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Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

ATRIUM CHEST DRAINAGE DUAL

Facility

IP

$189.63

Hospital Charge Code	270650496
Hospital Revenue Code	272
Min. Negotiated Rate	$28.44
Max. Negotiated Rate	$28.44
Rate for Payer: Qualcare PPO/HMO/WC	$28.44

ATRIUM CHEST DRAINAGE DUAL

Facility

OP

$189.63

Hospital Charge Code	270650496
Hospital Revenue Code	272
Min. Negotiated Rate	$5.39
Max. Negotiated Rate	$94.81
Rate for Payer: Aetna Commercial	$72.06
Rate for Payer: Aetna Medicare Advantage	$56.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.36
Rate for Payer: Cigna Commercial	$94.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.30
Rate for Payer: Oxford Commercial	$37.93
Rate for Payer: Qualcare PPO/HMO/WC	$28.44
Rate for Payer: UnitedHealthcare Commercial	$37.93
Rate for Payer: UnitedHealthcare Community & State	$5.99
Rate for Payer: Wellpoint Medicaid Managed Care	$5.39

ATRIUM CHESTDRAINAGE UNITSINGL

Facility

IP

$102.50

Service Code	HCPCS C1729
Hospital Charge Code	270650497S
Hospital Revenue Code	278
Min. Negotiated Rate	$15.38
Max. Negotiated Rate	$24.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.80
Rate for Payer: Qualcare PPO/HMO/WC	$15.38

ATRIUM CHESTDRAINAGE UNITSINGL

Facility

OP

$24.72

Service Code	HCPCS C1729
Hospital Charge Code	270650497N
Hospital Revenue Code	278
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$12.36
Rate for Payer: Aetna Commercial	$9.39
Rate for Payer: Aetna Medicare Advantage	$7.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.30
Rate for Payer: Cigna Commercial	$12.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.98
Rate for Payer: Qualcare PPO/HMO/WC	$3.71
Rate for Payer: UnitedHealthcare Community & State	$0.78
Rate for Payer: Wellpoint Medicaid Managed Care	$0.70

ATRIUM CHESTDRAINAGE UNITSINGL

Facility

IP

$24.72

Service Code	HCPCS C1729
Hospital Charge Code	270650497N
Hospital Revenue Code	278
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$5.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.98
Rate for Payer: Qualcare PPO/HMO/WC	$3.71

ATRIUM CHESTDRAINAGE UNITSINGL

Facility

OP

$102.50

Service Code	HCPCS C1729
Hospital Charge Code	270650497
Hospital Revenue Code	278
Min. Negotiated Rate	$2.91
Max. Negotiated Rate	$51.25
Rate for Payer: Aetna Commercial	$38.95
Rate for Payer: Aetna Medicare Advantage	$30.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.14
Rate for Payer: Cigna Commercial	$51.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.80
Rate for Payer: Qualcare PPO/HMO/WC	$15.38
Rate for Payer: UnitedHealthcare Community & State	$3.24
Rate for Payer: Wellpoint Medicaid Managed Care	$2.91

ATRIUM CHESTDRAINAGE UNITSINGL

Facility

IP

$102.50

Service Code	HCPCS C1729
Hospital Charge Code	270650497
Hospital Revenue Code	278
Min. Negotiated Rate	$15.38
Max. Negotiated Rate	$24.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.80
Rate for Payer: Qualcare PPO/HMO/WC	$15.38

ATRIUM CHESTDRAINAGE UNITSINGL

Facility

IP

$102.50

Hospital Charge Code	270650497R
Hospital Revenue Code	272
Min. Negotiated Rate	$15.38
Max. Negotiated Rate	$15.38
Rate for Payer: Qualcare PPO/HMO/WC	$15.38

ATRIUM CHESTDRAINAGE UNITSINGL

Facility

OP

$102.50

Service Code	HCPCS C1729
Hospital Charge Code	270650497S
Hospital Revenue Code	278
Min. Negotiated Rate	$2.91
Max. Negotiated Rate	$51.25
Rate for Payer: Aetna Commercial	$38.95
Rate for Payer: Aetna Medicare Advantage	$30.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.14
Rate for Payer: Cigna Commercial	$51.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.80
Rate for Payer: Qualcare PPO/HMO/WC	$15.38
Rate for Payer: UnitedHealthcare Community & State	$3.24
Rate for Payer: Wellpoint Medicaid Managed Care	$2.91

ATRIUM CHESTDRAINAGE UNITSINGL

Facility

OP

$102.50

Hospital Charge Code	270650497R
Hospital Revenue Code	272
Min. Negotiated Rate	$2.91
Max. Negotiated Rate	$51.25
Rate for Payer: Aetna Commercial	$38.95
Rate for Payer: Aetna Medicare Advantage	$30.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.14
Rate for Payer: Cigna Commercial	$51.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.65
Rate for Payer: Oxford Commercial	$20.50
Rate for Payer: Qualcare PPO/HMO/WC	$15.38
Rate for Payer: UnitedHealthcare Commercial	$20.50
Rate for Payer: UnitedHealthcare Community & State	$3.24
Rate for Payer: Wellpoint Medicaid Managed Care	$2.91

