|
BURR EGG 7.0MMx28MM MINI QC
|
Facility
|
OP
|
$381.50
|
|
| Hospital Charge Code |
270674543
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$190.75 |
| Rate for Payer: Aetna Commercial |
$144.97
|
| Rate for Payer: Aetna Medicare Advantage |
$114.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$97.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$97.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$97.28
|
| Rate for Payer: Cigna Commercial |
$190.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$114.45
|
| Rate for Payer: Oxford Commercial |
$76.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$76.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.11
|
|
|
BURR EGG 7.0MMx45MM MINI QC
|
Facility
|
IP
|
$381.50
|
|
| Hospital Charge Code |
270674544
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.23 |
| Max. Negotiated Rate |
$57.23 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.23
|
|
|
BURR EGG 7.0MMx45MM MINI QC
|
Facility
|
OP
|
$381.50
|
|
| Hospital Charge Code |
270674544
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$190.75 |
| Rate for Payer: Aetna Commercial |
$144.97
|
| Rate for Payer: Aetna Medicare Advantage |
$114.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$97.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$97.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$97.28
|
| Rate for Payer: Cigna Commercial |
$190.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$114.45
|
| Rate for Payer: Oxford Commercial |
$76.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$76.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.11
|
|
|
BURR EGG 8.0MMx28MM MINI QC
|
Facility
|
OP
|
$381.50
|
|
| Hospital Charge Code |
270674545
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$190.75 |
| Rate for Payer: Aetna Commercial |
$144.97
|
| Rate for Payer: Aetna Medicare Advantage |
$114.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$97.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$97.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$97.28
|
| Rate for Payer: Cigna Commercial |
$190.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$114.45
|
| Rate for Payer: Oxford Commercial |
$76.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$76.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.11
|
|
|
BURR EGG 8.0MMx28MM MINI QC
|
Facility
|
IP
|
$381.50
|
|
| Hospital Charge Code |
270674545
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.23 |
| Max. Negotiated Rate |
$57.23 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.23
|
|
|
BURR EGG 8.0MMx45MM MINI QC
|
Facility
|
OP
|
$381.50
|
|
| Hospital Charge Code |
270674546
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$190.75 |
| Rate for Payer: Aetna Commercial |
$144.97
|
| Rate for Payer: Aetna Medicare Advantage |
$114.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$97.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$97.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$97.28
|
| Rate for Payer: Cigna Commercial |
$190.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$114.45
|
| Rate for Payer: Oxford Commercial |
$76.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$76.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.11
|
|
|
BURR EGG 8.0MMx45MM MINI QC
|
Facility
|
IP
|
$381.50
|
|
| Hospital Charge Code |
270674546
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.23 |
| Max. Negotiated Rate |
$57.23 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.23
|
|
|
BURR EGG L 4MM HD LGTH 8MM
|
Facility
|
OP
|
$329.00
|
|
| Hospital Charge Code |
270674448
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$164.50 |
| Rate for Payer: Aetna Commercial |
$125.02
|
| Rate for Payer: Aetna Medicare Advantage |
$98.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$83.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$83.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$83.89
|
| Rate for Payer: Cigna Commercial |
$164.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$98.70
|
| Rate for Payer: Oxford Commercial |
$65.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$65.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.93
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.72
|
|
|
BURR EGG L 4MM HD LGTH 8MM
|
Facility
|
IP
|
$329.00
|
|
| Hospital Charge Code |
270674448
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.35 |
| Max. Negotiated Rate |
$49.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.35
|
|
|
BURR EGG L 5.5MM HD LGTH 10MM
|
Facility
|
IP
|
$329.00
|
|
| Hospital Charge Code |
270674451
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.35 |
| Max. Negotiated Rate |
$49.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.35
|
|
|
BURR EGG L 5.5MM HD LGTH 10MM
|
Facility
|
OP
|
$329.00
|
|
| Hospital Charge Code |
270674451
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$164.50 |
| Rate for Payer: Aetna Commercial |
$125.02
|
| Rate for Payer: Aetna Medicare Advantage |
$98.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$83.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$83.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$83.89
|
| Rate for Payer: Cigna Commercial |
$164.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$98.70
|
| Rate for Payer: Oxford Commercial |
$65.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$65.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.93
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.72
|
|
|
BURR EGG LGTH 28x7MM J-LATCH
|
Facility
|
OP
|
$381.50
|
|
| Hospital Charge Code |
270674587
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$190.75 |
| Rate for Payer: Aetna Commercial |
$144.97
|
| Rate for Payer: Aetna Medicare Advantage |
$114.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$97.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$97.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$97.28
|
| Rate for Payer: Cigna Commercial |
$190.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$114.45
|
| Rate for Payer: Oxford Commercial |
