Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

DOXYCYCLINE HYCLATE 100MG TAB

Facility

IP

$19.78

Hospital Charge Code	60630236
Hospital Revenue Code	250
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$2.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.97

DOXYCYLINE HYCLATE 100MG ORAL

Facility

IP

$15.11

Hospital Charge Code	606361052
Hospital Revenue Code	636
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$3.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.66
Rate for Payer: Qualcare PPO/HMO/WC	$2.27

DOXYCYLINE HYCLATE 100MG ORAL

Facility

OP

$15.11

Hospital Charge Code	606361052
Hospital Revenue Code	636
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$7.55
Rate for Payer: Aetna Commercial	$5.74
Rate for Payer: Aetna Medicare Advantage	$4.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.85
Rate for Payer: Cigna Commercial	$7.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.66
Rate for Payer: Qualcare PPO/HMO/WC	$2.27
Rate for Payer: UnitedHealthcare Community & State	$0.48
Rate for Payer: Wellpoint Medicaid Managed Care	$0.43

DPD GENE MUTATION

Facility

IP

$460.22

Service Code	HCPCS 81400
Hospital Charge Code	397080008
Hospital Revenue Code	306
Min. Negotiated Rate	$69.03
Max. Negotiated Rate	$69.03
Rate for Payer: Qualcare PPO/HMO/WC	$69.03

DPD GENE MUTATION

Facility

OP

$460.22

Service Code	HCPCS 81400
Hospital Charge Code	397080008
Hospital Revenue Code	306
Min. Negotiated Rate	$13.07
Max. Negotiated Rate	$232.01
Rate for Payer: Aetna Commercial	$173.97
Rate for Payer: Aetna Medicare Advantage	$207.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$232.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$232.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$63.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$232.01
Rate for Payer: Cigna Commercial	$230.11
Rate for Payer: Cigna Medicare Advantage	$63.96
Rate for Payer: Clover Medicare Advantage	$60.76
Rate for Payer: EmblemHealth Commercial	$191.88
Rate for Payer: Humana Medicare Advantage	$65.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$63.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.66
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.03
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$51.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$63.96
Rate for Payer: Wellcare Medicare Advantage	$63.96
Rate for Payer: Wellpoint Medicaid Managed Care	$13.07

DRAINAGE BAG W/JACKSON-PRATT10

Facility

IP

$103.00

Service Code	HCPCS A4357
Hospital Charge Code	270658349
Hospital Revenue Code	272
Min. Negotiated Rate	$15.45
Max. Negotiated Rate	$15.45
Rate for Payer: Qualcare PPO/HMO/WC	$15.45

DRAINAGE BAG W/JACKSON-PRATT10

Facility

IP

$103.00

Service Code	HCPCS A4357
Hospital Charge Code	270658349S
Hospital Revenue Code	272
Min. Negotiated Rate	$15.45
Max. Negotiated Rate	$15.45
Rate for Payer: Qualcare PPO/HMO/WC	$15.45

DRAINAGE BAG W/JACKSON-PRATT10

Facility

OP

$103.00

Service Code	HCPCS A4357
Hospital Charge Code	270658349S
Hospital Revenue Code	272
Min. Negotiated Rate	$2.93
Max. Negotiated Rate	$51.50
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$30.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.27
Rate for Payer: Cigna Commercial	$51.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.78
Rate for Payer: Oxford Commercial	$20.60
Rate for Payer: Qualcare PPO/HMO/WC	$15.45
Rate for Payer: UnitedHealthcare Commercial	$20.60
Rate for Payer: UnitedHealthcare Community & State	$3.25
Rate for Payer: Wellpoint Medicaid Managed Care	$2.93

DRAINAGE BAG W/JACKSON-PRATT10

Facility

IP

$100.00

Service Code	HCPCS A4357
Hospital Charge Code	270658349N
Hospital Revenue Code	272
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

