|
SYRINGE WHITE SALINE 20CC
|
Facility
|
IP
|
$2.50
|
|
| Hospital Charge Code |
270658327
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.38
|
|
|
SYRINGE YELLOE CONTRAST 10CC
|
Facility
|
OP
|
$9.75
|
|
| Hospital Charge Code |
2709000380
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$4.88 |
| Rate for Payer: Aetna Commercial |
$3.71
|
| Rate for Payer: Aetna Medicare Advantage |
$2.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.49
|
| Rate for Payer: Cigna Commercial |
$4.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.92
|
| Rate for Payer: Oxford Commercial |
$1.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.46
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.95
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.26
|
|
|
SYRINGE YELLOE CONTRAST 10CC
|
Facility
|
IP
|
$9.75
|
|
| Hospital Charge Code |
2709000380
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.46
|
|
|
SYRINGE YELLOW CONTRAST 10CC
|
Facility
|
IP
|
$1.95
|
|
| Hospital Charge Code |
270658331
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.29
|
|
|
SYRINGE YELLOW CONTRAST 10CC
|
Facility
|
OP
|
$1.95
|
|
| Hospital Charge Code |
270658331
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Aetna Commercial |
$0.74
|
| Rate for Payer: Aetna Medicare Advantage |
$0.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.59
|
| Rate for Payer: Oxford Commercial |
$0.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.29
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.39
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.05
|
|
|
SYS ACNET EMB PROTCT 101133475
|
Facility
|
IP
|
$7,688.00
|
|
| Hospital Charge Code |
270635099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,153.20 |
| Max. Negotiated Rate |
$1,153.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,153.20
|
|
|
SYS ACNET EMB PROTCT 101133475
|
Facility
|
OP
|
$7,688.00
|
|
| Hospital Charge Code |
270635099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$185.28 |
| Max. Negotiated Rate |
$3,844.00 |
| Rate for Payer: Aetna Commercial |
$2,921.44
|
| Rate for Payer: Aetna Medicare Advantage |
$2,306.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,960.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,960.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,960.44
|
| Rate for Payer: Cigna Commercial |
$3,844.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,306.40
|
| Rate for Payer: Oxford Commercial |
$1,537.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,153.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,537.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$185.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$203.73
|
|
|
SYS ANKLE SYNDESMOSIS FIXATION
|
Facility
|
IP
|
$5,730.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270645177
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$859.50 |
| Max. Negotiated Rate |
$1,386.66 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,146.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,386.66
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,260.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$859.50
|
|
|
SYS ANKLE SYNDESMOSIS FIXATION
|
Facility
|
OP
|
$5,730.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270645177
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.09 |
| Max. Negotiated Rate |
$2,865.00 |
| Rate for Payer: Aetna Commercial |
$2,177.40
|
| Rate for Payer: Aetna Medicare Advantage |
$1,719.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,461.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,461.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,146.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,461.15
|
| Rate for Payer: Cigna Commercial |
$2,865.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,386.66
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,260.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$859.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$138.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$151.84
|
|
|
SYS CHARG FOR PT PROG SC6412
|
Facility
|
IP
|
$15,020.00
|
|
| Hospital Charge Code |
270641625
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,253.00 |
| Max. Negotiated Rate |
$2,253.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,253.00
|
|
|
SYS CHARG FOR PT PROG SC6412
|
Facility
|
OP
|
$15,020.00
|
|
| Hospital Charge Code |
270641625
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$361.98 |
| Max. Negotiated Rate |
$7,510.00 |
| Rate for Payer: Aetna Commercial |
$5,707.60
|
| Rate for Payer: Aetna Medicare Advantage |
$4,506.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,830.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,830.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,830.10
|
| Rate for Payer: Cigna Commercial |
$7,510.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,506.00
|
| Rate for Payer: Oxford Commercial |
$3,004.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,253.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,004.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$361.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$398.03
|
|
|
SYS CLOS PERCLOSE PGLIDE 12673
|
Facility
|
IP
|
$1,075.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
270634327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.25 |
| Max. Negotiated Rate |
$260.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$215.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$260.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$236.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$161.25
|
|
|
SYS CLOS PERCLOSE PGLIDE 12673
|
Facility
|
OP
|
$1,075.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
270634327S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.91 |
| Max. Negotiated Rate |
$537.50 |
| Rate for Payer: Aetna Commercial |
$408.50
|
| Rate for Payer: Aetna Medicare Advantage |
$322.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$274.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$274.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$215.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$274.12
|
| Rate for Payer: Cigna Commercial |
$537.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$260.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$236.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$161.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$25.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.49
