|
WATER IRRIG STER 1000ml
|
Facility
|
IP
|
$17.70
|
|
| Hospital Charge Code |
270653165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.65
|
|
|
WATER IRRIG STER 1000ml
|
Facility
|
OP
|
$17.70
|
|
| Hospital Charge Code |
270653165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Aetna Commercial |
$5.31
|
| Rate for Payer: Aetna Medicare Advantage |
$5.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.51
|
| Rate for Payer: Cigna Commercial |
$8.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.30
|
| Rate for Payer: Oxford Commercial |
$8.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.85
|
|
|
WATER IRRIG STER 3000ml
|
Facility
|
OP
|
$47.70
|
|
| Hospital Charge Code |
270649261
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$23.85 |
| Rate for Payer: Aetna Commercial |
$14.31
|
| Rate for Payer: Aetna Medicare Advantage |
$14.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.16
|
| Rate for Payer: Cigna Commercial |
$23.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.20
|
| Rate for Payer: Oxford Commercial |
$23.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.16
|
| Rate for Payer: UnitedHealthcare Commercial |
$23.85
|
|
|
WATER IRRIG STER 3000ml
|
Facility
|
IP
|
$47.70
|
|
| Hospital Charge Code |
270649261
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.16 |
| Max. Negotiated Rate |
$7.16 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.16
|
|
|
WATER IRRIG STER 500ml 6139-03
|
Facility
|
OP
|
$22.50
|
|
| Hospital Charge Code |
270649263
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
WATER IRRIG STER 500ml 6139-03
|
Facility
|
IP
|
$22.50
|
|
| Hospital Charge Code |
270649263
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$3.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.38
|
|
|
WATER/MINERAL OIL/PETROL LOTIO
|
Facility
|
OP
|
$21.15
|
|
| Hospital Charge Code |
60628830
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$10.57 |
| Rate for Payer: Aetna Commercial |
$6.34
|
| Rate for Payer: Aetna Medicare Advantage |
$6.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5.39
|
| Rate for Payer: Cigna Commercial |
$10.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.75
|
| Rate for Payer: Oxford Commercial |
$10.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$10.57
|
|
|
WATER/MINERAL OIL/PETROL LOTIO
|
Facility
|
IP
|
$21.15
|
|
| Hospital Charge Code |
60628830
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.17
|
|
|
WATER PETROLAT MINRL OIL 120GM
|
Facility
|
OP
|
$34.37
|
|
|
Service Code
|
NDC 54162060002
|
| Hospital Charge Code |
60628463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna Commercial |
$10.31
|
| Rate for Payer: Aetna Medicare Advantage |
$10.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.76
|
| Rate for Payer: Cigna Commercial |
$17.18
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.47
|
| Rate for Payer: Oxford Commercial |
$17.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.16
|
| Rate for Payer: UnitedHealthcare Commercial |
$17.18
|
|
|
WATER PETROLAT MINRL OIL 120GM
|
Facility
|
IP
|
$34.37
|
|
|
Service Code
|
NDC 54162060002
|
| Hospital Charge Code |
60628463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$5.16 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.16
|
|
|
WATER PETROLAT MINRL OIL 454GM
|
Facility
|
OP
|
$94.45
|
|
| Hospital Charge Code |
60628464
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.28 |
| Max. Negotiated Rate |
$47.23 |
| Rate for Payer: Aetna Commercial |
$28.34
|
| Rate for Payer: Aetna Medicare Advantage |
$28.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$24.08
|
| Rate for Payer: Cigna Commercial |
$47.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.28
|
| Rate for Payer: Oxford Commercial |
$47.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$47.23
|
|
|
WATER PETROLAT MINRL OIL 454GM
|
Facility
|
IP
|
$94.45
|
|
| Hospital Charge Code |
60628464
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.17 |
| Max. Negotiated Rate |
$14.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.17
|
|
|
WATER SNAKE
|
Facility
|
OP
|
$939.45
|
|
| Hospital Charge Code |
270655971
