|
ASPIRIN/325MG/TAB
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
60632492
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$1.14
|
| 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 |
$0.90
|
| Rate for Payer: Oxford Commercial |
$0.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.08
|
|
|
ASPIRIN/325MG/TAB
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
60632491
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
|
|
ASPIRIN/325MG/TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
60632490
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Aetna Commercial |
$0.38
|
| Rate for Payer: Aetna Medicare Advantage |
$0.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.26
|
| Rate for Payer: Cigna Commercial |
$0.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.30
|
| Rate for Payer: Oxford Commercial |
$0.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.03
|
|
|
ASPIRIN/325MG/TAB
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
60632491
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$1.14
|
| 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 |
$0.90
|
| Rate for Payer: Oxford Commercial |
$0.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.08
|
|
|
ASPIRIN/325MG/TAB
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
60632492
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
|
|
ASPIRIN/325MG/TAB
|
Facility
|
IP
|
$1.00
|
|
| Hospital Charge Code |
60632490
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.15
|
|
|
ASPIRIN 325 MG TABLET
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 57896090101
|
| Hospital Charge Code |
6022156
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
|
|
ASPIRIN 325 MG TABLET
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 57896090101
|
| Hospital Charge Code |
6022156
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Aetna Commercial |
$1.52
|
| Rate for Payer: Aetna Medicare Advantage |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.02
|
| Rate for Payer: Cigna Commercial |
$2.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.20
|
| Rate for Payer: Oxford Commercial |
$0.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.11
|
|
|
ASPIRIN 600 MG SUPP
|
Facility
|
IP
|
$10.12
|
|
|
Service Code
|
NDC 574703612
|
| Hospital Charge Code |
60627677
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.52
|
|
|
ASPIRIN 600 MG SUPP
|
Facility
|
OP
|
$10.12
|
|
|
Service Code
|
NDC 574703612
|
| Hospital Charge Code |
60627677
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$5.06 |
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: Aetna Medicare Advantage |
$3.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.58
|
| Rate for Payer: Cigna Commercial |
$5.06
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.04
|
| Rate for Payer: Oxford Commercial |
$2.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.02
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.27
|
|
|
ASPIRIN 81 MG CHEW TAB
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 62107002636
|
| Hospital Charge Code |
60627678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
|
|
ASPIRIN 81 MG CHEW TAB
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 62107002636
|
| Hospital Charge Code |
60627678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Aetna Commercial |
$1.52
|
| Rate for Payer: Aetna Medicare Advantage |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.02
|
| Rate for Payer: Cigna Commercial |
$2.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.20
|
| Rate for Payer: Oxford Commercial |
$0.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.11
|
|
|
ASPIRIN 81 MG TAB
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 10135017310
|
| Hospital Charge Code |
6023238
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Aetna Commercial |
$1.52
|
| Rate for Payer: Aetna Medicare Advantage |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.02
|
| Rate for Payer: Cigna Commercial |
$2.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.20
|
| Rate for Payer: Oxford Commercial |
$0.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.11
|
|
|
ASPIRIN 81 MG TAB
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 10135017310
|
| Hospital Charge Code |
6023238
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
|
|
ASPIRIN ASSAY
|
Facility
|
OP
|
$147.65
|
|
|
Service Code
|
HCPCS 85576
|
| Hospital Charge Code |
3038136
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$67.76
|
| Rate for Payer: Aetna Medicare Advantage |
$80.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$89.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$89.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$24.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$89.92
|
| Rate for Payer: Cigna Commercial |
$73.83
|
| Rate for Payer: Cigna Medicare Advantage |
$24.91
|
| Rate for Payer: Clover Medicare Advantage |
$23.66
|
| Rate for Payer: EmblemHealth Commercial |
$74.73
|
| Rate for Payer: Humana Medicare Advantage |
$25.66
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$24.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$44.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.93
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$24.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$24.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.91
|
|
|
ASPIRIN ASSAY
|
Facility
|
IP
|
$147.65
|
|
|
Service Code
|
HCPCS 85576
|
| Hospital Charge Code |
3038136
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$22.15 |
| Max. Negotiated Rate |
$22.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.15
|
|
|
ASPIRIN SUPP 325MG
|
Facility
|
OP
|
$1.95
|
|
| Hospital Charge Code |
6022149
|
|
Hospital Revenue Code
|
257
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Aetna Commercial |
$0.74
|
| Rate for Payer: Aetna Medicare Advantage |
$0.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.59
|
| Rate for Payer: Oxford Commercial |
$0.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.29
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.39
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.05
|
|
|
ASPIRIN SUPP 325MG
|
Facility
|
IP
|
$1.95
|
|
| Hospital Charge Code |
6022149
|
|
Hospital Revenue Code
|
257
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.29
|
|
|
ASPIRIN SUPP/648MG
|
Facility
|
IP
|
$1.00
|
|
| Hospital Charge Code |
60634976
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.15
|
|
|
ASPIRIN SUPP/648MG
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
60634976
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Aetna Commercial |
$0.38
|
| Rate for Payer: Aetna Medicare Advantage |
$0.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.26
|
| Rate for Payer: Cigna Commercial |
$0.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.30
|
| Rate for Payer: Oxford Commercial |
$0.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.03
|
|
|
ASPIRIN SUPPOSITORY/648MG
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
60634527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
|
|
ASPIRIN SUPPOSITORY/648MG
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
60634527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$1.14
|
| 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 |
$0.90
|
| Rate for Payer: Oxford Commercial |
$0.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.08
|
|
|
ASPIRIN TAB BUFF 325MG
|
Facility
|
IP
|
$3.85
|
|
| Hospital Charge Code |
60628567
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.58
|
|
|
ASPIRIN TAB BUFF 325MG
|
Facility
|
OP
|
$3.85
|
|
| Hospital Charge Code |
60628567
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Aetna Commercial |
$1.46
|
| Rate for Payer: Aetna Medicare Advantage |
$1.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.98
|
| Rate for Payer: Cigna Commercial |
$1.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.16
|
| Rate for Payer: Oxford Commercial |
$0.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.77
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.10
|
|
|
ASPIRIN TAB CHEW 81MG
|
Facility
|
IP
|
$1.95
|
|
| Hospital Charge Code |
6024137
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.29
|
|