DRAINAGE BAG W/JACKSON-PRATT10

Facility

OP

$103.00

Hospital Charge Code	270658349R
Hospital Revenue Code	272
Min. Negotiated Rate	$2.93
Max. Negotiated Rate	$51.50
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$30.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.27
Rate for Payer: Cigna Commercial	$51.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.78
Rate for Payer: Oxford Commercial	$20.60
Rate for Payer: Qualcare PPO/HMO/WC	$15.45
Rate for Payer: UnitedHealthcare Commercial	$20.60
Rate for Payer: UnitedHealthcare Community & State	$3.25
Rate for Payer: Wellpoint Medicaid Managed Care	$2.93

DRAINAGE BAG W/JACKSON-PRATT10

Facility

IP

$103.00

Hospital Charge Code	270658349R
Hospital Revenue Code	272
Min. Negotiated Rate	$15.45
Max. Negotiated Rate	$15.45
Rate for Payer: Qualcare PPO/HMO/WC	$15.45

DRAINAGE BAG W/JACKSON-PRATT10

Facility

OP

$100.00

Service Code	HCPCS A4357
Hospital Charge Code	270658349N
Hospital Revenue Code	272
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Commercial	$38.00
Rate for Payer: Aetna Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.50
Rate for Payer: Cigna Commercial	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.00
Rate for Payer: Oxford Commercial	$20.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$20.00
Rate for Payer: UnitedHealthcare Community & State	$3.16
Rate for Payer: Wellpoint Medicaid Managed Care	$2.84

DRAINAGE BAG W/JACKSON-PRATT10

Facility

OP

$103.00

Service Code	HCPCS A4357
Hospital Charge Code	270658349
Hospital Revenue Code	272
Min. Negotiated Rate	$2.93
Max. Negotiated Rate	$51.50
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$30.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.27
Rate for Payer: Cigna Commercial	$51.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.78
Rate for Payer: Oxford Commercial	$20.60
Rate for Payer: Qualcare PPO/HMO/WC	$15.45
Rate for Payer: UnitedHealthcare Commercial	$20.60
Rate for Payer: UnitedHealthcare Community & State	$3.25
Rate for Payer: Wellpoint Medicaid Managed Care	$2.93

DRAINAGE LYMPH NODE LESION

Facility

OP

$16,852.60

Service Code	HCPCS 38305
Hospital Charge Code	1600000650
Hospital Revenue Code	360
Min. Negotiated Rate	$478.61
Max. Negotiated Rate	$12,518.07
Rate for Payer: Aetna Commercial	$9,386.39
Rate for Payer: Aetna Medicare Advantage	$11,180.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,518.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,518.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,450.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,518.07
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: Cigna Medicare Advantage	$3,450.88
Rate for Payer: Clover Medicare Advantage	$3,278.34
Rate for Payer: EmblemHealth Commercial	$10,352.64
Rate for Payer: Humana Medicare Advantage	$3,554.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,450.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,381.68
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,527.89
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$532.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,450.88
Rate for Payer: Wellcare Medicare Advantage	$3,450.88
Rate for Payer: Wellpoint Medicaid Managed Care	$478.61

DRAINAGE LYMPH NODE LESION

Facility

IP

$16,852.60

Service Code	HCPCS 38305
Hospital Charge Code	1600000650
Hospital Revenue Code	360
Min. Negotiated Rate	$2,527.89
Max. Negotiated Rate	$2,527.89
Rate for Payer: Qualcare PPO/HMO/WC	$2,527.89

DRAINAGE OF HIP AND JOINT

Facility

IP

$11,558.00

Service Code	HCPCS 27030
Hospital Charge Code	1600000332
Hospital Revenue Code	360
Min. Negotiated Rate	$1,733.70
Max. Negotiated Rate	$1,733.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,733.70

DRAINAGE OF HIP AND JOINT

Facility

OP

$11,558.00

Service Code	HCPCS 27030
Hospital Charge Code	1600000332
Hospital Revenue Code	360
Min. Negotiated Rate	$328.25
Max. Negotiated Rate	$31,271.12
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31,271.12
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,005.08
Rate for Payer: Oxford Commercial	$11,677.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,733.70
Rate for Payer: UnitedHealthcare Commercial	$12,906.00
Rate for Payer: UnitedHealthcare Community & State	$365.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$328.25

DRAINAGE OF NOSE LESION

Facility

IP

$714.00

Service Code	HCPCS 30000
Hospital Charge Code	16000923
Hospital Revenue Code	360
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$107.10
Rate for Payer: Qualcare PPO/HMO/WC	$107.10