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$122.13 |
| Max. Negotiated Rate |
$469.73 |
| Rate for Payer: Aetna Commercial |
$281.83
|
| Rate for Payer: Aetna Medicare Advantage |
$281.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$239.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$239.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$239.56
|
| Rate for Payer: Cigna Commercial |
$469.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$122.13
|
| Rate for Payer: Oxford Commercial |
$469.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$140.92
|
| Rate for Payer: UnitedHealthcare Commercial |
$469.73
|
|
|
WATER SNAKE
|
Facility
|
IP
|
$939.45
|
|
| Hospital Charge Code |
270655971
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$140.92 |
| Max. Negotiated Rate |
$140.92 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$140.92
|
|
|
WATER STERIL 1000cc BOTTLE
|
Facility
|
IP
|
$22.50
|
|
| Hospital Charge Code |
270650061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$3.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.38
|
|
|
WATER STERIL 1000cc BOTTLE
|
Facility
|
OP
|
$22.50
|
|
| Hospital Charge Code |
270650061
|
|
Hospital Revenue Code
|
272
|
| 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
|
|
|
WATER STERILE 1000cc BAG
|
Facility
|
IP
|
$17.70
|
|
| Hospital Charge Code |
270650118
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.65
|
|
|
WATER STERILE 1000cc BAG
|
Facility
|
OP
|
$17.70
|
|
| Hospital Charge Code |
270650118
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Aetna Commercial |
$5.31
|
| Rate for Payer: Aetna Medicare Advantage |
$5.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.51
|
| Rate for Payer: Cigna Commercial |
$8.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.30
|
| Rate for Payer: Oxford Commercial |
$8.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.85
|
|
|
WATER STERILE 1000ml BAG L8500
|
Facility
|
IP
|
$65.15
|
|
| Hospital Charge Code |
270632977
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$9.77 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.77
|
|
|
WATER STERILE 1000ml BAG L8500
|
Facility
|
OP
|
$65.15
|
|
| Hospital Charge Code |
270632977
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.47 |
| Max. Negotiated Rate |
$32.58 |
| Rate for Payer: Aetna Commercial |
$19.55
|
| Rate for Payer: Aetna Medicare Advantage |
$19.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$16.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$16.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$16.61
|
| Rate for Payer: Cigna Commercial |
$32.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.47
|
| Rate for Payer: Oxford Commercial |
$32.58
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.77
|
| Rate for Payer: UnitedHealthcare Commercial |
$32.58
|
|
|
WATER, STERILE 10ML 10 ML SOL
|
Facility
|
IP
|
$22.65
|
|
|
Service Code
|
NDC 63323018510
|
| Hospital Charge Code |
6063943271
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.40
|
|
|
WATER, STERILE 10ML 10 ML SOL
|
Facility
|
OP
|
$22.65
|
|
|
Service Code
|
NDC 63323018510
|
| Hospital Charge Code |
6063943271
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$11.32 |
| Rate for Payer: Aetna Commercial |
$6.79
|
| Rate for Payer: Aetna Medicare Advantage |
$6.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5.78
|
| Rate for Payer: Cigna Commercial |
$11.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.94
|
| Rate for Payer: Oxford Commercial |
$11.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.32
|
|
|
WATER STERILE 250cc BOTTLE
|
Facility
|
IP
|
$22.50
|
|
| Hospital Charge Code |
270650064
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$3.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.38
|
|
|
WATER STERILE 250cc BOTTLE
|
Facility
|
OP
|
$22.50
|
|
| Hospital Charge Code |
270650064
|
|
Hospital Revenue Code
|
272
|
| 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
|
|
|
WATER STERILE 2OUNCE BOTTLE
|
Facility
|
IP
|
$22.19
|
|
| Hospital Charge Code |
270653903
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$3.33 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.33
|
|