|
ABSTACK 5mm W/20 TACKS B000596
|
Facility
|
IP
|
$2,392.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270645859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$358.84 |
| Max. Negotiated Rate |
$578.92 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$478.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$578.92
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$358.84
|
|
|
ABSTACK 5mm W/20 TACKS B000596
|
Facility
|
OP
|
$2,392.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270645859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$358.84 |
| Max. Negotiated Rate |
$1,196.12 |
| Rate for Payer: Aetna Commercial |
$717.67
|
| Rate for Payer: Aetna Medicare Advantage |
$717.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$610.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$610.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$478.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$610.02
|
| Rate for Payer: Cigna Commercial |
$1,196.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$578.92
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$358.84
|
|
|
AB TOXOPLASMA
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86777
|
| Hospital Charge Code |
401386777
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$46.62
|
| Rate for Payer: Aetna Medicare Advantage |
$14.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$22.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$52.72
|
| Rate for Payer: Cigna Commercial |
$14.39
|
| Rate for Payer: Cigna Medicare Advantage |
$7.20
|
| Rate for Payer: Clover Medicare Advantage |
$13.67
|
| Rate for Payer: EmblemHealth Commercial |
$43.17
|
| Rate for Payer: Humana Medicare Advantage |
$14.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$50.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.39
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$15.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.39
|
|
|
AB TOXOPLASMA
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86777
|
| Hospital Charge Code |
401386777
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
AB TOXOPLASMA IGM
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86778
|
| Hospital Charge Code |
401386778
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
AB TOXOPLASMA IGM
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86778
|
| Hospital Charge Code |
401386778
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$46.69
|
| Rate for Payer: Aetna Medicare Advantage |
$14.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$28.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$52.80
|
| Rate for Payer: Cigna Commercial |
$14.41
|
| Rate for Payer: Cigna Medicare Advantage |
$7.21
|
| Rate for Payer: Clover Medicare Advantage |
$13.69
|
| Rate for Payer: EmblemHealth Commercial |
$43.23
|
| Rate for Payer: Humana Medicare Advantage |
$14.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$50.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.41
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$15.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.41
|
|
|
ABUTMENT EP HEALING 2PCS TH254
|
Facility
|
OP
|
$125.00
|
|
| Hospital Charge Code |
270620302
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$62.50 |
| Rate for Payer: Aetna Commercial |
$37.50
|
| Rate for Payer: Aetna Medicare Advantage |
$37.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$31.88
|
| Rate for Payer: Cigna Commercial |
$62.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.25
|
| Rate for Payer: Oxford Commercial |
$62.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$62.50
|
|
|
ABUTMENT EP HEALING 2PCS TH254
|
Facility
|
IP
|
$125.00
|
|
| Hospital Charge Code |
270620302
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
|
|
AB VIRUS,NON SPECIFIC
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
38476269
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$443.55 |
| Rate for Payer: Aetna Commercial |
$41.73
|
| Rate for Payer: Aetna Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$443.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47.19
|
| Rate for Payer: Cigna Commercial |
$12.88
|
| Rate for Payer: Cigna Medicare Advantage |
$6.44
|
| Rate for Payer: Clover Medicare Advantage |
$12.24
|
| Rate for Payer: EmblemHealth Commercial |
$38.64
|
| Rate for Payer: Humana Medicare Advantage |
$13.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$28.34
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$13.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.88
|
|
|
AB VIRUS,NON SPECIFIC
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
38476269
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$32.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.70
|
|
|
ACAPELLA PEDIATRIC BLUE
|
Facility
|
IP
|
$205.49
|
|
| Hospital Charge Code |
270664899
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.82 |
| Max. Negotiated Rate |
$30.82 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.82
|
|
|
ACAPELLA PEDIATRIC BLUE
|
Facility
|
OP
|
$205.49
|
|
| Hospital Charge Code |
270664899
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.71 |
| Max. Negotiated Rate |
$102.75 |
| Rate for Payer: Aetna Commercial |
$61.65
|
| Rate for Payer: Aetna Medicare Advantage |
$61.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$52.40
|
| Rate for Payer: Cigna Commercial |
$102.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$26.71
|
| Rate for Payer: Oxford Commercial |
$102.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.82
|
| Rate for Payer: UnitedHealthcare Commercial |
$102.75
|
|
|
ACARBOSE
