|
CLAVICULECTOMY,PARTIAL
|
Facility
|
IP
|
$40,769.55
|
|
|
Service Code
|
HCPCS 23120
|
| Hospital Charge Code |
16000814
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,115.43 |
| Max. Negotiated Rate |
$6,115.43 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,115.43
|
|
|
CLAW BMT TROCH 53 MED 11105020
|
Facility
|
OP
|
$2,863.25
|
|
| Hospital Charge Code |
270611649
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$1,431.62 |
| Rate for Payer: Aetna Commercial |
$1,088.04
|
| Rate for Payer: Aetna Medicare Advantage |
$858.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$730.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$730.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$730.13
|
| Rate for Payer: Cigna Commercial |
$1,431.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$858.98
|
| Rate for Payer: Oxford Commercial |
$572.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$429.49
|
| Rate for Payer: UnitedHealthcare Commercial |
$572.65
|
| Rate for Payer: UnitedHealthcare Community & State |
$69.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$75.88
|
|
|
CLAW BMT TROCH 53 MED 11105020
|
Facility
|
IP
|
$2,863.25
|
|
| Hospital Charge Code |
270611649
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$429.49 |
| Max. Negotiated Rate |
$429.49 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$429.49
|
|
|
CLEANER 15
|
Facility
|
IP
|
$4,750.00
|
|
| Hospital Charge Code |
270678575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$712.50 |
| Max. Negotiated Rate |
$712.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$712.50
|
|
|
CLEANER 15
|
Facility
|
IP
|
$4,750.00
|
|
| Hospital Charge Code |
270678575N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$712.50 |
| Max. Negotiated Rate |
$712.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$712.50
|
|
|
CLEANER 15
|
Facility
|
OP
|
$4,750.00
|
|
| Hospital Charge Code |
270678575N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.47 |
| Max. Negotiated Rate |
$2,375.00 |
| Rate for Payer: Aetna Commercial |
$1,805.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,425.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,211.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,211.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,211.25
|
| Rate for Payer: Cigna Commercial |
$2,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,425.00
|
| Rate for Payer: Oxford Commercial |
$950.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$712.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$950.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$114.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$125.88
|
|
|
CLEANER 15
|
Facility
|
OP
|
$4,750.00
|
|
| Hospital Charge Code |
270678575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.47 |
| Max. Negotiated Rate |
$2,375.00 |
| Rate for Payer: Aetna Commercial |
$1,805.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,425.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,211.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,211.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,211.25
|
| Rate for Payer: Cigna Commercial |
$2,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,425.00
|
| Rate for Payer: Oxford Commercial |
$950.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$712.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$950.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$114.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$125.88
|
|
|
CLEANER15 THR 7Fx65cm
|
Facility
|
OP
|
$3,250.00
|
|
| Hospital Charge Code |
270678569N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.33 |
| Max. Negotiated Rate |
$1,625.00 |
| Rate for Payer: Aetna Commercial |
$1,235.00
|
| Rate for Payer: Aetna Medicare Advantage |
$975.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$828.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$828.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$828.75
|
| Rate for Payer: Cigna Commercial |
$1,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$975.00
|
| Rate for Payer: Oxford Commercial |
$650.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$487.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$650.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$78.33
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$86.12
|
|
|
CLEANER15 THR 7Fx65cm
|
Facility
|
IP
|
$3,250.00
|
|
| Hospital Charge Code |
270678569
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$487.50 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$487.50
|
|
|
CLEANER15 THR 7Fx65cm
|
Facility
|
IP
|
$3,250.00
|
|
| Hospital Charge Code |
270678569N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$487.50 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$487.50
|
|
|
CLEANER15 THR 7Fx65cm
|
Facility
|
OP
|
$3,250.00
|
|
| Hospital Charge Code |
270678569
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.33 |
| Max. Negotiated Rate |
$1,625.00 |
| Rate for Payer: Aetna Commercial |
$1,235.00
|
| Rate for Payer: Aetna Medicare Advantage |
$975.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$828.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$828.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$828.75
|
| Rate for Payer: Cigna Commercial |
$1,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$975.00
|
| Rate for Payer: Oxford Commercial |
