|
SOCK ARTHROSCOPY SPEC
|
Facility
|
OP
|
$29.65
|
|
| Hospital Charge Code |
270601227
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$14.82 |
| Rate for Payer: Aetna Commercial |
$11.27
|
| Rate for Payer: Aetna Medicare Advantage |
$8.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.56
|
| Rate for Payer: Cigna Commercial |
$14.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.89
|
| Rate for Payer: Oxford Commercial |
$5.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.93
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.71
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.79
|
|
|
SOCK ARTHROSCOPY SPEC
|
Facility
|
IP
|
$29.65
|
|
| Hospital Charge Code |
270601227
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$4.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.45
|
|
|
SOCKET NON-SLIP 1/2 DRIVE
|
Facility
|
OP
|
$449.75
|
|
| Hospital Charge Code |
270617608
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.84 |
| Max. Negotiated Rate |
$224.88 |
| Rate for Payer: Aetna Commercial |
$170.91
|
| Rate for Payer: Aetna Medicare Advantage |
$134.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$114.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$114.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$114.69
|
| Rate for Payer: Cigna Commercial |
$224.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$134.93
|
| Rate for Payer: Oxford Commercial |
$89.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.46
|
| Rate for Payer: UnitedHealthcare Commercial |
$89.95
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.92
|
|
|
SOCKET NON-SLIP 1/2 DRIVE
|
Facility
|
IP
|
$449.75
|
|
| Hospital Charge Code |
270617608
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.46 |
| Max. Negotiated Rate |
$67.46 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.46
|
|
|
SOD ACETATE INJ/40MEQ/20M
|
Facility
|
OP
|
$7.00
|
|
| Hospital Charge Code |
60634293
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Aetna Commercial |
$2.66
|
| Rate for Payer: Aetna Medicare Advantage |
$2.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.78
|
| Rate for Payer: Cigna Commercial |
$3.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.10
|
| Rate for Payer: Oxford Commercial |
$1.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.19
|
|
|
SOD ACETATE INJ/40MEQ/20M
|
Facility
|
IP
|
$7.00
|
|
| Hospital Charge Code |
60634293
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.05
|
|
|
SODA SORB PRE-PACK
|
Facility
|
IP
|
$50.45
|
|
| Hospital Charge Code |
270070085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$7.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.57
|
|
|
SODA SORB PRE-PACK
|
Facility
|
OP
|
$50.45
|
|
| Hospital Charge Code |
270070085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$25.23 |
| Rate for Payer: Aetna Commercial |
$19.17
|
| Rate for Payer: Aetna Medicare Advantage |
$15.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.86
|
| Rate for Payer: Cigna Commercial |
$25.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.13
|
| Rate for Payer: Oxford Commercial |
$10.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$10.09
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.34
|
|
|
SODA SORB PRE-PACK
|
Facility
|
IP
|
$47.72
|
|
| Hospital Charge Code |
27070085
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.16 |
| Max. Negotiated Rate |
$7.16 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.16
|
|
|
SODA SORB PRE-PACK
|
Facility
|
OP
|
$47.72
|
|
| Hospital Charge Code |
27070085
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$23.86 |
| Rate for Payer: Aetna Commercial |
$18.13
|
| Rate for Payer: Aetna Medicare Advantage |
$14.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.17
|
| Rate for Payer: Cigna Commercial |
$23.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.32
|
| Rate for Payer: Oxford Commercial |
$9.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.16
|
| Rate for Payer: UnitedHealthcare Commercial |
$9.54
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.26
|
|
|
SODBIC 7.5% 50ML
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
60635515
|
|
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
|
|
|
SODBIC 7.5% 50ML
|
Facility
|
IP
|
$1.00
|
|
| Hospital Charge Code |
60635515
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.15
|
|
|
SOD BICARBONATE ABBO 4.2%
|
Facility
|
IP
|
$8.00
|
|
| Hospital Charge Code |
60634421
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.20
|
|
|
SOD BICARBONATE ABBO 4.2%
|
Facility
|
OP
|
$8.00
|
|
| Hospital Charge Code |
60634421
|
|
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
|
|
|
SOD BICARBONATE ABBO 8.4%
|
Facility
|
OP
|
$12.00
|
|
| Hospital Charge Code |
60634422
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Aetna Commercial |
$4.56
|
| Rate for Payer: Aetna Medicare Advantage |
$3.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.06
|
| Rate for Payer: Cigna Commercial |
$6.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.60
|
| Rate for Payer: Oxford Commercial |
$2.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.32
|
|
|
SOD BICARBONATE ABBO 8.4%
|
Facility
|
IP
|
$12.00
|
|
| Hospital Charge Code |
60634422
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.80
|
|
|
SOD CHL INJ/100MEQ/40ML
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
60634294
|
|
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
|
|
|
SOD CHL INJ/100MEQ/40ML
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
60634294
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
|
|
SOD CHL INJ 23.4%/30ML VI
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
60634295
|
|
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
|
|
|
SOD CHL INJ 23.4%/30ML VI
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
60634295
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
|
|
SOD CHLORIDE 0.9%/3ML
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
60635148
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
|
|
SOD CHLORIDE 0.9%/3ML
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
60635148
|
|
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
|
|
|
SOD.CHLORIDE 2ML SYRINGE
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
60635374
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
|
|
SOD.CHLORIDE 2ML SYRINGE
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
60635374
|
|
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
|
|
|
SOD CHLORIDE 5% INJ/500ML
|
Facility
|
IP
|
$34.00
|
|
| Hospital Charge Code |
60634237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.10
|
|