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Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

CRISIS PSYCHOTX MD EAADD 30MIN

Facility

OP

$275.00

Service Code	HCPCS 90840
Hospital Charge Code	4502708
Hospital Revenue Code	914
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$104.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$41.25
Rate for Payer: UnitedHealthcare Community & State	$6.63
Rate for Payer: Wellpoint Medicaid Managed Care	$7.29

CRISIS PSYCHOTX MD EAADD 30MIN

Facility

IP

$275.00

Service Code	HCPCS 90840
Hospital Charge Code	4510708
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

CRISIS PSYCHOTX MD EAADD 30MIN

Facility

OP

$275.00

Service Code	HCPCS 90840
Hospital Charge Code	4527708
Hospital Revenue Code	914
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$104.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$41.25
Rate for Payer: UnitedHealthcare Community & State	$6.63
Rate for Payer: Wellpoint Medicaid Managed Care	$7.29

CRISIS PSYCHOTX MD EAADD 30MIN

Facility

IP

$275.00

Service Code	HCPCS 90840
Hospital Charge Code	4546708
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

CRISIS PSYCHOTX MD EAADD 30MIN

Facility

IP

$275.00

Service Code	HCPCS 90840
Hospital Charge Code	4502708
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

CRISIS PSYCHOTX MD EAADD 30MIN

Facility

IP

$275.00

Service Code	HCPCS 90840
Hospital Charge Code	4509708
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

CRISIS PSYCHOTX MD EAADD 30MIN

Facility

OP

$275.00

Service Code	HCPCS 90840
Hospital Charge Code	4546708
Hospital Revenue Code	914
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$104.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$41.25
Rate for Payer: UnitedHealthcare Community & State	$6.63
Rate for Payer: Wellpoint Medicaid Managed Care	$7.29

CRISIS PSYCHOTX MD EAADD 30MIN

Facility

OP

$275.00

Service Code	HCPCS 90840
Hospital Charge Code	4511708
Hospital Revenue Code	914
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$104.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$41.25
Rate for Payer: UnitedHealthcare Community & State	$6.63
Rate for Payer: Wellpoint Medicaid Managed Care	$7.29

CRISIS PSYCHOTX MD EAADD 30MIN

Facility

IP

$275.00

Service Code	HCPCS 90840
Hospital Charge Code	4511708
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

CRISIS PSYCHOTX MD EAADD 30MIN

Facility

OP

$275.00

Service Code	HCPCS 90840
Hospital Charge Code	4818708
Hospital Revenue Code	914
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$104.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$41.25
Rate for Payer: UnitedHealthcare Community & State	$6.63
Rate for Payer: Wellpoint Medicaid Managed Care	$7.29

CRISIS PSYCHTHERAPY 60MIN

Facility

IP

$1,879.97

Service Code	HCPCS 90839
Hospital Charge Code	94810180
Hospital Revenue Code	914
Min. Negotiated Rate	$282.00
Max. Negotiated Rate	$282.00
Rate for Payer: Qualcare PPO/HMO/WC	$282.00

CRISIS PSYCHTHERAPY 60MIN

Facility

OP

$1,879.97

Service Code	HCPCS 90839
Hospital Charge Code	94810180
Hospital Revenue Code	914
Min. Negotiated Rate	$45.31
Max. Negotiated Rate	$761.18
Rate for Payer: Aetna Commercial	$573.57
Rate for Payer: Aetna Medicare Advantage	$683.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$761.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$761.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$210.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$120.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$761.18
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: Cigna Medicare Advantage	$210.87
Rate for Payer: Clover Medicare Advantage	$200.33
Rate for Payer: EmblemHealth Commercial	$632.61
Rate for Payer: Humana Medicare Advantage	$217.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$210.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$563.99
Rate for Payer: Qualcare PPO/HMO/WC	$282.00
Rate for Payer: UnitedHealthcare Community & State	$45.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellpoint Medicaid Managed Care	$49.82

CRISIS PSYCHTHERAPY 60MIN

Facility

IP

$1,879.97

Service Code	HCPCS 90839
Hospital Charge Code	94810145
Hospital Revenue Code	914
Min. Negotiated Rate	$282.00
Max. Negotiated Rate	$282.00
Rate for Payer: Qualcare PPO/HMO/WC	$282.00

CRISIS PSYCHTHERAPY 60MIN

Facility

OP

$1,879.97

Service Code	HCPCS 90839
Hospital Charge Code	94810145
Hospital Revenue Code	914
Min. Negotiated Rate	$45.31
Max. Negotiated Rate	$761.18
Rate for Payer: Aetna Commercial	$573.57
Rate for Payer: Aetna Medicare Advantage	$683.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$761.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$761.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$210.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$120.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$761.18
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: Cigna Medicare Advantage	$210.87
Rate for Payer: Clover Medicare Advantage	$200.33
Rate for Payer: EmblemHealth Commercial	$632.61
Rate for Payer: Humana Medicare Advantage	$217.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$210.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$563.99
Rate for Payer: Qualcare PPO/HMO/WC	$282.00
Rate for Payer: UnitedHealthcare Community & State	$45.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellpoint Medicaid Managed Care	$49.82

