|
JAMSHEDI /TROCAR
|
Facility
|
OP
|
$750.00
|
|
| Hospital Charge Code |
270704095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| Rate for Payer: Aetna Medicare Advantage |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$97.50
|
| Rate for Payer: Oxford Commercial |
$375.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$375.00
|
|
|
JAMSHEDI /TROCAR
|
Facility
|
IP
|
$750.00
|
|
| Hospital Charge Code |
270704095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
JAMSHIDI
|
Facility
|
OP
|
$1,250.00
|
|
| Hospital Charge Code |
270703278
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$162.50 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: Aetna Commercial |
$375.00
|
| Rate for Payer: Aetna Medicare Advantage |
$375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$318.75
|
| Rate for Payer: Cigna Commercial |
$625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$162.50
|
| Rate for Payer: Oxford Commercial |
$625.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$625.00
|
|
|
JAMSHIDI
|
Facility
|
IP
|
$1,250.00
|
|
| Hospital Charge Code |
270703278
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
|
|
JAMSHIDI
|
Facility
|
OP
|
$750.00
|
|
| Hospital Charge Code |
270703850
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| Rate for Payer: Aetna Medicare Advantage |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$97.50
|
| Rate for Payer: Oxford Commercial |
$375.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$375.00
|
|
|
JAMSHIDI
|
Facility
|
IP
|
$750.00
|
|
| Hospital Charge Code |
270703850
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
JAMSHIDI BONE GRAFT NEEDLE
|
Facility
|
OP
|
$675.00
|
|
| Hospital Charge Code |
270704179
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$87.75 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Aetna Medicare Advantage |
$202.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$172.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$172.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$172.12
|
| Rate for Payer: Cigna Commercial |
$337.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$87.75
|
| Rate for Payer: Oxford Commercial |
$337.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$101.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$337.50
|
|
|
JAMSHIDI BONE GRAFT NEEDLE
|
Facility
|
IP
|
$675.00
|
|
| Hospital Charge Code |
270704179
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$101.25 |
| Max. Negotiated Rate |
$101.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$101.25
|
|
|
JAMSHIDI EVOLVE
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
270702850
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$211.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$175.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$211.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.25
|
|
|
JAMSHIDI EVOLVE
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
270702850
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$437.50 |
| Rate for Payer: Aetna Commercial |
$262.50
|
| Rate for Payer: Aetna Medicare Advantage |
$262.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$223.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$223.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$175.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$223.12
|
| Rate for Payer: Cigna Commercial |
$437.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$211.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.25
|
|
|
JAM SHIDI NEEDLE
|
Facility
|
IP
|
$2,250.00
|
|
| Hospital Charge Code |
270705702
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
|
|
JAM SHIDI NEEDLE
|
Facility
|
OP
|
$2,250.00
|
|
| Hospital Charge Code |
270705702
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$292.50 |
| Max. Negotiated Rate |
$1,125.00 |
| Rate for Payer: Aetna Commercial |
$675.00
|
| Rate for Payer: Aetna Medicare Advantage |
$675.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$573.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$573.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$573.75
|
| Rate for Payer: Cigna Commercial |
$1,125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$292.50
|
| Rate for Payer: Oxford Commercial |
$1,125.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,125.00
|
|
|
JAMSHIDI NEEDLE 11GX5IN
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
270705446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.75 |
| Max. Negotiated Rate |
$437.50 |
| Rate for Payer: Aetna Commercial |
$262.50
|
| Rate for Payer: Aetna Medicare Advantage |
$262.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$223.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$223.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$223.12
|
| Rate for Payer: Cigna Commercial |
$437.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$113.75
|
| Rate for Payer: Oxford Commercial |
$437.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$437.50
|
|
|
JAMSHIDI NEEDLE 11GX5IN
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
270705446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$131.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.25
|
|
|
JAMSHIDI NEEDLE 8G
|
Facility
|
OP
|
$500.00
|
|
| Hospital Charge Code |
270696835
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$150.00
|
| Rate for Payer: Aetna Medicare Advantage |
$150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$127.50
|
| Rate for Payer: Cigna Commercial |
$250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$65.00
|
| Rate for Payer: Oxford Commercial |
$250.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$250.00
|
|
|
JAMSHIDI NEEDLE 8G
|
Facility
|
IP
|
$500.00
|
|
| Hospital Charge Code |
270696835
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
|
|
JANSSEN COV19 VACC AD26 .5ML
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 91303
|
| Hospital Charge Code |
606390404
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.00
|
| Rate for Payer: Aetna Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.00
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
JANSSEN COV19 VACC AD26 .5ML
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 91303
|
| Hospital Charge Code |
606390404
|
|
Hospital Revenue Code
|
636
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
JANSSEN COVID19 BOOSTER ADMIN
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS 0034A
|
| Hospital Charge Code |
43080034A
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
|
|
JANSSEN COVID19 BOOSTER ADMIN
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS 0034A
|
| Hospital Charge Code |
42010034A
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: Aetna Commercial |
$15.00
|
| Rate for Payer: Aetna Medicare Advantage |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.75
|
| Rate for Payer: Cigna Commercial |
$25.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.50
|
| Rate for Payer: Oxford Commercial |
$91.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$103.00
|
|
|
JANSSEN COVID19 BOOSTER ADMIN
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS 0034A
|
| Hospital Charge Code |
32480034A
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: Aetna Commercial |
$15.00
|
| Rate for Payer: Aetna Medicare Advantage |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.75
|
| Rate for Payer: Cigna Commercial |
$25.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.50
|
| Rate for Payer: Oxford Commercial |
$91.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$103.00
|
|
|
JANSSEN COVID19 BOOSTER ADMIN
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS 0034A
|
| Hospital Charge Code |
32480034A
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
|
|
JANSSEN COVID19 BOOSTER ADMIN
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS 0034A
|
| Hospital Charge Code |
43080034A
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: Aetna Commercial |
$15.00
|
| Rate for Payer: Aetna Medicare Advantage |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.75
|
| Rate for Payer: Cigna Commercial |
$25.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.50
|
| Rate for Payer: Oxford Commercial |
$91.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$103.00
|
|
|
JANSSEN COVID19 BOOSTER ADMIN
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS 0034A
|
| Hospital Charge Code |
30470034A
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
|
|
JANSSEN COVID19 BOOSTER ADMIN
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS 0034A
|
| Hospital Charge Code |
32350034A
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: Aetna Commercial |
$15.00
|
| Rate for Payer: Aetna Medicare Advantage |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.75
|
| Rate for Payer: Cigna Commercial |
$25.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.50
|
| Rate for Payer: Oxford Commercial |
$91.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$103.00
|
|