DRAINAGE OF NOSE LESION

Facility

OP

$714.00

Service Code	HCPCS 30000
Hospital Charge Code	16000923
Hospital Revenue Code	360
Min. Negotiated Rate	$20.28
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$765.35
Rate for Payer: Aetna Medicare Advantage	$911.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$281.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.71
Rate for Payer: Cigna Commercial	$564.04
Rate for Payer: Cigna Medicare Advantage	$281.38
Rate for Payer: Clover Medicare Advantage	$267.31
Rate for Payer: EmblemHealth Commercial	$844.14
Rate for Payer: Humana Medicare Advantage	$289.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$281.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$185.64
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$107.10
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$22.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$281.38
Rate for Payer: Wellcare Medicare Advantage	$281.38
Rate for Payer: Wellpoint Medicaid Managed Care	$20.28

DRAINAGE OF SCROTAL WALL ABSCE

Facility

IP

$6,799.08

Service Code	HCPCS 55100
Hospital Charge Code	160000233
Hospital Revenue Code	360
Min. Negotiated Rate	$1,019.86
Max. Negotiated Rate	$1,019.86
Rate for Payer: Qualcare PPO/HMO/WC	$1,019.86

DRAINAGE OF SCROTAL WALL ABSCE

Facility

OP

$6,799.08

Service Code	HCPCS 55100
Hospital Charge Code	160000233
Hospital Revenue Code	360
Min. Negotiated Rate	$193.09
Max. Negotiated Rate	$7,117.66
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,117.66
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,767.76
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,019.86
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$214.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$193.09

DRAINAGE OF SCROTUM

Facility

IP

$6,782.72

Service Code	HCPCS 54700
Hospital Charge Code	16000650
Hospital Revenue Code	360
Min. Negotiated Rate	$1,017.41
Max. Negotiated Rate	$1,017.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,017.41

DRAINAGE OF SCROTUM

Facility

OP

$6,782.72

Service Code	HCPCS 54700
Hospital Charge Code	16000650
Hospital Revenue Code	360
Min. Negotiated Rate	$192.63
Max. Negotiated Rate	$9,008.64
Rate for Payer: Aetna Commercial	$6,754.93
Rate for Payer: Aetna Medicare Advantage	$8,046.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,008.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,008.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,483.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,008.64
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: Cigna Medicare Advantage	$2,483.43
Rate for Payer: Clover Medicare Advantage	$2,359.26
Rate for Payer: EmblemHealth Commercial	$7,450.29
Rate for Payer: Humana Medicare Advantage	$2,557.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,483.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,763.51
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,017.41
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$214.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,483.43
Rate for Payer: Wellcare Medicare Advantage	$2,483.43
Rate for Payer: Wellpoint Medicaid Managed Care	$192.63

DRAINAGE PAROTID ABSCESS COMPL

Facility

OP

$7,090.00

Service Code	HCPCS 42305
Hospital Charge Code	5780220
Hospital Revenue Code	450
Min. Negotiated Rate	$130.90
Max. Negotiated Rate	$14,288.18
Rate for Payer: Aetna Commercial	$10,713.67
Rate for Payer: Aetna Medicare Advantage	$12,761.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,288.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,288.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,938.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,288.18
Rate for Payer: Cigna Commercial	$7,895.42
Rate for Payer: Cigna Medicare Advantage	$3,938.85
Rate for Payer: Clover Medicare Advantage	$3,741.91
Rate for Payer: EmblemHealth Commercial	$11,816.55
Rate for Payer: Humana Medicare Advantage	$4,057.02
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,938.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,843.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,063.50
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,938.85
Rate for Payer: Wellcare Medicare Advantage	$3,938.85
Rate for Payer: Wellpoint Medicaid Managed Care	$201.36

DRAINAGE PAROTID ABSCESS COMPL

Facility

IP

$7,090.00

Service Code	HCPCS 42305
Hospital Charge Code	5780220
Hospital Revenue Code	450
Min. Negotiated Rate	$1,063.50
Max. Negotiated Rate	$1,063.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,063.50

<<
<
960
961
962
963
964
965
966
967
968
969
>
>>