$650.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$487.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$650.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$78.33
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$86.12
|
|
|
CLEANER CAUTERY TIP
|
Facility
|
OP
|
$9.65
|
|
| Hospital Charge Code |
270061200
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: Aetna Medicare Advantage |
$2.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.46
|
| Rate for Payer: Cigna Commercial |
$4.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.90
|
| Rate for Payer: Oxford Commercial |
$1.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.93
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.26
|
|
|
CLEANER CAUTERY TIP
|
Facility
|
IP
|
$9.65
|
|
| Hospital Charge Code |
270061200
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$1.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.45
|
|
|
CLEANER CAUTERY TIP STERILE
|
Facility
|
IP
|
$6.30
|
|
| Hospital Charge Code |
270646973
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.95
|
|
|
CLEANER CAUTERY TIP STERILE
|
Facility
|
OP
|
$6.30
|
|
| Hospital Charge Code |
270646973
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Aetna Commercial |
$2.39
|
| Rate for Payer: Aetna Medicare Advantage |
$1.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.61
|
| Rate for Payer: Cigna Commercial |
$3.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.89
|
| Rate for Payer: Oxford Commercial |
$1.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.26
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.17
|
|
|
CLEANER DISINFECTANT 22 OUNCE
|
Facility
|
OP
|
$24.55
|
|
| Hospital Charge Code |
270665155
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$12.28 |
| Rate for Payer: Aetna Commercial |
$9.33
|
| Rate for Payer: Aetna Medicare Advantage |
$7.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6.26
|
| Rate for Payer: Cigna Commercial |
$12.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.37
|
| Rate for Payer: Oxford Commercial |
$4.91
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.91
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.65
|
|
|
CLEANER DISINFECTANT 22 OUNCE
|
Facility
|
IP
|
$24.55
|
|
| Hospital Charge Code |
270665155
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.68
|
|
|
CLEANER DISINFECTANT 31% ISOPR
|
Facility
|
OP
|
$38.10
|
|
| Hospital Charge Code |
270665371
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$19.05 |
| Rate for Payer: Aetna Commercial |
$14.48
|
| Rate for Payer: Aetna Medicare Advantage |
$11.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.72
|
| Rate for Payer: Cigna Commercial |
$19.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.43
|
| Rate for Payer: Oxford Commercial |
$7.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.71
|
| Rate for Payer: UnitedHealthcare Commercial |
$7.62
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.01
|
|
|
CLEANER DISINFECTANT 31% ISOPR
|
Facility
|
IP
|
$38.10
|
|
| Hospital Charge Code |
270665371
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.71 |
| Max. Negotiated Rate |
$5.71 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.71
|
|
|
CLEANER ELECTRO-SURGICAL TIP
|
Facility
|
IP
|
$3.05
|
|
| Hospital Charge Code |
270649369N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.46
|
|
|
CLEANER ELECTRO-SURGICAL TIP
|
Facility
|
OP
|
$3.05
|
|
| Hospital Charge Code |
270649369S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Aetna Commercial |
$1.16
|
| Rate for Payer: Aetna Medicare Advantage |
$0.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.78
|
| Rate for Payer: Cigna Commercial |
$1.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.92
|
| Rate for Payer: Oxford Commercial |
$0.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.46
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.61
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.08
|
|
|
CLEANER ELECTRO-SURGICAL TIP
|
Facility
|
IP
|
$3.05
|
|
| Hospital Charge Code |
270649369S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.46
|
|
|
CLEANER ELECTRO-SURGICAL TIP
|
Facility
|
IP
|
$3.05
|
|
| Hospital Charge Code |
270649369
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.46
|
|
|
CLEANER ELECTRO-SURGICAL TIP
|
Facility
|
OP
|
$3.05
|
|
| Hospital Charge Code |
270649369
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Aetna Commercial |
$1.16
|
| Rate for Payer: Aetna Medicare Advantage |
$0.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.78
|
| Rate for Payer: Cigna Commercial |
$1.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.92
|
| Rate for Payer: Oxford Commercial |
$0.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.46
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.61
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.08
|
|
|
CLEANER ELECTRO-SURGICAL TIP
|
Facility
|
OP
|
$3.05
|
|
| Hospital Charge Code |
270649369N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Aetna Commercial |
$1.16
|
| Rate for Payer: Aetna Medicare Advantage |
$0.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.78
|
| Rate for Payer: Cigna Commercial |
$1.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.92
|
| Rate for Payer: Oxford Commercial |
$0.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.46
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.61
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.08
|
|