford Commercial	$301.38
Rate for Payer: Qualcare PPO/HMO/WC	$90.41
Rate for Payer: UnitedHealthcare Commercial	$301.38

VISTASEAL FIBRIN 4 ML

Facility

$1,116.20

Hospital Charge Code	270688740
Hospital Revenue Code	272
Min. Negotiated Rate	$145.11
Max. Negotiated Rate	$558.10
Rate for Payer: Aetna Commercial	$334.86
Rate for Payer: Aetna Medicare Advantage	$334.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$284.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$284.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$284.63
Rate for Payer: Cigna Commercial	$558.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.11
Rate for Payer: Oxford Commercial	$558.10
Rate for Payer: Qualcare PPO/HMO/WC	$167.43
Rate for Payer: UnitedHealthcare Commercial	$558.10

VISTASEAL FIBRIN 4 ML

Facility

$1,116.20

Hospital Charge Code	270688740
Hospital Revenue Code	272
Min. Negotiated Rate	$167.43
Max. Negotiated Rate	$167.43
Rate for Payer: Qualcare PPO/HMO/WC	$167.43

VISTASEAL, FIBRIN SEALANT 10MG

Facility

$2,567.25

Service Code	HCPCS C1765
Hospital Charge Code	270688748
Hospital Revenue Code	278
Min. Negotiated Rate	$385.09
Max. Negotiated Rate	$621.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$513.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$621.27
Rate for Payer: Qualcare PPO/HMO/WC	$385.09

VISTASEAL, FIBRIN SEALANT 10MG

Facility

$2,567.25

Service Code	HCPCS C1765
Hospital Charge Code	270688748
Hospital Revenue Code	278
Min. Negotiated Rate	$385.09
Max. Negotiated Rate	$1,283.62
Rate for Payer: Aetna Commercial	$770.17
Rate for Payer: Aetna Medicare Advantage	$770.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$654.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$654.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$513.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$654.65
Rate for Payer: Cigna Commercial	$1,283.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$621.27
Rate for Payer: Qualcare PPO/HMO/WC	$385.09

VISTIDE

Facility

$3,249.00

Hospital Charge Code	60635116
Hospital Revenue Code	250
Min. Negotiated Rate	$422.37
Max. Negotiated Rate	$1,624.50
Rate for Payer: Aetna Commercial	$974.70
Rate for Payer: Aetna Medicare Advantage	$974.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$828.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$828.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$828.50
Rate for Payer: Cigna Commercial	$1,624.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$422.37
Rate for Payer: Oxford Commercial	$1,624.50
Rate for Payer: Qualcare PPO/HMO/WC	$487.35
Rate for Payer: UnitedHealthcare Commercial	$1,624.50

VISTIDE

Facility

$3,249.00

Hospital Charge Code	60635116
Hospital Revenue Code	250
Min. Negotiated Rate	$487.35
Max. Negotiated Rate	$487.35
Rate for Payer: Qualcare PPO/HMO/WC	$487.35

VITAFOL LIQUID

Facility

$3.00

Hospital Charge Code	60634980
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

VITAFOL LIQUID

Facility

$3.00

Hospital Charge Code	60634980
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

VITAGEL SURG.HEMOSTAT 4.5 ML

Facility

$858.00

Hospital Charge Code	270335970
Hospital Revenue Code	272
Min. Negotiated Rate	$128.70
Max. Negotiated Rate	$128.70
Rate for Payer: Qualcare PPO/HMO/WC	$128.70

Know your out-of-pocket cost for care.

All Charges