|
CONTRAST INJECTOR LEVEREDGE
|
Facility
|
OP
|
$995.50
|
|
| Hospital Charge Code |
270669885
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.99 |
| Max. Negotiated Rate |
$497.75 |
| Rate for Payer: Aetna Commercial |
$378.29
|
| Rate for Payer: Aetna Medicare Advantage |
$298.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$253.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$253.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$253.85
|
| Rate for Payer: Cigna Commercial |
$497.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$298.65
|
| Rate for Payer: Oxford Commercial |
$199.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$149.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$199.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.38
|
|
|
CONTRAST INJECTOR LEVEREDGE
|
Facility
|
IP
|
$995.50
|
|
| Hospital Charge Code |
270669885
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.32 |
| Max. Negotiated Rate |
$149.32 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$149.32
|
|
|
CONTRAST IOVERSOL 320MG/1ML
|
Facility
|
OP
|
$157.45
|
|
| Hospital Charge Code |
270628529C
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$78.72 |
| Rate for Payer: Aetna Commercial |
$59.83
|
| Rate for Payer: Aetna Medicare Advantage |
$47.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$40.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$40.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$40.15
|
| Rate for Payer: Cigna Commercial |
$78.72
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.23
|
| Rate for Payer: Oxford Commercial |
$31.49
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.62
|
| Rate for Payer: UnitedHealthcare Commercial |
$31.49
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.79
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.17
|
|
|
CONTRAST IOVERSOL 320MG/1ML
|
Facility
|
IP
|
$157.45
|
|
| Hospital Charge Code |
270628529C
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$23.62 |
| Max. Negotiated Rate |
$23.62 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.62
|
|
|
CONTRAST MEDIA CYSTOGRAFIN
|
Facility
|
IP
|
$171.00
|
|
| Hospital Charge Code |
270331233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$41.38 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$41.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.65
|
|
|
CONTRAST MEDIA CYSTOGRAFIN
|
Facility
|
OP
|
$171.00
|
|
| Hospital Charge Code |
270331233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna Commercial |
$64.98
|
| Rate for Payer: Aetna Medicare Advantage |
$51.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.60
|
| Rate for Payer: Cigna Commercial |
$85.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$41.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.65
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.53
|
|
|
CONTRAST MEDIA GASTROGRAFIN
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
270331234
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$12.30 |
| Max. Negotiated Rate |
$12.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.30
|
|
|
CONTRAST MEDIA GASTROGRAFIN
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
270331234
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: Aetna Commercial |
$31.16
|
| Rate for Payer: Aetna Medicare Advantage |
$24.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20.91
|
| Rate for Payer: Cigna Commercial |
$41.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24.60
|
| Rate for Payer: Oxford Commercial |
$16.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$16.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.17
|
|
|
CONTRAST MEDIA HYPAQUE 120ML
|
Facility
|
IP
|
$98.00
|
|
| Hospital Charge Code |
270331240
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$14.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.70
|
|
|
CONTRAST MEDIA HYPAQUE 120ML
|
Facility
|
OP
|
$98.00
|
|
| Hospital Charge Code |
270331240
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: Aetna Commercial |
$37.24
|
| Rate for Payer: Aetna Medicare Advantage |
$29.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$24.99
|
| Rate for Payer: Cigna Commercial |
$49.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.40
|
| Rate for Payer: Oxford Commercial |
$19.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$19.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.60
|
|
|
CONTRAST MEDIA RENOGRAFIN-60
|
Facility
|
IP
|
$31.00
|
|
| Hospital Charge Code |
270331232
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$4.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.65
|
|
|
CONTRAST MEDIA RENOGRAFIN-60
|
Facility
|
OP
|
$31.00
|
|
| Hospital Charge Code |
270331232
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$15.50 |
| Rate for Payer: Aetna Commercial |
$11.78
|
| Rate for Payer: Aetna Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.91
|
| Rate for Payer: Cigna Commercial |
$15.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.30
|
| Rate for Payer: Oxford Commercial |
$6.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.82
|
|
|
CONTRAST MED OPTISON 3M 270703
|
Facility
|
OP
|
$205.50
|
|
| Hospital Charge Code |
74117068
