|
PACK CUSTOM ARTHROSCOPY
|
Facility
|
OP
|
$474.45
|
|
| Hospital Charge Code |
270600342
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.43 |
| Max. Negotiated Rate |
$237.22 |
| Rate for Payer: Aetna Commercial |
$180.29
|
| Rate for Payer: Aetna Medicare Advantage |
$142.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$120.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$120.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$120.98
|
| Rate for Payer: Cigna Commercial |
$237.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$142.34
|
| Rate for Payer: Oxford Commercial |
$94.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$71.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$94.89
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.57
|
|
|
PACK CUSTOM ARTHRSC SOP11ARBYA
|
Facility
|
IP
|
$240.00
|
|
| Hospital Charge Code |
270625053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.00
|
|
|
PACK CUSTOM ARTHRSC SOP11ARBYA
|
Facility
|
OP
|
$240.00
|
|
| Hospital Charge Code |
270625053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$91.20
|
| Rate for Payer: Aetna Medicare Advantage |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.20
|
| Rate for Payer: Cigna Commercial |
$120.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.00
|
| Rate for Payer: Oxford Commercial |
$48.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$48.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.78
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.36
|
|
|
PACK CUSTOM BASIC EXTREMITY
|
Facility
|
IP
|
$318.20
|
|
| Hospital Charge Code |
270631346
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.73 |
| Max. Negotiated Rate |
$47.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$47.73
|
|
|
PACK CUSTOM BASIC EXTREMITY
|
Facility
|
IP
|
$235.25
|
|
| Hospital Charge Code |
270642265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.29 |
| Max. Negotiated Rate |
$35.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.29
|
|
|
PACK CUSTOM BASIC EXTREMITY
|
Facility
|
OP
|
$235.25
|
|
| Hospital Charge Code |
270642265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$117.62 |
| Rate for Payer: Aetna Commercial |
$89.39
|
| Rate for Payer: Aetna Medicare Advantage |
$70.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$59.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$59.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$59.99
|
| Rate for Payer: Cigna Commercial |
$117.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$70.58
|
| Rate for Payer: Oxford Commercial |
$47.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.29
|
| Rate for Payer: UnitedHealthcare Commercial |
$47.05
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.23
|
|
|
PACK CUSTOM BASIC EXTREMITY
|
Facility
|
OP
|
$318.20
|
|
| Hospital Charge Code |
270631346
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.67 |
| Max. Negotiated Rate |
$159.10 |
| Rate for Payer: Aetna Commercial |
$120.92
|
| Rate for Payer: Aetna Medicare Advantage |
$95.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$81.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$81.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$81.14
|
| Rate for Payer: Cigna Commercial |
$159.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$95.46
|
| Rate for Payer: Oxford Commercial |
$63.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$47.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$63.64
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.43
|
|
|
PACK CUSTOM CATH AVIBMBM00112
|
Facility
|
OP
|
$392.70
|
|
| Hospital Charge Code |
270642262
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$196.35 |
| Rate for Payer: Aetna Commercial |
$149.23
|
| Rate for Payer: Aetna Medicare Advantage |
$117.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$100.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$100.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$100.14
|
| Rate for Payer: Cigna Commercial |
$196.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.81
|
| Rate for Payer: Oxford Commercial |
$78.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.91
|
| Rate for Payer: UnitedHealthcare Commercial |
$78.54
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.41
|
|
|
PACK CUSTOM CATH AVIBMBM00112
|
Facility
|
IP
|
$392.70
|
|
| Hospital Charge Code |
270642262
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.91 |
| Max. Negotiated Rate |
$58.91 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.91
|
|
|
PACK CUSTOM CATHLAB W/CHLORAPR
|
Facility
|
OP
|
$352.90
|
|
| Hospital Charge Code |
270677786N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$176.45 |
| Rate for Payer: Aetna Commercial |
$134.10
|
| Rate for Payer: Aetna Medicare Advantage |
$105.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$89.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$89.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$89.99
|
| Rate for Payer: Cigna Commercial |
$176.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$105.87
|
| Rate for Payer: Oxford Commercial |
$70.58
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$70.58
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.35
|
|
|
PACK CUSTOM CATHLAB W/CHLORAPR
|
Facility
|
IP
|
$352.90
|
|
| Hospital Charge Code |
270677786N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.94 |
| Max. Negotiated Rate |
$52.94 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.94
|
|
|
PACK CUSTOM CATHLAB W/CHLORAPR
|
Facility
|
IP
|
$391.25
|
|
| Hospital Charge Code |
270677786
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.69 |
| Max. Negotiated Rate |
$58.69 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.69
|
|
|
PACK CUSTOM CATHLAB W/CHLORAPR
|
Facility
|
IP
|
$391.25
|
|
| Hospital Charge Code |
270677786S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.69 |
| Max. Negotiated Rate |
$58.69 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.69
|
|
|
PACK CUSTOM CATHLAB W/CHLORAPR
|
Facility
|
OP
|
$391.25
|
|
| Hospital Charge Code |
270677786
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.43 |
| Max. Negotiated Rate |
$195.62 |
| Rate for Payer: Aetna Commercial |
$148.68
|
| Rate for Payer: Aetna Medicare Advantage |