|
|
|
SYS CLOS PERCLOSE PGLIDE 12673
|
Facility
|
OP
|
$1,075.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
270634327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.91 |
| Max. Negotiated Rate |
$537.50 |
| Rate for Payer: Aetna Commercial |
$408.50
|
| Rate for Payer: Aetna Medicare Advantage |
$322.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$274.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$274.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$215.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$274.12
|
| Rate for Payer: Cigna Commercial |
$537.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$260.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$236.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$161.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$25.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.49
|
|
|
SYS CLOS PERCLOSE PGLIDE 12673
|
Facility
|
IP
|
$2,334.86
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
270634327N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$350.23 |
| Max. Negotiated Rate |
$565.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$466.97
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$565.04
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$513.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$350.23
|
|
|
SYS CLOS PERCLOSE PGLIDE 12673
|
Facility
|
IP
|
$1,075.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
270634327S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.25 |
| Max. Negotiated Rate |
$260.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$215.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$260.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$236.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$161.25
|
|
|
SYS CLOS PERCLOSE PGLIDE 12673
|
Facility
|
OP
|
$2,334.86
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
270634327N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.27 |
| Max. Negotiated Rate |
$1,167.43 |
| Rate for Payer: Aetna Commercial |
$887.25
|
| Rate for Payer: Aetna Medicare Advantage |
$700.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$595.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$595.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$466.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$595.39
|
| Rate for Payer: Cigna Commercial |
$1,167.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$565.04
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$513.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$350.23
|
| Rate for Payer: UnitedHealthcare Community & State |
$56.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$61.87
|
|
|
SYS COAXIAL BONE BIOPSY 11Gx12
|
Facility
|
OP
|
$750.00
|
|
| Hospital Charge Code |
270650183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.07 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$285.00
|
| Rate for Payer: Aetna Medicare Advantage |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$225.00
|
| Rate for Payer: Oxford Commercial |
$150.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$150.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.88
|
|
|
SYS COAXIAL BONE BIOPSY 11Gx12
|
Facility
|
IP
|
$750.00
|
|
| Hospital Charge Code |
270650183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
SYS COBAN COMPRESS 4509002094
|
Facility
|
IP
|
$55.65
|
|
| Hospital Charge Code |
270641454W
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.35 |
| Max. Negotiated Rate |
$8.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.35
|
|
|
SYS COBAN COMPRESS 4509002094
|
Facility
|
OP
|
$55.65
|
|
| Hospital Charge Code |
270641454W
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$27.82 |
| Rate for Payer: Aetna Commercial |
$21.15
|
| Rate for Payer: Aetna Medicare Advantage |
$16.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.19
|
| Rate for Payer: Cigna Commercial |
$27.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.70
|
| Rate for Payer: Oxford Commercial |
$11.13
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.13
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.47
|
|
|
SYS COMP FEMOSTOP PLUS 11160
|
Facility
|
OP
|
$335.25
|
|
| Hospital Charge Code |
270623731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$167.62 |
| Rate for Payer: Aetna Commercial |
$127.39
|
| Rate for Payer: Aetna Medicare Advantage |
$100.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$85.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$85.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$85.49
|
| Rate for Payer: Cigna Commercial |
$167.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$100.58
|
| Rate for Payer: Oxford Commercial |
$67.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.29
|
| Rate for Payer: UnitedHealthcare Commercial |
$67.05
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.88
|
|
|
SYS COMP FEMOSTOP PLUS 11160
|
Facility
|
IP
|
$335.25
|
|
| Hospital Charge Code |
270623731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.29 |
| Max. Negotiated Rate |
$50.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.29
|
|
|
SYS DELIV F/OSTEOPLAST 100.500
|
Facility
|
OP
|
$7,250.00
|
|
| Hospital Charge Code |
270637812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$174.72 |
| Max. Negotiated Rate |
$3,625.00 |
| Rate for Payer: Aetna Commercial |
$2,755.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,175.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,848.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,848.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,848.75
|
| Rate for Payer: Cigna Commercial |
$3,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,175.00
|
| Rate for Payer: Oxford Commercial |
$1,450.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,087.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,450.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$174.72
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$192.12
|
|
|
SYS DELIV F/OSTEOPLAST 100.500
|
Facility
|
IP
|
$7,250.00
|
|
| Hospital Charge Code |
270637812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,087.50 |
| Max. Negotiated Rate |
$1,087.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,087.50
|
|
