|
BIT DR 2.7MM
|
Facility
|
OP
|
$62.50
|
|
| Hospital Charge Code |
270603569
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$31.25 |
| Rate for Payer: Aetna Commercial |
$23.75
|
| Rate for Payer: Aetna Medicare Advantage |
$18.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15.94
|
| Rate for Payer: Cigna Commercial |
$31.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.75
|
| Rate for Payer: Oxford Commercial |
$12.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$12.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.51
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.66
|
|
|
BIT DR 3.5MM
|
Facility
|
OP
|
$62.50
|
|
| Hospital Charge Code |
270604443
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$31.25 |
| Rate for Payer: Aetna Commercial |
$23.75
|
| Rate for Payer: Aetna Medicare Advantage |
$18.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15.94
|
| Rate for Payer: Cigna Commercial |
$31.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.75
|
| Rate for Payer: Oxford Commercial |
$12.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$12.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.51
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.66
|
|
|
BIT DR 3.5MM
|
Facility
|
OP
|
$104.00
|
|
| Hospital Charge Code |
270603573
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: Aetna Commercial |
$39.52
|
| Rate for Payer: Aetna Medicare Advantage |
$31.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$26.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$26.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$26.52
|
| Rate for Payer: Cigna Commercial |
$52.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$31.20
|
| Rate for Payer: Oxford Commercial |
$20.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$20.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.51
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.76
|
|
|
BIT DR 3.5MM
|
Facility
|
IP
|
$104.00
|
|
| Hospital Charge Code |
270603573
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$15.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.60
|
|
|
BIT DR 3.5MM
|
Facility
|
IP
|
$62.50
|
|
| Hospital Charge Code |
270604443
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$9.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.38
|
|
|
BIT DR .5MM LONG
|
Facility
|
OP
|
$71.00
|
|
| Hospital Charge Code |
270603562
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$35.50 |
| Rate for Payer: Aetna Commercial |
$26.98
|
| Rate for Payer: Aetna Medicare Advantage |
$21.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.11
|
| Rate for Payer: Cigna Commercial |
$35.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.30
|
| Rate for Payer: Oxford Commercial |
$14.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$14.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.71
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.88
|
|
|
BIT DR .5MM LONG
|
Facility
|
IP
|
$71.00
|
|
| Hospital Charge Code |
270603562
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$10.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.65
|
|
|
BIT DR FLUT 2.0MM
|
Facility
|
IP
|
$81.00
|
|
| Hospital Charge Code |
270604465
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$12.15 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.15
|
|
|
BIT DR FLUT 2.0MM
|
Facility
|
OP
|
$81.00
|
|
| Hospital Charge Code |
270604465
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna Commercial |
$30.78
|
| Rate for Payer: Aetna Medicare Advantage |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20.66
|
| Rate for Payer: Cigna Commercial |
$40.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24.30
|
| Rate for Payer: Oxford Commercial |
$16.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$16.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.15
|
|
|
BIT DR FLUTED 2.0mm LG
|
Facility
|
IP
|
$109.00
|
|
| Hospital Charge Code |
270604145
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$16.35 |
| Max. Negotiated Rate |
$16.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.35
|
|
|
BIT DR FLUTED 2.0mm LG
|
Facility
|
OP
|
$109.00
|
|
| Hospital Charge Code |
270604145
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$54.50 |
| Rate for Payer: Aetna Commercial |
$41.42
|
| Rate for Payer: Aetna Medicare Advantage |
$32.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$27.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$27.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$27.80
|
| Rate for Payer: Cigna Commercial |
$54.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.70
|
| Rate for Payer: Oxford Commercial |
$21.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$21.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.89
|
|
|
BIT DR FLUTED 2.0mm XLG***
|
Facility
|
IP
|
$81.00
|
|
| Hospital Charge Code |
270604466
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$12.15 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.15
|
|
|
BIT DR FLUTED 2.0mm XLG***
|
Facility
|
OP
|
$81.00
|
|
| Hospital Charge Code |
270604466
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna Commercial |
$30.78
|
| Rate for Payer: Aetna Medicare Advantage |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20.66
|
