|
NACL 0.9% 1000cc BAG
|
Facility
|
IP
|
$6.35
|
|
| Hospital Charge Code |
270650062
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.95
|
|
|
NACL 0.9% 1000cc BAG
|
Facility
|
OP
|
$6.35
|
|
| Hospital Charge Code |
270650062
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: Aetna Commercial |
$1.91
|
| Rate for Payer: Aetna Medicare Advantage |
$1.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.62
|
| Rate for Payer: Cigna Commercial |
$3.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.83
|
| Rate for Payer: Oxford Commercial |
$3.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.17
|
|
|
NACL 0.9% 1000ML
|
Facility
|
IP
|
$9.65
|
|
| Hospital Charge Code |
270040190
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$1.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.45
|
|
|
NACL 0.9% 1000ML
|
Facility
|
OP
|
$9.65
|
|
| Hospital Charge Code |
270040190
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna Commercial |
$2.90
|
| Rate for Payer: Aetna Medicare Advantage |
$2.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.46
|
| Rate for Payer: Cigna Commercial |
$4.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.25
|
| Rate for Payer: Oxford Commercial |
$4.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.83
|
|
|
NACL 0.9% 1000ML***
|
Facility
|
IP
|
$22.00
|
|
| Hospital Charge Code |
7000193
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.30
|
|
|
NACL 0.9% 1000ML***
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
7000193
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: Aetna Commercial |
$6.60
|
| Rate for Payer: Aetna Medicare Advantage |
$6.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5.61
|
| Rate for Payer: Cigna Commercial |
$11.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.86
|
| Rate for Payer: Oxford Commercial |
$11.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.00
|
|
|
NACL 0.9% 100ML
|
Facility
|
OP
|
$9.65
|
|
| Hospital Charge Code |
270040200
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna Commercial |
$2.90
|
| Rate for Payer: Aetna Medicare Advantage |
$2.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.46
|
| Rate for Payer: Cigna Commercial |
$4.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.25
|
| Rate for Payer: Oxford Commercial |
$4.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.83
|
|
|
NACL 0.9% 100ML
|
Facility
|
IP
|
$9.65
|
|
| Hospital Charge Code |
270040200
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$1.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.45
|
|
|
NACL 0.9% 100ML ********
|
Facility
|
OP
|
$10.00
|
|
| Hospital Charge Code |
7000672
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Aetna Commercial |
$3.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.55
|
| Rate for Payer: Cigna Commercial |
$5.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.30
|
| Rate for Payer: Oxford Commercial |
$5.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.00
|
|
|
NACL 0.9% 100ML ********
|
Facility
|
IP
|
$10.00
|
|
| Hospital Charge Code |
7000672
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.50
|
|
|
NACL 0.9% 20 KCL 1000ml
|
Facility
|
IP
|
$9.95
|
|
| Hospital Charge Code |
270650116
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.49
|
|
|
NACL 0.9% 20 KCL 1000ml
|
Facility
|
OP
|
$9.95
|
|
| Hospital Charge Code |
270650116
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna Commercial |
$2.98
|
| Rate for Payer: Aetna Medicare Advantage |
$2.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.54
|
| Rate for Payer: Cigna Commercial |
$4.97
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.29
|
| Rate for Payer: Oxford Commercial |
$4.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.49
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.97
|
|
|
NACL 0.9% 250cc BOTTLE
|
Facility
|
IP
|
$5.10
|
|
| Hospital Charge Code |
270650057
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.77
|
|
|
NACL 0.9% 250cc BOTTLE
|
Facility
|
OP
|
$5.10
|
|
| Hospital Charge Code |
270650057
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Aetna Commercial |
$1.53
|
| Rate for Payer: Aetna Medicare Advantage |
$1.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.30
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.66
|
| Rate for Payer: Oxford Commercial |
$2.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.77
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.55
|
|
|
NACL .09% 250ML
|
Facility
|
OP
|
$22.50
|
|
| Hospital Charge Code |
270649313S
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$11.25 |
| Rate for Payer: Aetna Commercial |
$6.75
|
| Rate for Payer: Aetna Medicare Advantage |
$6.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5.74
|
| Rate for Payer: Cigna Commercial |
$11.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.92
|
| Rate for Payer: Oxford Commercial |
$11.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.25
|
|
|
NACL .09% 250ML
|
Facility
|
IP
|
$22.50
|
|
| Hospital Charge Code |
270649313S
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$3.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.38
|
|
|
NACL 0.9% 250ML
|
Facility
|
IP
|
$5.65
|
|
| Hospital Charge Code |
270040095
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.85
|
|
|
NACL 0.9% 250ML
|
Facility
|
OP
|
$5.65
|
|
| Hospital Charge Code |
270040095
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$2.83 |
| Rate for Payer: Aetna Commercial |
$1.70
|
| Rate for Payer: Aetna Medicare Advantage |
$1.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.44
|
| Rate for Payer: Cigna Commercial |
$2.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.73
|
| Rate for Payer: Oxford Commercial |
$2.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.83
|
|
|
NACL 0.9% 250ML*****
|
Facility
|
OP
|
$10.00
|
|
| Hospital Charge Code |
7000185
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Aetna Commercial |
$3.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.55
|
| Rate for Payer: Cigna Commercial |
$5.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.30
|
| Rate for Payer: Oxford Commercial |
$5.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.00
|
|
|
NACL 0.9% 250ML*****
|
Facility
|
IP
|
$10.00
|
|
| Hospital Charge Code |
7000185
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.50
|
|
|
NACL 0.9% 250ML GLASS ******
|
Facility
|
IP
|
$16.00
|
|
| Hospital Charge Code |
7000508
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.40
|
|
|
NACL 0.9% 250ML GLASS ******
|
Facility
|
OP
|
$16.00
|
|
| Hospital Charge Code |
7000508
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Aetna Commercial |
$4.80
|
| Rate for Payer: Aetna Medicare Advantage |
$4.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.08
|
| Rate for Payer: Cigna Commercial |
$8.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.08
|
| Rate for Payer: Oxford Commercial |
$8.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.00
|
|
|
NACL 0.9% 3000ML ******
|
Facility
|
OP
|
$23.00
|
|
| Hospital Charge Code |
1608231
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$11.50 |
| Rate for Payer: Aetna Commercial |
$6.90
|
| Rate for Payer: Aetna Medicare Advantage |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5.87
|
| Rate for Payer: Cigna Commercial |
$11.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.99
|
| Rate for Payer: Oxford Commercial |
$11.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.50
|
|
|
NACL 0.9% 3000ML ******
|
Facility
|
IP
|
$23.00
|
|
| Hospital Charge Code |
1608231
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$3.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.45
|
|
|
NACL .09% 3000ml CBI
|
Facility
|
OP
|
$35.00
|
|
| Hospital Charge Code |
270650080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Aetna Commercial |
$10.50
|
| Rate for Payer: Aetna Medicare Advantage |
$10.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.93
|
| Rate for Payer: Cigna Commercial |
$17.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.55
|
| Rate for Payer: Oxford Commercial |
$17.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$17.50
|
|