|
EDMS III BECKER
|
Facility
|
OP
|
$981.00
|
|
| Hospital Charge Code |
270670474
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.53 |
| Max. Negotiated Rate |
$490.50 |
| Rate for Payer: Aetna Commercial |
$294.30
|
| Rate for Payer: Aetna Medicare Advantage |
$294.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$250.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$250.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$250.16
|
| Rate for Payer: Cigna Commercial |
$490.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$127.53
|
| Rate for Payer: Oxford Commercial |
$490.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$490.50
|
|
|
EDM VENTRICULAR CATHETER
|
Facility
|
OP
|
$249.00
|
|
| Hospital Charge Code |
270335578
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.37 |
| Max. Negotiated Rate |
$124.50 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Aetna Medicare Advantage |
$74.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$63.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$63.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$63.49
|
| Rate for Payer: Cigna Commercial |
$124.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.37
|
| Rate for Payer: Oxford Commercial |
$124.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.50
|
|
|
EDM VENTRICULAR CATHETER
|
Facility
|
IP
|
$249.00
|
|
| Hospital Charge Code |
270335578
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.35 |
| Max. Negotiated Rate |
$37.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.35
|
|
|
EDROPH CHLOR INJ 10MG/ML 15ML
|
Facility
|
OP
|
$154.25
|
|
| Hospital Charge Code |
6002158
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$77.12 |
| Rate for Payer: Aetna Commercial |
$46.27
|
| Rate for Payer: Aetna Medicare Advantage |
$46.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$39.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$39.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$39.33
|
| Rate for Payer: Cigna Commercial |
$77.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.05
|
| Rate for Payer: Oxford Commercial |
$77.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$77.12
|
|
|
EDROPH CHLOR INJ 10MG/ML 15ML
|
Facility
|
IP
|
$154.25
|
|
| Hospital Charge Code |
6002158
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.14 |
| Max. Negotiated Rate |
$23.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.14
|
|
|
EDROPH CHLOR INJ 10MG/ML 1ML
|
Facility
|
OP
|
$37.80
|
|
| Hospital Charge Code |
6002141
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$18.90 |
| Rate for Payer: Aetna Commercial |
$11.34
|
| Rate for Payer: Aetna Medicare Advantage |
$11.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.64
|
| Rate for Payer: Cigna Commercial |
$18.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.91
|
| Rate for Payer: Oxford Commercial |
$18.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.67
|
| Rate for Payer: UnitedHealthcare Commercial |
$18.90
|
|
|
EDROPH CHLOR INJ 10MG/ML 1ML
|
Facility
|
IP
|
$37.80
|
|
| Hospital Charge Code |
6002141
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$5.67 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.67
|
|
|
EDROPHONIUM 10 MG/ML INJ
|
Facility
|
IP
|
$44.85
|
|
| Hospital Charge Code |
60627876
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$6.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.73
|
|
|
EDROPHONIUM 10 MG/ML INJ
|
Facility
|
OP
|
$44.85
|
|
| Hospital Charge Code |
60627876
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$22.43 |
| Rate for Payer: Aetna Commercial |
$13.46
|
| Rate for Payer: Aetna Medicare Advantage |
$13.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$11.44
|
| Rate for Payer: Cigna Commercial |
$22.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.83
|
| Rate for Payer: Oxford Commercial |
$22.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$22.43
|
|
|
EDROPHONIUM CHLORIDE 10 MG/ML
|
Facility
|
OP
|
$42.88
|
|
|
Service Code
|
NDC 67457019015
|
| Hospital Charge Code |
6063943195
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$21.44 |
| Rate for Payer: Aetna Commercial |
$12.86
|
| Rate for Payer: Aetna Medicare Advantage |
$12.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.93
|
| Rate for Payer: Cigna Commercial |
$21.44
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.57
|
| Rate for Payer: Oxford Commercial |
$21.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.43
|
| Rate for Payer: UnitedHealthcare Commercial |
$21.44
|
|
|
EDROPHONIUM CHLORIDE 10 MG/ML
|
Facility
|
IP
|
$42.88
|
|
|
Service Code
|
NDC 67457019015
|
| Hospital Charge Code |
6063943195
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$6.43 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.43
|
|
|
ED URINE PREGNANCY TEST
|
Facility
|
OP
|
$697.62
|
|
|
Service Code
|
HCPCS 81025
|
| Hospital Charge Code |
5700265
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$27.90
|
| Rate for Payer: Aetna Medicare Advantage |
$8.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$31.55
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Cigna Medicare Advantage |
$4.30
|
| Rate for Payer: Clover Medicare Advantage |
$8.18
|
| Rate for Payer: EmblemHealth Commercial |
$25.83
|
| Rate for Payer: Humana Medicare Advantage |
$8.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$90.69
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$104.64
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8.61
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$9.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.61
|
|
|
ED URINE PREGNANCY TEST
|
Facility
|
IP
|
$697.62
|
|
|
Service Code
|
HCPCS 81025
|
| Hospital Charge Code |
5700265
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.64 |
| Max. Negotiated Rate |
$104.64 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$104.64
|
|
|
EEG *******
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 95816
