|
BURR SWAN L 4MM HD LGTH 12.7MM
|
Facility
|
IP
|
$430.50
|
|
| Hospital Charge Code |
270674499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
|
|
BURR SWAN M 2MM HD LGTH 6.3MM
|
Facility
|
IP
|
$430.50
|
|
| Hospital Charge Code |
270674492
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
|
|
BURR SWAN M 2MM HD LGTH 6.3MM
|
Facility
|
OP
|
$430.50
|
|
| Hospital Charge Code |
270674492
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$215.25 |
| Rate for Payer: Aetna Commercial |
$163.59
|
| Rate for Payer: Aetna Medicare Advantage |
$129.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$109.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$109.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$109.78
|
| Rate for Payer: Cigna Commercial |
$215.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$129.15
|
| Rate for Payer: Oxford Commercial |
$86.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$86.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.41
|
|
|
BURR SWAN M 3MM HD LGTH 9.7MM
|
Facility
|
OP
|
$430.50
|
|
| Hospital Charge Code |
270674495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$215.25 |
| Rate for Payer: Aetna Commercial |
$163.59
|
| Rate for Payer: Aetna Medicare Advantage |
$129.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$109.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$109.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$109.78
|
| Rate for Payer: Cigna Commercial |
$215.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$129.15
|
| Rate for Payer: Oxford Commercial |
$86.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$86.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.41
|
|
|
BURR SWAN M 3MM HD LGTH 9.7MM
|
Facility
|
IP
|
$430.50
|
|
| Hospital Charge Code |
270674495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
|
|
BURR SWAN M 4MM HD LGTH 12.7MM
|
Facility
|
IP
|
$430.50
|
|
| Hospital Charge Code |
270674498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
|
|
BURR SWAN M 4MM HD LGTH 12.7MM
|
Facility
|
OP
|
$430.50
|
|
| Hospital Charge Code |
270674498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$215.25 |
| Rate for Payer: Aetna Commercial |
$163.59
|
| Rate for Payer: Aetna Medicare Advantage |
$129.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$109.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$109.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$109.78
|
| Rate for Payer: Cigna Commercial |
$215.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$129.15
|
| Rate for Payer: Oxford Commercial |
$86.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$86.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.41
|
|
|
BURR SWAN S 2MM HD LGTH 6.3MM
|
Facility
|
OP
|
$430.50
|
|
| Hospital Charge Code |
270674491
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$215.25 |
| Rate for Payer: Aetna Commercial |
$163.59
|
| Rate for Payer: Aetna Medicare Advantage |
$129.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$109.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$109.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$109.78
|
| Rate for Payer: Cigna Commercial |
$215.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$129.15
|
| Rate for Payer: Oxford Commercial |
$86.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$86.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.41
|
|
|
BURR SWAN S 2MM HD LGTH 6.3MM
|
Facility
|
IP
|
$430.50
|
|
| Hospital Charge Code |
270674491
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
|
|
BURR SWAN S 3MM HD LGTH 9.7MM
|
Facility
|
OP
|
$430.50
|
|
| Hospital Charge Code |
270674494
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$215.25 |
| Rate for Payer: Aetna Commercial |
$163.59
|
| Rate for Payer: Aetna Medicare Advantage |
$129.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$109.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$109.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$109.78
|
| Rate for Payer: Cigna Commercial |
$215.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$129.15
|
| Rate for Payer: Oxford Commercial |
$86.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$86.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.41
|
|
|
BURR SWAN S 3MM HD LGTH 9.7MM
|
Facility
|
IP
|
$430.50
|
|
| Hospital Charge Code |
270674494
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
|
|
BURR SWAN S 4MM HD LGTH 12.7MM
|
Facility
|
IP
|
$430.50
|
|
| Hospital Charge Code |
270674497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
|
|
BURR SWAN S 4MM HD LGTH 12.7MM
|
Facility
|
OP
|
$430.50
|
|
| Hospital Charge Code |
270674497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$215.25 |
| Rate for Payer: Aetna Commercial |
$163.59
|
| Rate for Payer: Aetna Medicare Advantage |
