|
YUTOPAR/10MG/1ML
|
Facility
|
IP
|
$414.00
|
|
| Hospital Charge Code |
60634186
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$62.10 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.10
|
|
|
YUTOPAR/10MG/1ML
|
Facility
|
OP
|
$414.00
|
|
| Hospital Charge Code |
60634186
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.82 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna Commercial |
$124.20
|
| Rate for Payer: Aetna Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$105.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$105.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$105.57
|
| Rate for Payer: Cigna Commercial |
$207.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$53.82
|
| Rate for Payer: Oxford Commercial |
$207.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$207.00
|
|
|
YUTOPAR/TAB
|
Facility
|
IP
|
$13.00
|
|
| Hospital Charge Code |
60634693
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.95
|
|
|
YUTOPAR/TAB
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
60634693
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna Medicare Advantage |
$3.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.31
|
| Rate for Payer: Cigna Commercial |
$6.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.69
|
| Rate for Payer: Oxford Commercial |
$6.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.50
|
|
|
ZA10 PTA FEMORAL-POPLITEAL AR
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS 37224
|
| Hospital Charge Code |
1600000375
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$750.00
|
|
|
ZA10 PTA FEMORAL-POPLITEAL AR
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS 37224
|
| Hospital Charge Code |
1600000375
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$9,851.00 |
| Rate for Payer: Aetna Commercial |
$1,500.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,275.00
|
| Rate for Payer: Cigna Commercial |
$2,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$650.00
|
| Rate for Payer: Oxford Commercial |
$8,679.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$750.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$9,851.00
|
|
|
ZALCITABINE 0.375 MG TAB
|
Facility
|
OP
|
$19.25
|
|
| Hospital Charge Code |
60627339
|
|
Hospital Revenue Code
|
252
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$9.62 |
| Rate for Payer: Aetna Commercial |
$5.78
|
| Rate for Payer: Aetna Medicare Advantage |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.91
|
| Rate for Payer: Cigna Commercial |
$9.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.50
|
| Rate for Payer: Oxford Commercial |
$9.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$9.62
|
|
|
ZALCITABINE 0.375 MG TAB
|
Facility
|
IP
|
$19.25
|
|
| Hospital Charge Code |
60627339
|
|
Hospital Revenue Code
|
252
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.89
|
|
|
ZANOSAR PER 1GM INJ
|
Facility
|
OP
|
$1,999.01
|
|
| Hospital Charge Code |
606394262
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$299.85 |
| Max. Negotiated Rate |
$999.50 |
| Rate for Payer: Aetna Commercial |
$599.70
|
| Rate for Payer: Aetna Medicare Advantage |
$599.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$509.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$509.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$509.75
|
| Rate for Payer: Cigna Commercial |
$999.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$483.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$299.85
|
|
|
ZANOSAR PER 1GM INJ
|
Facility
|
IP
|
$1,999.01
|
|
| Hospital Charge Code |
606394262
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$299.85 |
| Max. Negotiated Rate |
$483.76 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$483.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$299.85
|
|
|
ZANTAC 150MG GELDOSE
|
Facility
|
OP
|
$7.00
|
|
| Hospital Charge Code |
60635056
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: Aetna Medicare Advantage |
$2.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.78
|
| Rate for Payer: Cigna Commercial |
$3.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.91
|
| Rate for Payer: Oxford Commercial |
$3.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.50
|
|
|
ZANTAC 150MG GELDOSE
|
Facility
|
IP
|
$7.00
|
|
| Hospital Charge Code |
60635056
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.05
|
|
|
ZANTAC 150MG GELDOSE UD
|
Facility
|
IP
|
$15.00
|
|
| Hospital Charge Code |
60635057
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.25
|
|
|
ZANTAC 150MG GELDOSE UD
|
Facility
|
OP
|
$15.00
|
|
| Hospital Charge Code |
60635057
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.83
|
| Rate for Payer: Cigna Commercial |
$7.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.95
|
| Rate for Payer: Oxford Commercial |
$7.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$7.50
|
|
|
ZANTAC/150MG/TAB
|
Facility
|
OP
|
$12.00
|
|
| Hospital Charge Code |
60634188
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Medicare Advantage |
$3.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.06
|
| Rate for Payer: Cigna Commercial |
$6.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.56
|
| Rate for Payer: Oxford Commercial |
$6.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.00
|
|
|
ZANTAC/150MG/TAB
|
Facility
|
IP
|
$12.00
|
|
| Hospital Charge Code |
60634188
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.80
|
|
|
ZANTAC/25MG/1ML
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
60634189
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: Aetna Medicare Advantage |
$7.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6.12
|
| Rate for Payer: Cigna Commercial |
$12.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.12
|
| Rate for Payer: Oxford Commercial |
$12.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$12.00
|
|
|
ZANTAC/25MG/1ML
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
60634189
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.60
|
|
|
ZANTAC 300MG GELDOSE
|
Facility
|
OP
|
$15.00
|
|
| Hospital Charge Code |
60635058
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.83
|
| Rate for Payer: Cigna Commercial |
$7.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.95
|
| Rate for Payer: Oxford Commercial |
$7.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$7.50
|
|
|
ZANTAC 300MG GELDOSE
|
Facility
|
IP
|
$15.00
|
|
| Hospital Charge Code |
60635058
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.25
|
|
|
ZANTAC 300MG GELDOSE UD
|
Facility
|
IP
|
$21.00
|
|
| Hospital Charge Code |
60635059
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.15
|
|
|
ZANTAC 300MG GELDOSE UD
|
Facility
|
OP
|
$21.00
|
|
| Hospital Charge Code |
60635059
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Aetna Commercial |
$6.30
|
| Rate for Payer: Aetna Medicare Advantage |
$6.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5.36
|
| Rate for Payer: Cigna Commercial |
$10.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.73
|
| Rate for Payer: Oxford Commercial |
$10.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$10.50
|
|
|
ZANTAC/300MG/TAB
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
60634190
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna Medicare Advantage |
$3.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.31
|
| Rate for Payer: Cigna Commercial |
$6.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.69
|
| Rate for Payer: Oxford Commercial |
$6.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.50
|
|
|
ZANTAC/300MG/TAB
|
Facility
|
IP
|
$13.00
|
|
| Hospital Charge Code |
60634191
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.95
|
|
|
ZANTAC/300MG/TAB
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
60634191
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna Medicare Advantage |
$3.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.31
|
| Rate for Payer: Cigna Commercial |
$6.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.69
|
| Rate for Payer: Oxford Commercial |
$6.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.50
|
|