Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

TOOL METAL GUIDEWIRE INSERTION

Facility

IP

$19.30

Hospital Charge Code	270637999
Hospital Revenue Code	272
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$2.90
Rate for Payer: Qualcare PPO/HMO/WC	$2.90

TOOL METAL GUIDEWIRE INSERTION

Facility

OP

$19.30

Hospital Charge Code	270637999S
Hospital Revenue Code	272
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$9.65
Rate for Payer: Aetna Commercial	$7.33
Rate for Payer: Aetna Medicare Advantage	$5.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.92
Rate for Payer: Cigna Commercial	$9.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.79
Rate for Payer: Oxford Commercial	$3.86
Rate for Payer: Qualcare PPO/HMO/WC	$2.90
Rate for Payer: UnitedHealthcare Commercial	$3.86
Rate for Payer: UnitedHealthcare Community & State	$0.47
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

TOOL METAL GUIDEWIRE INSERTION

Facility

OP

$19.30

Hospital Charge Code	270637999
Hospital Revenue Code	272
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$9.65
Rate for Payer: Aetna Commercial	$7.33
Rate for Payer: Aetna Medicare Advantage	$5.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.92
Rate for Payer: Cigna Commercial	$9.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.79
Rate for Payer: Oxford Commercial	$3.86
Rate for Payer: Qualcare PPO/HMO/WC	$2.90
Rate for Payer: UnitedHealthcare Commercial	$3.86
Rate for Payer: UnitedHealthcare Community & State	$0.47
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

TOOL METAL GUIDEWIRE INSERTION

Facility

IP

$19.30

Hospital Charge Code	270637999S
Hospital Revenue Code	272
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$2.90
Rate for Payer: Qualcare PPO/HMO/WC	$2.90

TOOL METAL GUIDEWIRE INSERTION

Facility

IP

$19.30

Hospital Charge Code	270637999N
Hospital Revenue Code	272
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$2.90
Rate for Payer: Qualcare PPO/HMO/WC	$2.90

TOOL METAL GUIDEWIRE INSERTION

Facility

OP

$19.30

Hospital Charge Code	270637999N
Hospital Revenue Code	272
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$9.65
Rate for Payer: Aetna Commercial	$7.33
Rate for Payer: Aetna Medicare Advantage	$5.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.92
Rate for Payer: Cigna Commercial	$9.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.79
Rate for Payer: Oxford Commercial	$3.86
Rate for Payer: Qualcare PPO/HMO/WC	$2.90
Rate for Payer: UnitedHealthcare Commercial	$3.86
Rate for Payer: UnitedHealthcare Community & State	$0.47
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

TOOL, MIDAS REX DISSECTING

Facility

OP

$1,170.00

Hospital Charge Code	270690927
Hospital Revenue Code	272
Min. Negotiated Rate	$28.20
Max. Negotiated Rate	$585.00
Rate for Payer: Aetna Commercial	$444.60
Rate for Payer: Aetna Medicare Advantage	$351.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$298.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$298.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$298.35
Rate for Payer: Cigna Commercial	$585.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$351.00
Rate for Payer: Oxford Commercial	$234.00
Rate for Payer: Qualcare PPO/HMO/WC	$175.50
Rate for Payer: UnitedHealthcare Commercial	$234.00
Rate for Payer: UnitedHealthcare Community & State	$28.20
Rate for Payer: Wellpoint Medicaid Managed Care	$31.00

TOOL, MIDAS REX DISSECTING

Facility

IP

$1,170.00

Hospital Charge Code	270690927
Hospital Revenue Code	272
Min. Negotiated Rate	$175.50
Max. Negotiated Rate	$175.50
Rate for Payer: Qualcare PPO/HMO/WC	$175.50

TOOTHBRUSH YOUTH

Facility

OP

$2.45

Hospital Charge Code	270300440
Hospital Revenue Code	270
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.93
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.62
Rate for Payer: Cigna Commercial	$1.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.74
Rate for Payer: Oxford Commercial	$0.49
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$0.49
Rate for Payer: UnitedHealthcare Community & State	$0.06
Rate for Payer: Wellpoint Medicaid Managed Care	$0.06

TOOTHBRUSH YOUTH

Facility

IP

$2.45

Hospital Charge Code	270300440
Hospital Revenue Code	270
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

TOOTHETTE ORAL CARE ******

Facility

OP

$19.00

Hospital Charge Code	8004376
Hospital Revenue Code	272
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$9.50
Rate for Payer: Aetna Commercial	$7.22
Rate for Payer: Aetna Medicare Advantage	$5.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.84
Rate for Payer: Cigna Commercial	$9.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.70
Rate for Payer: Oxford Commercial	$3.80
Rate for Payer: Qualcare PPO/HMO/WC	$2.85
Rate for Payer: UnitedHealthcare Commercial	$3.80
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.50

TOOTHETTE ORAL CARE ******

Facility

IP

$19.00

Hospital Charge Code	8004376
Hospital Revenue Code	272
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$2.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.85

TOOTHETTE ORAL CARE KIT

Facility

OP

$50.45

Hospital Charge Code	270302207
Hospital Revenue Code	270
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

TOOTHETTE ORAL CARE KIT

Facility

IP

$50.45

Hospital Charge Code	270302207
Hospital Revenue Code	270
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$7.57
Rate for Payer: Qualcare PPO/HMO/WC	$7.57