$129.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$109.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$109.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$109.78
|
| Rate for Payer: Cigna Commercial |
$215.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$129.15
|
| Rate for Payer: Oxford Commercial |
$86.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$86.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.41
|
|
|
BURR SWANSON L 5.0MMx15.8MM
|
Facility
|
OP
|
$430.50
|
|
| Hospital Charge Code |
270674539
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$215.25 |
| Rate for Payer: Aetna Commercial |
$163.59
|
| Rate for Payer: Aetna Medicare Advantage |
$129.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$109.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$109.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$109.78
|
| Rate for Payer: Cigna Commercial |
$215.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$129.15
|
| Rate for Payer: Oxford Commercial |
$86.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$86.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.41
|
|
|
BURR SWANSON L 5.0MMx15.8MM
|
Facility
|
IP
|
$430.50
|
|
| Hospital Charge Code |
270674539
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
|
|
BURR SWANSON M 5.0MMx15.8MM
|
Facility
|
IP
|
$430.50
|
|
| Hospital Charge Code |
270674538
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
|
|
BURR SWANSON M 5.0MMx15.8MM
|
Facility
|
OP
|
$430.50
|
|
| Hospital Charge Code |
270674538
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$215.25 |
| Rate for Payer: Aetna Commercial |
$163.59
|
| Rate for Payer: Aetna Medicare Advantage |
$129.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$109.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$109.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$109.78
|
| Rate for Payer: Cigna Commercial |
$215.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$129.15
|
| Rate for Payer: Oxford Commercial |
$86.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$86.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.41
|
|
|
BURR SWANSON S 5.0MMx15.8MM
|
Facility
|
OP
|
$430.50
|
|
| Hospital Charge Code |
270674537
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$215.25 |
| Rate for Payer: Aetna Commercial |
$163.59
|
| Rate for Payer: Aetna Medicare Advantage |
$129.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$109.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$109.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$109.78
|
| Rate for Payer: Cigna Commercial |
$215.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$129.15
|
| Rate for Payer: Oxford Commercial |
$86.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$86.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.41
|
|
|
BURR SWANSON S 5.0MMx15.8MM
|
Facility
|
IP
|
$430.50
|
|
| Hospital Charge Code |
270674537
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
|
|
BURR TAPER DIAM 15D ANG
|
Facility
|
OP
|
$2,275.00
|
|
| Hospital Charge Code |
270693077
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.83 |
| Max. Negotiated Rate |
$1,137.50 |
| Rate for Payer: Aetna Commercial |
$864.50
|
| Rate for Payer: Aetna Medicare Advantage |
$682.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$580.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$580.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$580.12
|
| Rate for Payer: Cigna Commercial |
$1,137.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$682.50
|
| Rate for Payer: Oxford Commercial |
$455.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$341.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$455.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$54.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$60.29
|
|
|
BURR TAPER DIAM 15D ANG
|
Facility
|
IP
|
$2,275.00
|
|
| Hospital Charge Code |
270693077
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$341.25 |
| Max. Negotiated Rate |
$341.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$341.25
|
|
|
BURR TAPER FISS 2.1x31MM J-LAT
|
Facility
|
OP
|
$381.50
|
|
| Hospital Charge Code |
270674608
|
|
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 TAPER FISS 2.1x31MM J-LAT
|
Facility
|
IP
|
$381.50
|
|
| Hospital Charge Code |
270674608
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.23 |
| Max. Negotiated Rate |
$57.23 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.23
|
|
|
BURR TAPER FISS 2.1x31MM MQC
|
Facility
|
OP
|
$381.50
|
|
| Hospital Charge Code |
270674560
|
|
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 TAPER FISS 2.1x31MM MQC
|
Facility
|
IP
|
$381.50
|
|
| Hospital Charge Code |
270674560
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.23 |
| Max. Negotiated Rate |
$57.23 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.23
|
|