|
ASPIRATION KIT SMALL VOLUME
|
Facility
|
OP
|
$750.00
|
|
| Hospital Charge Code |
270691941
|
|
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
|
|
|
ASPIRATOR IRRIGATION STR TIP
|
Facility
|
IP
|
$1,437.50
|
|
| Hospital Charge Code |
270657680
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$215.62 |
| Max. Negotiated Rate |
$347.88 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$287.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$347.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$215.62
|
|
|
ASPIRATOR IRRIGATION STR TIP
|
Facility
|
OP
|
$1,437.50
|
|
| Hospital Charge Code |
270657680
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$215.62 |
| Max. Negotiated Rate |
$718.75 |
| Rate for Payer: Aetna Commercial |
$431.25
|
| Rate for Payer: Aetna Medicare Advantage |
$431.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$366.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$366.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$287.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$366.56
|
| Rate for Payer: Cigna Commercial |
$718.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$347.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$215.62
|
|
|
ASPIRATOR KIT 3H 4 NEEDLE
|
Facility
|
OP
|
$1,085.00
|
|
| Hospital Charge Code |
270659844
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.05 |
| Max. Negotiated Rate |
$542.50 |
| Rate for Payer: Aetna Commercial |
$325.50
|
| Rate for Payer: Aetna Medicare Advantage |
$325.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$276.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$276.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$276.68
|
| Rate for Payer: Cigna Commercial |
$542.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$141.05
|
| Rate for Payer: Oxford Commercial |
$542.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$542.50
|
|
|
ASPIRATOR KIT 3H 4 NEEDLE
|
Facility
|
IP
|
$1,085.00
|
|
| Hospital Charge Code |
270659844
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$162.75 |
| Max. Negotiated Rate |
$162.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.75
|
|
|
ASPIRATOR MECONIUM
|
Facility
|
OP
|
$33.65
|
|
| Hospital Charge Code |
270600596
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$16.82 |
| Rate for Payer: Aetna Commercial |
$10.10
|
| Rate for Payer: Aetna Medicare Advantage |
$10.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.58
|
| Rate for Payer: Cigna Commercial |
$16.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.37
|
| Rate for Payer: Oxford Commercial |
$16.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$16.82
|
|
|
ASPIRATOR MECONIUM
|
Facility
|
IP
|
$33.65
|
|
| Hospital Charge Code |
270600596
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$5.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.05
|
|
|
ASPIRIN/130MG/TAB
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
60632489
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| 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 |
$0.39
|
| Rate for Payer: Oxford Commercial |
$1.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.50
|
|
|
ASPIRIN/130MG/TAB
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
60632489
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
|
|
ASPIRIN/300MG/EACH
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
60632488
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Aetna Commercial |
$0.30
|
| 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 |
$0.13
|
| Rate for Payer: Oxford Commercial |
$0.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.50
|
|
|
ASPIRIN/300MG/EACH
|
Facility
|
IP
|
$1.00
|
|
| Hospital Charge Code |
60632488
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.15
|
|
|
ASPIRIN 300 MG SUPP
|
Facility
|
OP
|
$9.78
|
|
|
Service Code
|
NDC 574703412
|
| Hospital Charge Code |
60627675
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$4.89 |
| Rate for Payer: Aetna Commercial |
$2.93
|
| Rate for Payer: Aetna Medicare Advantage |
$2.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.49
|
| Rate for Payer: Cigna Commercial |
$4.89
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.27
|
| Rate for Payer: Oxford Commercial |
$4.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.47
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.89
|
|
|
ASPIRIN 300 MG SUPP
|
Facility
|
IP
|
$9.78
|
|
|
Service Code
|
NDC 574703412
|
| Hospital Charge Code |
60627675
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$1.47 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.47
|
|
|
ASPIRIN 325MG BUFFERED TAB
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 904201559
|
| Hospital Charge Code |
606350925
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
|
|
ASPIRIN 325MG BUFFERED TAB
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 904201559
|
| Hospital Charge Code |
606350925
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Aetna Commercial |
$1.20
|
| 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 |
$0.52
|
| Rate for Payer: Oxford Commercial |
$2.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.00
|
|
|
ASPIRIN 325MG EC TAB UD
|
Facility
|
IP
|
$2.79
|
|
| Hospital Charge Code |
606350924
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.42
|
|
|
ASPIRIN 325MG EC TAB UD
|
Facility
|
OP
|
$2.79
|
|
| Hospital Charge Code |
606350924
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna Commercial |
$0.84
|
| Rate for Payer: Aetna Medicare Advantage |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.71
|
| Rate for Payer: Cigna Commercial |
$1.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.36
|
| Rate for Payer: Oxford Commercial |
$1.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.42
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.40
|
|
|
ASPIRIN 325MG TAB
|
Facility
|
OP
|
$2.00
|
|
| Hospital Charge Code |
83652551
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna Commercial |
$0.60
|
| Rate for Payer: Aetna Medicare Advantage |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.51
|
| Rate for Payer: Cigna Commercial |
$1.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.26
|
| Rate for Payer: Oxford Commercial |
$1.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.00
|
|
|
ASPIRIN 325MG TAB
|
Facility
|
IP
|
$2.00
|
|
| Hospital Charge Code |
83652551
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.30
|
|
|
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
|
OP
|
$3.00
|
|
| Hospital Charge Code |
60632491
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| 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 |
$0.39
|
| Rate for Payer: Oxford Commercial |
$1.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.50
|
|
|
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
|
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/325MG/TAB
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
60632493
|
|
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 |
$0.13 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Aetna Commercial |
$0.30
|
| 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 |
$0.13
|
| Rate for Payer: Oxford Commercial |
$0.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.50
|
|