$117.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$99.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$99.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$99.77
|
| Rate for Payer: Cigna Commercial |
$195.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.38
|
| Rate for Payer: Oxford Commercial |
$78.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$78.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.37
|
|
|
PACK CUSTOM CATHLAB W/CHLORAPR
|
Facility
|
OP
|
$391.25
|
|
| Hospital Charge Code |
270677786S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.43 |
| Max. Negotiated Rate |
$195.62 |
| Rate for Payer: Aetna Commercial |
$148.68
|
| Rate for Payer: Aetna Medicare Advantage |
$117.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$99.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$99.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$99.77
|
| Rate for Payer: Cigna Commercial |
$195.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.38
|
| Rate for Payer: Oxford Commercial |
$78.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$78.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.37
|
|
|
PACK CUSTOM CENTURION SYSTEM
|
Facility
|
IP
|
$1,532.15
|
|
| Hospital Charge Code |
270683573
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$229.82 |
| Max. Negotiated Rate |
$229.82 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$229.82
|
|
|
PACK CUSTOM CENTURION SYSTEM
|
Facility
|
OP
|
$1,532.15
|
|
| Hospital Charge Code |
270683573
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.92 |
| Max. Negotiated Rate |
$766.08 |
| Rate for Payer: Aetna Commercial |
$582.22
|
| Rate for Payer: Aetna Medicare Advantage |
$459.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$390.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$390.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$390.70
|
| Rate for Payer: Cigna Commercial |
$766.08
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$459.64
|
| Rate for Payer: Oxford Commercial |
$306.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$229.82
|
| Rate for Payer: UnitedHealthcare Commercial |
$306.43
|
| Rate for Payer: UnitedHealthcare Community & State |
$36.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$40.60
|
|
|
PACK CUSTOM CENTURION VISION
|
Facility
|
OP
|
$743.75
|
|
| Hospital Charge Code |
270684100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$371.88 |
| Rate for Payer: Aetna Commercial |
$282.62
|
| Rate for Payer: Aetna Medicare Advantage |
$223.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$189.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$189.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$189.66
|
| Rate for Payer: Cigna Commercial |
$371.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$223.12
|
| Rate for Payer: Oxford Commercial |
$148.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.56
|
| Rate for Payer: UnitedHealthcare Commercial |
$148.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.71
|
|
|
PACK CUSTOM CENTURION VISION
|
Facility
|
IP
|
$743.75
|
|
| Hospital Charge Code |
270684100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.56 |
| Max. Negotiated Rate |
$111.56 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.56
|
|
|
PACK CUSTOM D&C AVIBMBM008-12
|
Facility
|
OP
|
$143.05
|
|
| Hospital Charge Code |
270642267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$71.53 |
| Rate for Payer: Aetna Commercial |
$54.36
|
| Rate for Payer: Aetna Medicare Advantage |
$42.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$36.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$36.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$36.48
|
| Rate for Payer: Cigna Commercial |
$71.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.91
|
| Rate for Payer: Oxford Commercial |
$28.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.46
|
| Rate for Payer: UnitedHealthcare Commercial |
$28.61
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.45
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.79
|
|
|
PACK CUSTOM D&C AVIBMBM008-12
|
Facility
|
IP
|
$143.05
|
|
| Hospital Charge Code |
270642267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.46 |
| Max. Negotiated Rate |
$21.46 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.46
|
|
|
PACK CUSTOM D&C SMA11DCBYA
|
Facility
|
OP
|
$153.50
|
|
| Hospital Charge Code |
270632134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$76.75 |
| Rate for Payer: Aetna Commercial |
$58.33
|
| Rate for Payer: Aetna Medicare Advantage |
$46.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$39.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$39.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$39.14
|
| Rate for Payer: Cigna Commercial |
$76.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.05
|
| Rate for Payer: Oxford Commercial |
$30.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$30.70
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.07
|
|
|
PACK CUSTOM D&C SMA11DCBYA
|
Facility
|
IP
|
$153.50
|
|
| Hospital Charge Code |
270632134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.02 |
| Max. Negotiated Rate |
$23.02 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.02
|
|
|
PACK CUSTOM ENDOVAS SCV11EVBYA
|
Facility
|
IP
|
$371.05
|
|
| Hospital Charge Code |
270626895
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$55.66 |
| Max. Negotiated Rate |
$55.66 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$55.66
|
|
|
PACK CUSTOM ENDOVAS SCV11EVBYA
|
Facility
|
OP
|
$371.05
|
|
| Hospital Charge Code |
270626895
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$185.53 |
| Rate for Payer: Aetna Commercial |
$141.00
|
| Rate for Payer: Aetna Medicare Advantage |
$111.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$94.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$94.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$94.62
|
| Rate for Payer: Cigna Commercial |
$185.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$111.31
|
| Rate for Payer: Oxford Commercial |
$74.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$55.66
|
| Rate for Payer: UnitedHealthcare Commercial |
$74.21
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.94
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.83
|
|