CRITIC AID AF OINT

Facility

IP

$55.81

Service Code	NDC 11701006723
Hospital Charge Code	6063943264
Hospital Revenue Code	250
Min. Negotiated Rate	$8.37
Max. Negotiated Rate	$8.37
Rate for Payer: Qualcare PPO/HMO/WC	$8.37

CRITIC AID AF OINT

Facility

OP

$55.81

Service Code	NDC 11701006723
Hospital Charge Code	6063943264
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$27.91
Rate for Payer: Aetna Commercial	$21.21
Rate for Payer: Aetna Medicare Advantage	$16.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.23
Rate for Payer: Cigna Commercial	$27.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.74
Rate for Payer: Oxford Commercial	$11.16
Rate for Payer: Qualcare PPO/HMO/WC	$8.37
Rate for Payer: UnitedHealthcare Commercial	$11.16
Rate for Payer: UnitedHealthcare Community & State	$1.35
Rate for Payer: Wellpoint Medicaid Managed Care	$1.48

CRITICAL CARE 1ST HOUR

Facility

OP

$10,659.26

Service Code	HCPCS 99291
Hospital Charge Code	411099291
Hospital Revenue Code	361
Min. Negotiated Rate	$256.89
Max. Negotiated Rate	$3,542.34
Rate for Payer: Aetna Commercial	$2,669.24
Rate for Payer: Aetna Medicare Advantage	$3,179.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,542.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,542.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$981.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,542.34
Rate for Payer: Cigna Commercial	$1,967.11
Rate for Payer: Cigna Medicare Advantage	$981.34
Rate for Payer: Clover Medicare Advantage	$932.27
Rate for Payer: EmblemHealth Commercial	$2,944.02
Rate for Payer: Humana Medicare Advantage	$1,010.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$981.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,197.78
Rate for Payer: Qualcare PPO/HMO/WC	$1,598.89
Rate for Payer: UnitedHealthcare Community & State	$256.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$981.34
Rate for Payer: Wellcare Medicare Advantage	$981.34
Rate for Payer: Wellpoint Medicaid Managed Care	$282.47

CRITICAL CARE 1ST HOUR

Facility

IP

$10,659.26

Service Code	HCPCS 99291
Hospital Charge Code	411099291
Hospital Revenue Code	361
Min. Negotiated Rate	$1,598.89
Max. Negotiated Rate	$1,598.89
Rate for Payer: Qualcare PPO/HMO/WC	$1,598.89

CRITICAL EA ADDL 30 MIN

Facility

IP

$837.50

Service Code	HCPCS 99292
Hospital Charge Code	411099292
Hospital Revenue Code	361
Min. Negotiated Rate	$125.62
Max. Negotiated Rate	$125.62
Rate for Payer: Qualcare PPO/HMO/WC	$125.62

CRITICAL EA ADDL 30 MIN

Facility

OP

$837.50

Service Code	HCPCS 99292
Hospital Charge Code	411099292
Hospital Revenue Code	361
Min. Negotiated Rate	$20.18
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$318.25
Rate for Payer: Aetna Medicare Advantage	$251.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$213.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$213.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$213.56
Rate for Payer: Cigna Commercial	$418.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$251.25
Rate for Payer: Qualcare PPO/HMO/WC	$125.62
Rate for Payer: UnitedHealthcare Community & State	$20.18
Rate for Payer: Wellpoint Medicaid Managed Care	$22.19

CRIXIVAN 200MG

Facility

OP

$8.00

Hospital Charge Code	60635154
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.04
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.40
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$1.60
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

CRIXIVAN 200MG

Facility

IP

$8.00

Hospital Charge Code	60635154
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

CRNEA HUMAN TISSUE IMPLNTABLE

Facility

IP

$19,000.00

Service Code	HCPCS V2785
Hospital Charge Code	270660661
Hospital Revenue Code	810
Min. Negotiated Rate	$2,850.00
Max. Negotiated Rate	$2,850.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,850.00

CRNEA HUMAN TISSUE IMPLNTABLE

Facility

OP

$19,000.00

Service Code	HCPCS V2785
Hospital Charge Code	270660661
Hospital Revenue Code	810
Min. Negotiated Rate	$457.90
Max. Negotiated Rate	$9,500.00
Rate for Payer: Aetna Commercial	$7,220.00
Rate for Payer: Aetna Medicare Advantage	$5,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,845.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,845.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,845.00
Rate for Payer: Cigna Commercial	$9,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,700.00
Rate for Payer: Oxford Commercial	$3,800.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,850.00
Rate for Payer: UnitedHealthcare Commercial	$3,800.00
Rate for Payer: UnitedHealthcare Community & State	$457.90
Rate for Payer: Wellpoint Medicaid Managed Care	$503.50

CROMOLYN 4% OPHTH SOLN

Facility

IP

$186.25

Hospital Charge Code	60628007
Hospital Revenue Code	250
Min. Negotiated Rate	$27.94
Max. Negotiated Rate	$27.94
Rate for Payer: Qualcare PPO/HMO/WC	$27.94