|
TRAZODONE,SERUM (DESYREL)
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
38473097
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.45 |
| Max. Negotiated Rate |
$48.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$48.45
|
|
|
TRAZODONE,SERUM (DESYREL)
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
38473097
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$60.39
|
| Rate for Payer: Aetna Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$68.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$68.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$68.30
|
| Rate for Payer: Cigna Commercial |
$18.64
|
| Rate for Payer: Cigna Medicare Advantage |
$9.32
|
| Rate for Payer: Clover Medicare Advantage |
$17.71
|
| Rate for Payer: EmblemHealth Commercial |
$55.92
|
| Rate for Payer: Humana Medicare Advantage |
$19.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$41.99
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$48.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.64
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$19.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.64
|
|
|
TRAZODONE TAB 100MG
|
Facility
|
OP
|
$5.80
|
|
| Hospital Charge Code |
60628729
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.90 |
| Rate for Payer: Aetna Commercial |
$1.74
|
| Rate for Payer: Aetna Medicare Advantage |
$1.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.48
|
| Rate for Payer: Cigna Commercial |
$2.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.75
|
| Rate for Payer: Oxford Commercial |
$2.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.87
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.90
|
|
|
TRAZODONE TAB 100MG
|
Facility
|
IP
|
$5.80
|
|
| Hospital Charge Code |
60628729
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.87
|
|
|
TR BAND LNG W/INFLATOR XXRF06L
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
270643741C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.50
|
|
|
TR BAND LNG W/INFLATOR XXRF06L
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
270643741C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: Aetna Medicare Advantage |
$63.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$53.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$53.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$53.55
|
| Rate for Payer: Cigna Commercial |
$105.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.30
|
| Rate for Payer: Oxford Commercial |
$105.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$105.00
|
|
|
TR BAND LONG W INFLATR XXRF06L
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
270643741S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.50
|
|
|
TR BAND LONG W INFLATR XXRF06L
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
270643741S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: Aetna Medicare Advantage |
$63.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$53.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$53.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$53.55
|
| Rate for Payer: Cigna Commercial |
$105.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.30
|
| Rate for Payer: Oxford Commercial |
$105.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$105.00
|
|
|
TR BAND LONG W INFLATR XXRF06L
|
Facility
|
OP
|
$1,150.00
|
|
| Hospital Charge Code |
270643741
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.50 |
| Max. Negotiated Rate |
$575.00 |
| Rate for Payer: Aetna Commercial |
$345.00
|
| Rate for Payer: Aetna Medicare Advantage |
$345.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$293.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$293.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$293.25
|
| Rate for Payer: Cigna Commercial |
$575.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$149.50
|
| Rate for Payer: Oxford Commercial |
$575.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$172.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$575.00
|
|
|
TR BAND LONG W INFLATR XXRF06L
|
Facility
|
IP
|
$1,150.00
|
|
| Hospital Charge Code |
270643741
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$172.50 |
| Max. Negotiated Rate |
$172.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$172.50
|
|
|
TR BAND LONG W INFLATR XXRF06L
|
Facility
|
IP
|
$175.00
|
|
| Hospital Charge Code |
270643741N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.25
|
|
|
TR BAND LONG W INFLATR XXRF06L
|
Facility
|
OP
|
$175.00
|
|
| Hospital Charge Code |
270643741N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: Aetna Commercial |
$52.50
|
| Rate for Payer: Aetna Medicare Advantage |
$52.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$44.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$44.62
|
| Rate for Payer: Cigna Commercial |
$87.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.75
|
| Rate for Payer: Oxford Commercial |
$87.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$87.50
|
|
|
TR BAND STD W/INFLATOR XXRF06
|
Facility
|
IP
|
$1,150.00
|
|
| Hospital Charge Code |
270643105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$172.50 |
| Max. Negotiated Rate |
$172.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$172.50
|
|
|
TR BAND STD W/INFLATOR XXRF06
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
270643105S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: Aetna Medicare Advantage |
$63.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$53.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$53.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$53.55
|
| Rate for Payer: Cigna Commercial |
$105.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.30
|
| Rate for Payer: Oxford Commercial |
$105.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$105.00
|
|
|
TR BAND STD W/INFLATOR XXRF06
|
Facility
|
OP
|
$1,150.00
|
|
| Hospital Charge Code |
270643105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.50 |
| Max. Negotiated Rate |
$575.00 |
| Rate for Payer: Aetna Commercial |
$345.00
|
| Rate for Payer: Aetna Medicare Advantage |
$345.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$293.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$293.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$293.25
|
| Rate for Payer: Cigna Commercial |
$575.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$149.50
|
| Rate for Payer: Oxford Commercial |
$575.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$172.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$575.00
|
|
|
TR BAND STD W/INFLATOR XXRF06
|
Facility
|
OP
|
$175.00
|
|
| Hospital Charge Code |
270643105N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: Aetna Commercial |
$52.50
|
| Rate for Payer: Aetna Medicare Advantage |
$52.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$44.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$44.62
|
| Rate for Payer: Cigna Commercial |
$87.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.75
|
| Rate for Payer: Oxford Commercial |
$87.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$87.50
|
|
|
TR BAND STD W/INFLATOR XXRF06
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
270643105S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.50
|
|
|
TR BAND STD W/INFLATOR XXRF06
|
Facility
|
IP
|
$175.00
|
|
| Hospital Charge Code |
270643105N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.25
|
|
|
TR BAND STD W INFTR XX RF06
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
270643105C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: Aetna Medicare Advantage |
$63.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$53.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$53.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$53.55
|
| Rate for Payer: Cigna Commercial |
$105.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.30
|
| Rate for Payer: Oxford Commercial |
$105.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$105.00
|
|
|
TR BAND STD W INFTR XX RF06
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
270643105C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.50
|
|
|
TRCOR2 UROBIOP NDL18x20
|
Facility
|
IP
|
$235.00
|
|
| Hospital Charge Code |
270643164
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.25 |
| Max. Negotiated Rate |
$35.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.25
|
|
|
TRCOR2 UROBIOP NDL18x20
|
Facility
|
OP
|
$235.00
|
|
| Hospital Charge Code |
270643164
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.55 |
| Max. Negotiated Rate |
$117.50 |
| Rate for Payer: Aetna Commercial |
$70.50
|
| Rate for Payer: Aetna Medicare Advantage |
$70.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$59.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$59.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$59.92
|
| Rate for Payer: Cigna Commercial |
$117.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.55
|
| Rate for Payer: Oxford Commercial |
$117.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$117.50
|
|
|
TRCU VENIPUNCTURE
|
Facility
|
IP
|
$26.25
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
1000101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$3.94 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.94
|
|
|
TRCU VENIPUNCTURE
|
Facility
|
OP
|
$26.25
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
1000101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Medicare Advantage |
$9.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.22
|
| Rate for Payer: Cigna Commercial |
$9.34
|
| Rate for Payer: Cigna Medicare Advantage |
$4.67
|
| Rate for Payer: Clover Medicare Advantage |
$8.87
|
| Rate for Payer: EmblemHealth Commercial |
$28.02
|
| Rate for Payer: Humana Medicare Advantage |
$9.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.41
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.34
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$9.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.34
|
|
|
TREANDA 100MG/20ML
|
Facility
|
IP
|
$23,893.27
|
|
|
Service Code
|
HCPCS J9033
|
| Hospital Charge Code |
60630209
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,583.99 |
| Max. Negotiated Rate |
$5,782.17 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,782.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,583.99
|
|