|
| Hospital Charge Code |
5400015
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.00
|
|
|
EEG *******
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 95816
|
| Hospital Charge Code |
5400015
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$3,847.00 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Aetna Medicare Advantage |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$45.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$45.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$294.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$45.90
|
| Rate for Payer: Cigna Commercial |
$514.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$23.40
|
| Rate for Payer: Oxford Commercial |
$3,390.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,847.00
|
|
|
EEG AWAKE AND ASLEEP
|
Facility
|
OP
|
$1,004.00
|
|
|
Service Code
|
HCPCS 95819
|
| Hospital Charge Code |
90000045
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$130.52 |
| Max. Negotiated Rate |
$3,847.00 |
| Rate for Payer: Aetna Commercial |
$301.20
|
| Rate for Payer: Aetna Medicare Advantage |
$301.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$256.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$256.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$277.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$256.02
|
| Rate for Payer: Cigna Commercial |
$514.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$130.52
|
| Rate for Payer: Oxford Commercial |
$3,390.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,847.00
|
|
|
EEG AWAKE AND ASLEEP
|
Facility
|
IP
|
$1,004.00
|
|
|
Service Code
|
HCPCS 95819
|
| Hospital Charge Code |
90000045
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$150.60 |
| Max. Negotiated Rate |
$150.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.60
|
|
|
EEG AWAKE/DROWSY
|
Facility
|
IP
|
$576.00
|
|
|
Service Code
|
HCPCS 95816
|
| Hospital Charge Code |
5500028
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$86.40 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.40
|
|
|
EEG AWAKE/DROWSY
|
Facility
|
OP
|
$576.00
|
|
|
Service Code
|
HCPCS 95816
|
| Hospital Charge Code |
5500028
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$74.88 |
| Max. Negotiated Rate |
$3,847.00 |
| Rate for Payer: Aetna Commercial |
$172.80
|
| Rate for Payer: Aetna Medicare Advantage |
$172.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$146.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$146.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$294.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$146.88
|
| Rate for Payer: Cigna Commercial |
$514.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$74.88
|
| Rate for Payer: Oxford Commercial |
$3,390.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,847.00
|
|
|
EEG AWAKE/SLEEP
|
Facility
|
OP
|
$2,208.72
|
|
|
Service Code
|
HCPCS 95819
|
| Hospital Charge Code |
5500026
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$277.15 |
| Max. Negotiated Rate |
$3,847.00 |
| Rate for Payer: Aetna Commercial |
$662.62
|
| Rate for Payer: Aetna Medicare Advantage |
$662.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$563.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$563.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$277.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$563.22
|
| Rate for Payer: Cigna Commercial |
$514.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$287.13
|
| Rate for Payer: Oxford Commercial |
$3,390.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$331.31
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,847.00
|
|
|
EEG AWAKE/SLEEP
|
Facility
|
IP
|
$2,208.72
|
|
|
Service Code
|
HCPCS 95819
|
| Hospital Charge Code |
5500026
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$331.31 |
| Max. Negotiated Rate |
$331.31 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$331.31
|
|
|
EEG BRAIN DEATH
|
Facility
|
OP
|
$1,105.00
|
|
|
Service Code
|
HCPCS 95824
|
| Hospital Charge Code |
36540015
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$23.23 |
| Max. Negotiated Rate |
$3,847.00 |
| Rate for Payer: Aetna Commercial |
$331.50
|
| Rate for Payer: Aetna Medicare Advantage |
$331.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$281.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$281.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$281.77
|
| Rate for Payer: Cigna Commercial |
$888.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$143.65
|
| Rate for Payer: Oxford Commercial |
$3,390.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$165.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,847.00
|
|
|
EEG BRAIN DEATH
|
Facility
|
IP
|
$1,105.00
|
|
|
Service Code
|
HCPCS 95824
|
| Hospital Charge Code |
36540015
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$165.75 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$165.75
|
|
|
EEG COMA OR SLEEP ONLY
|
Facility
|
IP
|
$1,004.00
|
|
|
Service Code
|
HCPCS 95822
|
| Hospital Charge Code |
90000050
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$150.60 |
| Max. Negotiated Rate |
$150.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.60
|
|
|
EEG COMA OR SLEEP ONLY
|
Facility
|
OP
|
$1,004.00
|
|
|
Service Code
|
HCPCS 95822
|
| Hospital Charge Code |
90000050
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$130.52 |
| Max. Negotiated Rate |
$3,847.00 |
| Rate for Payer: Aetna Commercial |
$301.20
|
| Rate for Payer: Aetna Medicare Advantage |
$301.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$256.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$256.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$269.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$256.02
|
| Rate for Payer: Cigna Commercial |
$514.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$130.52
|
| Rate for Payer: Oxford Commercial |
$3,390.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,847.00
|
|