$76.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$76.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.11
|
|
|
BURR EGG LGTH 28x7MM J-LATCH
|
Facility
|
IP
|
$381.50
|
|
| Hospital Charge Code |
270674587
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.23 |
| Max. Negotiated Rate |
$57.23 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.23
|
|
|
BURR EGG LGTH 28x8MM J-LATCH
|
Facility
|
IP
|
$381.50
|
|
| Hospital Charge Code |
270674594
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.23 |
| Max. Negotiated Rate |
$57.23 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.23
|
|
|
BURR EGG LGTH 28x8MM J-LATCH
|
Facility
|
OP
|
$381.50
|
|
| Hospital Charge Code |
270674594
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$190.75 |
| Rate for Payer: Aetna Commercial |
$144.97
|
| Rate for Payer: Aetna Medicare Advantage |
$114.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$97.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$97.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$97.28
|
| Rate for Payer: Cigna Commercial |
$190.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$114.45
|
| Rate for Payer: Oxford Commercial |
$76.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$76.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.11
|
|
|
BURR EGG LGTH 45x7MM J-LATCH
|
Facility
|
OP
|
$381.50
|
|
| Hospital Charge Code |
270674593
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$190.75 |
| Rate for Payer: Aetna Commercial |
$144.97
|
| Rate for Payer: Aetna Medicare Advantage |
$114.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$97.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$97.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$97.28
|
| Rate for Payer: Cigna Commercial |
$190.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$114.45
|
| Rate for Payer: Oxford Commercial |
$76.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$76.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.11
|
|
|
BURR EGG LGTH 45x7MM J-LATCH
|
Facility
|
IP
|
$381.50
|
|
| Hospital Charge Code |
270674593
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.23 |
| Max. Negotiated Rate |
$57.23 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.23
|
|
|
BURR EGG LGTH 45x8MM J-LATCH
|
Facility
|
IP
|
$381.50
|
|
| Hospital Charge Code |
270674595
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.23 |
| Max. Negotiated Rate |
$57.23 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.23
|
|
|
BURR EGG LGTH 45x8MM J-LATCH
|
Facility
|
OP
|
$381.50
|
|
| Hospital Charge Code |
270674595
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$190.75 |
| Rate for Payer: Aetna Commercial |
$144.97
|
| Rate for Payer: Aetna Medicare Advantage |
$114.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$97.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$97.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$97.28
|
| Rate for Payer: Cigna Commercial |
$190.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$114.45
|
| Rate for Payer: Oxford Commercial |
$76.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$76.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.11
|
|
|
BURR EGG M 4MM HD LGTH 8MM
|
Facility
|
IP
|
$329.00
|
|
| Hospital Charge Code |
270674447
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.35 |
| Max. Negotiated Rate |
$49.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.35
|
|
|
BURR EGG M 4MM HD LGTH 8MM
|
Facility
|
OP
|
$329.00
|
|
| Hospital Charge Code |
270674447
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$164.50 |
| Rate for Payer: Aetna Commercial |
$125.02
|
| Rate for Payer: Aetna Medicare Advantage |
$98.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$83.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$83.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$83.89
|
| Rate for Payer: Cigna Commercial |
$164.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$98.70
|
| Rate for Payer: Oxford Commercial |
$65.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$65.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.93
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.72
|
|
|
BURR EGG M 5.5MM HD LGTH 10MM
|
Facility
|
OP
|
$329.00
|
|
| Hospital Charge Code |
270674450
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$164.50 |
| Rate for Payer: Aetna Commercial |
$125.02
|
| Rate for Payer: Aetna Medicare Advantage |
$98.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$83.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$83.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$83.89
|
| Rate for Payer: Cigna Commercial |
$164.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$98.70
|
| Rate for Payer: Oxford Commercial |
$65.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$65.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.93
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.72
|
|
|
BURR EGG M 5.5MM HD LGTH 10MM
|
Facility
|
IP
|
$329.00
|
|
| Hospital Charge Code |
270674450
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.35 |
| Max. Negotiated Rate |
$49.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.35
|
|
|
BURR EGG S 4MM HD LGTH 8MM
|
Facility
|
OP
|
$329.00
|
|
| Hospital Charge Code |
270674446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$164.50 |
| Rate for Payer: Aetna Commercial |
$125.02
|
| Rate for Payer: Aetna Medicare Advantage |
$98.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$83.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$83.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$83.89
|
| Rate for Payer: Cigna Commercial |
$164.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$98.70
|
| Rate for Payer: Oxford Commercial |
$65.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$65.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.93
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.72
|
|
|
BURR EGG S 4MM HD LGTH 8MM
|
Facility
|
IP
|
$329.00
|
|
| Hospital Charge Code |
270674446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.35 |
| Max. Negotiated Rate |
$49.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.35
|
|