| Rate for Payer: Cigna Commercial |
$40.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24.30
|
| Rate for Payer: Oxford Commercial |
$16.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$16.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.15
|
|
|
BIT DR FLUTED 2.5mm 604467***
|
Facility
|
OP
|
$81.00
|
|
| Hospital Charge Code |
270604467
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna Commercial |
$30.78
|
| Rate for Payer: Aetna Medicare Advantage |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20.66
|
| Rate for Payer: Cigna Commercial |
$40.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24.30
|
| Rate for Payer: Oxford Commercial |
$16.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$16.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.15
|
|
|
BIT DR FLUTED 2.5mm 604467***
|
Facility
|
IP
|
$81.00
|
|
| Hospital Charge Code |
270604467
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$12.15 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.15
|
|
|
BIT DR FLUTED 2.5MM L
|
Facility
|
IP
|
$121.00
|
|
| Hospital Charge Code |
270604147
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$18.15 |
| Max. Negotiated Rate |
$18.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.15
|
|
|
BIT DR FLUTED 2.5MM L
|
Facility
|
OP
|
$121.00
|
|
| Hospital Charge Code |
270604147
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$60.50 |
| Rate for Payer: Aetna Commercial |
$45.98
|
| Rate for Payer: Aetna Medicare Advantage |
$36.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$30.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$30.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$30.86
|
| Rate for Payer: Cigna Commercial |
$60.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.30
|
| Rate for Payer: Oxford Commercial |
$24.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$24.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.21
|
|
|
BIT DR FLUTED 2.5MM XLG****
|
Facility
|
IP
|
$121.00
|
|
| Hospital Charge Code |
270604468
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$18.15 |
| Max. Negotiated Rate |
$18.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.15
|
|
|
BIT DR FLUTED 2.5MM XLG****
|
Facility
|
OP
|
$121.00
|
|
| Hospital Charge Code |
270604468
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$60.50 |
| Rate for Payer: Aetna Commercial |
$45.98
|
| Rate for Payer: Aetna Medicare Advantage |
$36.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$30.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$30.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$30.86
|
| Rate for Payer: Cigna Commercial |
$60.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.30
|
| Rate for Payer: Oxford Commercial |
$24.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$24.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.21
|
|
|
BIT DR FLUTED 2.7mm 604148
|
Facility
|
OP
|
$81.00
|
|
| Hospital Charge Code |
270604148
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna Commercial |
$30.78
|
| Rate for Payer: Aetna Medicare Advantage |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20.66
|
| Rate for Payer: Cigna Commercial |
$40.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24.30
|
| Rate for Payer: Oxford Commercial |
$16.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$16.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.15
|
|
|
BIT DR FLUTED 2.7mm 604148
|
Facility
|
IP
|
$81.00
|
|
| Hospital Charge Code |
270604148
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$12.15 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.15
|
|
|
BIT DR FLUTED 2.7mm 604469***
|
Facility
|
OP
|
$81.00
|
|
| Hospital Charge Code |
270604469
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna Commercial |
$30.78
|
| Rate for Payer: Aetna Medicare Advantage |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20.66
|
| Rate for Payer: Cigna Commercial |
$40.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24.30
|
| Rate for Payer: Oxford Commercial |
$16.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$16.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.15
|
|
|
BIT DR FLUTED 2.7mm 604469***
|
Facility
|
IP
|
$81.00
|
|
| Hospital Charge Code |
270604469
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$12.15 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.15
|
|
|
BIT DR FLUTED 2.7mm L 604149
|
Facility
|
OP
|
$121.00
|
|
| Hospital Charge Code |
270604149
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$60.50 |
| Rate for Payer: Aetna Commercial |
$45.98
|
| Rate for Payer: Aetna Medicare Advantage |
$36.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$30.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$30.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$30.86
|
| Rate for Payer: Cigna Commercial |
$60.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.30
|
| Rate for Payer: Oxford Commercial |
$24.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$24.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.21
|
|
|
BIT DR FLUTED 2.7mm L 604149
|
Facility
|
IP
|
$121.00
|
|
| Hospital Charge Code |
270604149
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$18.15 |
| Max. Negotiated Rate |
$18.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.15
|
|