TOPAMAX 100MG TAB

Facility

IP

$95.68

Service Code	NDC 50458064165
Hospital Charge Code	60635506
Hospital Revenue Code	250
Min. Negotiated Rate	$14.35
Max. Negotiated Rate	$14.35
Rate for Payer: Qualcare PPO/HMO/WC	$14.35

TOPAMAX 100MG TAB

Facility

OP

$95.68

Service Code	NDC 50458064165
Hospital Charge Code	60635506
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$47.84
Rate for Payer: Aetna Commercial	$36.36
Rate for Payer: Aetna Medicare Advantage	$28.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.40
Rate for Payer: Cigna Commercial	$47.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.70
Rate for Payer: Oxford Commercial	$19.14
Rate for Payer: Qualcare PPO/HMO/WC	$14.35
Rate for Payer: UnitedHealthcare Commercial	$19.14
Rate for Payer: UnitedHealthcare Community & State	$2.31
Rate for Payer: Wellpoint Medicaid Managed Care	$2.54

TOPAZ MICRODEBRIDER W/IFS

Facility

OP

$2,265.00

Hospital Charge Code	270675005
Hospital Revenue Code	272
Min. Negotiated Rate	$54.59
Max. Negotiated Rate	$1,132.50
Rate for Payer: Aetna Commercial	$860.70
Rate for Payer: Aetna Medicare Advantage	$679.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$577.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$577.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$577.58
Rate for Payer: Cigna Commercial	$1,132.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$679.50
Rate for Payer: Oxford Commercial	$453.00
Rate for Payer: Qualcare PPO/HMO/WC	$339.75
Rate for Payer: UnitedHealthcare Commercial	$453.00
Rate for Payer: UnitedHealthcare Community & State	$54.59
Rate for Payer: Wellpoint Medicaid Managed Care	$60.02

TOPAZ MICRODEBRIDER W/IFS

Facility

IP

$2,265.00

Hospital Charge Code	270675005
Hospital Revenue Code	272
Min. Negotiated Rate	$339.75
Max. Negotiated Rate	$339.75
Rate for Payer: Qualcare PPO/HMO/WC	$339.75

TOPICAL COMPOUND

Facility

IP

$215.05

Hospital Charge Code	6010326
Hospital Revenue Code	251
Min. Negotiated Rate	$32.26
Max. Negotiated Rate	$32.26
Rate for Payer: Qualcare PPO/HMO/WC	$32.26

TOPICAL COMPOUND

Facility

OP

$215.05

Hospital Charge Code	6010326
Hospital Revenue Code	251
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$107.53
Rate for Payer: Aetna Commercial	$81.72
Rate for Payer: Aetna Medicare Advantage	$64.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.84
Rate for Payer: Cigna Commercial	$107.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.52
Rate for Payer: Oxford Commercial	$43.01
Rate for Payer: Qualcare PPO/HMO/WC	$32.26
Rate for Payer: UnitedHealthcare Commercial	$43.01
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$5.70

TOPICAL FIBRINOLYSIN OINT

Facility

IP

$383.25

Hospital Charge Code	60628459
Hospital Revenue Code	250
Min. Negotiated Rate	$57.49
Max. Negotiated Rate	$57.49
Rate for Payer: Qualcare PPO/HMO/WC	$57.49

TOPICAL FIBRINOLYSIN OINT

Facility

OP

$383.25

Hospital Charge Code	60628459
Hospital Revenue Code	250
Min. Negotiated Rate	$9.24
Max. Negotiated Rate	$191.62
Rate for Payer: Aetna Commercial	$145.63
Rate for Payer: Aetna Medicare Advantage	$114.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.73
Rate for Payer: Cigna Commercial	$191.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.97
Rate for Payer: Oxford Commercial	$76.65
Rate for Payer: Qualcare PPO/HMO/WC	$57.49
Rate for Payer: UnitedHealthcare Commercial	$76.65
Rate for Payer: UnitedHealthcare Community & State	$9.24
Rate for Payer: Wellpoint Medicaid Managed Care	$10.16

TOPICAL SKIN ADHESIVE 35ML

Facility

IP

$798.60

Hospital Charge Code	270663132
Hospital Revenue Code	270
Min. Negotiated Rate	$119.79
Max. Negotiated Rate	$119.79
Rate for Payer: Qualcare PPO/HMO/WC	$119.79

TOPICAL SKIN ADHESIVE 35ML

Facility

OP

$798.60

Hospital Charge Code	270663132
Hospital Revenue Code	270
Min. Negotiated Rate	$19.25
Max. Negotiated Rate	$399.30
Rate for Payer: Aetna Commercial	$303.47
Rate for Payer: Aetna Medicare Advantage	$239.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$203.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$203.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$203.64
Rate for Payer: Cigna Commercial	$399.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$239.58
Rate for Payer: Oxford Commercial	$159.72
Rate for Payer: Qualcare PPO/HMO/WC	$119.79
Rate for Payer: UnitedHealthcare Commercial	$159.72
Rate for Payer: UnitedHealthcare Community & State	$19.25
Rate for Payer: Wellpoint Medicaid Managed Care	$21.16

TOPICAL SOL *******

Facility

IP

$38.00

Hospital Charge Code	8001778
Hospital Revenue Code	279
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$5.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.70