ATROP/HYOS/SCOP/PHENOB ELIXIR

Facility

OP

$72.29

Service Code	NDC 66213042304
Hospital Charge Code	60637426
Hospital Revenue Code	250
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$36.15
Rate for Payer: Aetna Commercial	$27.47
Rate for Payer: Aetna Medicare Advantage	$21.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.43
Rate for Payer: Cigna Commercial	$36.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.80
Rate for Payer: Oxford Commercial	$14.46
Rate for Payer: Qualcare PPO/HMO/WC	$10.84
Rate for Payer: UnitedHealthcare Commercial	$14.46
Rate for Payer: UnitedHealthcare Community & State	$2.28
Rate for Payer: Wellpoint Medicaid Managed Care	$2.05

ATROP/HYOS/SCOP/PHENOB ELIXIR

Facility

IP

$72.29

Service Code	NDC 66213042304
Hospital Charge Code	60637426
Hospital Revenue Code	250
Min. Negotiated Rate	$10.84
Max. Negotiated Rate	$10.84
Rate for Payer: Qualcare PPO/HMO/WC	$10.84

ATROPINE 0.4 MG/ML INJ (1 ML)

Facility

IP

$28.01

Service Code	HCPCS J0461
Hospital Charge Code	60627424
Hospital Revenue Code	636
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$6.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.78
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

ATROPINE 0.4 MG/ML INJ (1 ML)

Facility

OP

$28.01

Service Code	HCPCS J0461
Hospital Charge Code	60627424
Hospital Revenue Code	636
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$14.01
Rate for Payer: Aetna Commercial	$10.64
Rate for Payer: Aetna Medicare Advantage	$8.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.14
Rate for Payer: Cigna Commercial	$14.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.78
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Community & State	$0.89
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

ATROPINE 0.4 MG/ML INJ (1ML)

Facility

IP

$58.63

Service Code	HCPCS J0461
Hospital Charge Code	60627423
Hospital Revenue Code	636
Min. Negotiated Rate	$8.79
Max. Negotiated Rate	$14.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.19
Rate for Payer: Qualcare PPO/HMO/WC	$8.79

ATROPINE 0.4 MG/ML INJ (1ML)

Facility

OP

$58.63

Service Code	HCPCS J0461
Hospital Charge Code	60627423
Hospital Revenue Code	636
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$29.32
Rate for Payer: Aetna Commercial	$22.28
Rate for Payer: Aetna Medicare Advantage	$17.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.95
Rate for Payer: Cigna Commercial	$29.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.19
Rate for Payer: Qualcare PPO/HMO/WC	$8.79
Rate for Payer: UnitedHealthcare Community & State	$1.85
Rate for Payer: Wellpoint Medicaid Managed Care	$1.67

ATROPINE 0.8MG/2ML

Facility

OP

$4.00

Service Code	HCPCS J0461
Hospital Charge Code	6063943061
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

ATROPINE 0.8MG/2ML

Facility

IP

$4.00

Service Code	HCPCS J0461
Hospital Charge Code	6063943061
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ATROPINE 1% OPHTHALMIN SOLN 2M

Facility

OP

$320.66

Service Code	NDC 17478021502
Hospital Charge Code	6063943291
Hospital Revenue Code	250
Min. Negotiated Rate	$9.11
Max. Negotiated Rate	$160.33
Rate for Payer: Aetna Commercial	$121.85
Rate for Payer: Aetna Medicare Advantage	$96.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.77
Rate for Payer: Cigna Commercial	$160.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.37
Rate for Payer: Oxford Commercial	$64.13
Rate for Payer: Qualcare PPO/HMO/WC	$48.10
Rate for Payer: UnitedHealthcare Commercial	$64.13
Rate for Payer: UnitedHealthcare Community & State	$10.13
Rate for Payer: Wellpoint Medicaid Managed Care	$9.11

ATROPINE 1% OPHTHALMIN SOLN 2M

Facility

IP

$320.66

Service Code	NDC 17478021502
Hospital Charge Code	6063943291
Hospital Revenue Code	250
Min. Negotiated Rate	$48.10
Max. Negotiated Rate	$48.10
Rate for Payer: Qualcare PPO/HMO/WC	$48.10

ATROPINE 1% OPHTH SOLN UD

Facility

OP

$2,404.97

Service Code	NDC 17478021505
Hospital Charge Code	60628064
Hospital Revenue Code	250
Min. Negotiated Rate	$68.30
Max. Negotiated Rate	$1,202.48
Rate for Payer: Aetna Commercial	$913.89
Rate for Payer: Aetna Medicare Advantage	$721.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$613.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$613.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$613.27
Rate for Payer: Cigna Commercial	$1,202.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$625.29
Rate for Payer: Oxford Commercial	$480.99
Rate for Payer: Qualcare PPO/HMO/WC	$360.75
Rate for Payer: UnitedHealthcare Commercial	$480.99
Rate for Payer: UnitedHealthcare Community & State	$76.00
Rate for Payer: Wellpoint Medicaid Managed Care	$68.30

ATROPINE 1% OPHTH SOLN UD

Facility

IP

$2,404.97

Service Code	NDC 17478021505
Hospital Charge Code	60628064
Hospital Revenue Code	250
Min. Negotiated Rate	$360.75
Max. Negotiated Rate	$360.75
Rate for Payer: Qualcare PPO/HMO/WC	$360.75

ATROPINE SULFATE/0.4MG/1M

Facility

IP

$4.00

Service Code	NDC 10019025012
Hospital Charge Code	60632505
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ATROPINE SULFATE/0.4MG/1M

Facility

OP

$4.00

Service Code	NDC 10019025012
Hospital Charge Code	60632505
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

ATROPINE SULFATE 0.5MG/5ML SYR

Facility

OP

$4.00

Service Code	NDC 70121170501
Hospital Charge Code	606390568
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

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