Heights University Hospital

All Charges

Charge

Type

Setting

Price

VIVACIT POLY ARTICLAR SURFACE

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689592
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

VIVACIT POLY ARTICLAR SURFACE

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689502
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

VIVACIT POLY ARTICLAR SURFACE

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689502
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: Aetna Commercial	$1,800.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

VIVACIT POLY ARTICLAR SURFACE

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689592
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$1,800.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

VIVACTIL/10MG/TAB

Facility

$3.00

Hospital Charge Code	60634409
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

VIVACTIL/10MG/TAB

Facility

$3.00

Hospital Charge Code	60634409
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

VIVACTIL/5MG/TAB

Facility

$3.00

Hospital Charge Code	60634408
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

VIVACTIL/5MG/TAB

Facility

$3.00

Hospital Charge Code	60634408
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

VIVATROL ER INJ 380MG

Facility

$10,218.84

Service Code	HCPCS J2315
Hospital Charge Code	606390234
Hospital Revenue Code	636
Min. Negotiated Rate	$1,532.83
Max. Negotiated Rate	$3,065.65
Rate for Payer: Aetna Commercial	$3,065.65
Rate for Payer: Aetna Medicare Advantage	$3,065.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,605.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,605.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,605.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,472.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,532.83

VIVATROL ER INJ 380MG

Facility

$10,218.84

Service Code	HCPCS J2315
Hospital Charge Code	606390234
Hospital Revenue Code	636
Min. Negotiated Rate	$1,532.83
Max. Negotiated Rate	$2,472.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,472.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,532.83

VI VENOUS ANGIOPLASTY

Facility

$5,659.55

Service Code	HCPCS 35476
Hospital Charge Code	5600004
Hospital Revenue Code	361
Min. Negotiated Rate	$848.93
Max. Negotiated Rate	$848.93
Rate for Payer: Qualcare PPO/HMO/WC	$848.93

VI VENOUS ANGIOPLASTY

Facility

$5,659.55

Service Code	HCPCS 35476
Hospital Charge Code	5600004
Hospital Revenue Code	361
Min. Negotiated Rate	$735.74
Max. Negotiated Rate	$2,829.78
Rate for Payer: Aetna Commercial	$1,697.87
Rate for Payer: Aetna Medicare Advantage	$1,697.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,443.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,443.19
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	$1,443.19
Rate for Payer: Cigna Commercial	$2,829.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$735.74
Rate for Payer: Qualcare PPO/HMO/WC	$848.93

VIVIGEN GRAFT 1CC

Facility

$2,855.00

Service Code	HCPCS C1762
Hospital Charge Code	270685524
Hospital Revenue Code	278
Min. Negotiated Rate	$428.25
Max. Negotiated Rate	$1,427.50
Rate for Payer: Aetna Commercial	$856.50
Rate for Payer: Aetna Medicare Advantage	$856.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$728.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$728.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$571.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$728.02
Rate for Payer: Cigna Commercial	$1,427.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$690.91
Rate for Payer: Qualcare PPO/HMO/WC	$428.25

VIVIGEN GRAFT 1CC

Facility

$2,715.00

Service Code	HCPCS C1762
Hospital Charge Code	270679087
Hospital Revenue Code	278
Min. Negotiated Rate	$407.25
Max. Negotiated Rate	$657.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$543.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$657.03
Rate for Payer: Qualcare PPO/HMO/WC	$407.25

VIVIGEN GRAFT 1CC

Facility

$2,855.00

Service Code	HCPCS C1762
Hospital Charge Code	270685524
Hospital Revenue Code	278
Min. Negotiated Rate	$428.25
Max. Negotiated Rate	$690.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$571.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$690.91
Rate for Payer: Qualcare PPO/HMO/WC	$428.25