|
Facility
|
OP
|
$8.51
|
|
|
Service Code
|
NDC 50419086148
|
| Hospital Charge Code |
6024202
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Aetna Commercial |
$2.55
|
| Rate for Payer: Aetna Medicare Advantage |
$2.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.17
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.11
|
| Rate for Payer: Oxford Commercial |
$4.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.25
|
|
|
ACARBOSE
|
Facility
|
IP
|
$8.51
|
|
|
Service Code
|
NDC 50419086148
|
| Hospital Charge Code |
6024202
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$1.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.28
|
|
|
ACCELL CONNEXUS 5CC PUTTY
|
Facility
|
IP
|
$5,500.00
|
|
| Hospital Charge Code |
270657197
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$1,331.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,331.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$825.00
|
|
|
ACCELL CONNEXUS 5CC PUTTY
|
Facility
|
OP
|
$5,500.00
|
|
| Hospital Charge Code |
270657197
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$2,750.00 |
| Rate for Payer: Aetna Commercial |
$1,650.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,402.50
|
| Rate for Payer: Cigna Commercial |
$2,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,331.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$825.00
|
|
|
ACCELL DBM 100 021000010
|
Facility
|
OP
|
$1,550.00
|
|
| Hospital Charge Code |
270638108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.50 |
| Max. Negotiated Rate |
$775.00 |
| Rate for Payer: Aetna Commercial |
$465.00
|
| Rate for Payer: Aetna Medicare Advantage |
$465.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$395.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$395.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$395.25
|
| Rate for Payer: Cigna Commercial |
$775.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.50
|
| Rate for Payer: Oxford Commercial |
$775.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$232.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$775.00
|
|
|
ACCELL DBM 100 021000010
|
Facility
|
IP
|
$1,550.00
|
|
| Hospital Charge Code |
270638108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$232.50 |
| Max. Negotiated Rate |
$232.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$232.50
|
|
|
ACCESS DSC 5 F X 125CM
|
Facility
|
IP
|
$6,750.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270685192
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,012.50 |
| Max. Negotiated Rate |
$1,633.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,350.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,633.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,012.50
|
|
|
ACCESS DSC 5 F X 125CM
|
Facility
|
OP
|
$6,750.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270685192
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,012.50 |
| Max. Negotiated Rate |
$3,375.00 |
| Rate for Payer: Aetna Commercial |
$2,025.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,025.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,721.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,721.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,721.25
|
| Rate for Payer: Cigna Commercial |
$3,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,633.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,012.50
|
|
|
ACCESS NAVIEN DSC 6F X 115CM
|
Facility
|
IP
|
$5,750.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270685193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.50 |
| Max. Negotiated Rate |
$1,391.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,391.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$862.50
|
|
|
ACCESS NAVIEN DSC 6F X 115CM
|
Facility
|
OP
|
$5,750.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270685193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.50 |
| Max. Negotiated Rate |
$2,875.00 |
| Rate for Payer: Aetna Commercial |
$1,725.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,725.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,466.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,466.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,466.25
|
| Rate for Payer: Cigna Commercial |
$2,875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,391.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$862.50
|
|
|
ACCESS NEEDLE 8Gx11CM
|
Facility
|
IP
|
$1,375.00
|
|
| Hospital Charge Code |
270672820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$206.25 |
| Max. Negotiated Rate |
$206.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$206.25
|
|
|
ACCESS NEEDLE 8Gx11CM
|
Facility
|
OP
|
$1,375.00
|
|
| Hospital Charge Code |
270672820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$178.75 |
| Max. Negotiated Rate |
$687.50 |
| Rate for Payer: Aetna Commercial |
$412.50
|
| Rate for Payer: Aetna Medicare Advantage |
$412.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$350.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$350.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$350.62
|
| Rate for Payer: Cigna Commercial |
$687.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$178.75
|
| Rate for Payer: Oxford Commercial |
$687.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$206.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$687.50
|
|
|
ACCESSORY BLOOD PRESSURE KIT
|
Facility
|
IP
|
$3,875.00
|
|
| Hospital Charge Code |
270656966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$581.25 |
| Max. Negotiated Rate |
$581.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$581.25
|
|