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$102.75 |
| Rate for Payer: Aetna Commercial |
$78.09
|
| Rate for Payer: Aetna Medicare Advantage |
$61.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$52.40
|
| Rate for Payer: Cigna Commercial |
$102.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$49.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.82
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.45
|
|
|
CONTRAST MED OPTISON 3M 270703
|
Facility
|
IP
|
$205.50
|
|
| Hospital Charge Code |
74115068
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.82 |
| Max. Negotiated Rate |
$49.73 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$49.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.82
|
|
|
CONTRAST MED OPTISON 3M 270703
|
Facility
|
IP
|
$205.50
|
|
| Hospital Charge Code |
74116068
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.82 |
| Max. Negotiated Rate |
$49.73 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$49.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.82
|
|
|
CONTRAST MED OPTISON 3M 270703
|
Facility
|
OP
|
$205.50
|
|
| Hospital Charge Code |
74115068
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$102.75 |
| Rate for Payer: Aetna Commercial |
$78.09
|
| Rate for Payer: Aetna Medicare Advantage |
$61.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$52.40
|
| Rate for Payer: Cigna Commercial |
$102.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$49.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.82
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.45
|
|
|
CONTRAST MED OPTISON 3M 270703
|
Facility
|
IP
|
$205.50
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
270629560
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.82 |
| Max. Negotiated Rate |
$49.73 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$49.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.82
|
|
|
CONTRAST MED OPTISON 3M 270703
|
Facility
|
OP
|
$205.50
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
270629560
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$102.75 |
| Rate for Payer: Aetna Commercial |
$78.09
|
| Rate for Payer: Aetna Medicare Advantage |
$61.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$52.40
|
| Rate for Payer: Cigna Commercial |
$102.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$49.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.82
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.45
|
|
|
CONTRAST MED OPTISON 3M 270703
|
Facility
|
IP
|
$205.50
|
|
| Hospital Charge Code |
94053155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.82 |
| Max. Negotiated Rate |
$49.73 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$49.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.82
|
|
|
CONTRAST MED OPTISON 3M 270703
|
Facility
|
IP
|
$205.50
|
|
| Hospital Charge Code |
74117068
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.82 |
| Max. Negotiated Rate |
$49.73 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$49.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.82
|
|
|
CONTRAST MED OPTISON 3M 270703
|
Facility
|
OP
|
$205.50
|
|
| Hospital Charge Code |
74116068
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$102.75 |
| Rate for Payer: Aetna Commercial |
$78.09
|
| Rate for Payer: Aetna Medicare Advantage |
$61.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$52.40
|
| Rate for Payer: Cigna Commercial |
$102.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$49.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.82
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.45
|
|
|
CONTRAST MED OPTISON 3M 270703
|
Facility
|
OP
|
$205.50
|
|
| Hospital Charge Code |
94053155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$102.75 |
| Rate for Payer: Aetna Commercial |
$78.09
|
| Rate for Payer: Aetna Medicare Advantage |
$61.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$52.40
|
| Rate for Payer: Cigna Commercial |
$102.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$49.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.82
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.45
|
|
|
CONTRAST OMNIPAQUE 125cc BOTTL
|
Facility
|
IP
|
$228.85
|
|
| Hospital Charge Code |
605514
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.33 |
| Max. Negotiated Rate |
$55.38 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$34.33
|
|
|
CONTRAST OMNIPAQUE 125cc BOTTL
|
Facility
|
OP
|
$228.85
|
|
| Hospital Charge Code |
605514
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.52 |
| Max. Negotiated Rate |
$114.42 |
| Rate for Payer: Aetna Commercial |
$86.96
|
| Rate for Payer: Aetna Medicare Advantage |
$68.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$58.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$58.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$58.36
|
| Rate for Payer: Cigna Commercial |
$114.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$34.33
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.06
|
|
|
CONTRAST OMNIPAQUE 300mg 100ml
|
Facility
|
IP
|
$71.95
|
|
| Hospital Charge Code |
270643912C
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$10.79 |
| Max. Negotiated Rate |
$10.79 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.79
|
|