VIVIGEN GRAFT 1CC

Facility

$2,715.00

Service Code	HCPCS C1762
Hospital Charge Code	270679087
Hospital Revenue Code	278
Min. Negotiated Rate	$407.25
Max. Negotiated Rate	$1,357.50
Rate for Payer: Aetna Commercial	$814.50
Rate for Payer: Aetna Medicare Advantage	$814.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$692.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$692.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$543.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$692.33
Rate for Payer: Cigna Commercial	$1,357.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$657.03
Rate for Payer: Qualcare PPO/HMO/WC	$407.25

VIVIGEN GRAFT 5CC

Facility

$12,250.00

Service Code	HCPCS C1762
Hospital Charge Code	270679086
Hospital Revenue Code	278
Min. Negotiated Rate	$1,837.50
Max. Negotiated Rate	$2,964.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,964.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50

VIVIGEN GRAFT 5CC

Facility

$12,250.00

Service Code	HCPCS C1762
Hospital Charge Code	270679086
Hospital Revenue Code	278
Min. Negotiated Rate	$1,837.50
Max. Negotiated Rate	$6,125.00
Rate for Payer: Aetna Commercial	$3,675.00
Rate for Payer: Aetna Medicare Advantage	$3,675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,123.75
Rate for Payer: Cigna Commercial	$6,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,964.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50

Vivitrol 380mg inj

Facility

$10,218.84

Service Code	HCPCS J2315
Hospital Charge Code	606390242
Hospital Revenue Code	636
Min. Negotiated Rate	$1,532.83
Max. Negotiated Rate	$2,472.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,472.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,532.83

Vivitrol 380mg inj

Facility

$10,218.84

Service Code	HCPCS J2315
Hospital Charge Code	606390242
Hospital Revenue Code	636
Min. Negotiated Rate	$1,532.83
Max. Negotiated Rate	$3,065.65
Rate for Payer: Aetna Commercial	$3,065.65
Rate for Payer: Aetna Medicare Advantage	$3,065.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,605.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,605.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,605.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,472.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,532.83

Vivitrol 380mg Susp Syrg

Facility

$6,600.00

Hospital Charge Code	606380006
Hospital Revenue Code	636
Min. Negotiated Rate	$990.00
Max. Negotiated Rate	$3,300.00
Rate for Payer: Aetna Commercial	$1,980.00
Rate for Payer: Aetna Medicare Advantage	$1,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.00
Rate for Payer: Cigna Commercial	$3,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: Qualcare PPO/HMO/WC	$990.00

Vivitrol 380mg Susp Syrg

Facility

$6,600.00

Hospital Charge Code	606380006
Hospital Revenue Code	636
Min. Negotiated Rate	$990.00
Max. Negotiated Rate	$1,597.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: Qualcare PPO/HMO/WC	$990.00

VIVONEX JEJUNOSTOMY KIT

Facility

$389.00

Hospital Charge Code	270332052
Hospital Revenue Code	272
Min. Negotiated Rate	$50.57
Max. Negotiated Rate	$194.50
Rate for Payer: Aetna Commercial	$116.70
Rate for Payer: Aetna Medicare Advantage	$116.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.19
Rate for Payer: Cigna Commercial	$194.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.57
Rate for Payer: Oxford Commercial	$194.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.35
Rate for Payer: UnitedHealthcare Commercial	$194.50

VIVONEX JEJUNOSTOMY KIT

Facility

$389.00

Hospital Charge Code	270332052
Hospital Revenue Code	272
Min. Negotiated Rate	$58.35
Max. Negotiated Rate	$58.35
Rate for Payer: Qualcare PPO/HMO/WC	$58.35

VIZADISC 2 PK REPLACEMENT KIT

Facility

$170.00

Hospital Charge Code	270668075
Hospital Revenue Code	272
Min. Negotiated Rate	$22.10
Max. Negotiated Rate	$85.00
Rate for Payer: Aetna Commercial	$51.00
Rate for Payer: Aetna Medicare Advantage	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.35
Rate for Payer: Cigna Commercial	$85.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.10
Rate for Payer: Oxford Commercial	$85.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.50
Rate for Payer: UnitedHealthcare Commercial	$85.00

Know your out-of-pocket cost for care.

All Charges