|
DLU ENDO GIA 60 4.8 030316
|
Facility
|
OP
|
$995.25
|
|
| Hospital Charge Code |
270600107
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$129.38 |
| Max. Negotiated Rate |
$497.62 |
| Rate for Payer: Aetna Commercial |
$298.57
|
| Rate for Payer: Aetna Medicare Advantage |
$298.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$253.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$253.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$253.79
|
| Rate for Payer: Cigna Commercial |
$497.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$129.38
|
| Rate for Payer: Oxford Commercial |
$497.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$149.29
|
| Rate for Payer: UnitedHealthcare Commercial |
$497.62
|
|
|
DLU ENDO GIA 60 4.8 030316
|
Facility
|
IP
|
$995.25
|
|
| Hospital Charge Code |
270600107
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.29 |
| Max. Negotiated Rate |
$149.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$149.29
|
|
|
DLU ENDO GIA II 30 2.5 030418
|
Facility
|
IP
|
$715.25
|
|
| Hospital Charge Code |
270608863
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.29 |
| Max. Negotiated Rate |
$107.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$107.29
|
|
|
DLU ENDO GIA II 30 2.5 030418
|
Facility
|
OP
|
$715.25
|
|
| Hospital Charge Code |
270608863
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.98 |
| Max. Negotiated Rate |
$357.62 |
| Rate for Payer: Aetna Commercial |
$214.57
|
| Rate for Payer: Aetna Medicare Advantage |
$214.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$182.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$182.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$182.39
|
| Rate for Payer: Cigna Commercial |
$357.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$92.98
|
| Rate for Payer: Oxford Commercial |
$357.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$107.29
|
| Rate for Payer: UnitedHealthcare Commercial |
$357.62
|
|
|
DLU ENDO GIA II 30 3.5 030419
|
Facility
|
OP
|
$439.47
|
|
| Hospital Charge Code |
270608864
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.13 |
| Max. Negotiated Rate |
$219.74 |
| Rate for Payer: Aetna Commercial |
$131.84
|
| Rate for Payer: Aetna Medicare Advantage |
$131.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$112.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$112.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$112.06
|
| Rate for Payer: Cigna Commercial |
$219.74
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$57.13
|
| Rate for Payer: Oxford Commercial |
$219.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$65.92
|
| Rate for Payer: UnitedHealthcare Commercial |
$219.74
|
|
|
DLU ENDO GIA II 30 3.5 030419
|
Facility
|
IP
|
$439.47
|
|
| Hospital Charge Code |
270608864
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.92 |
| Max. Negotiated Rate |
$65.92 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$65.92
|
|
|
DLU ENDO GIA II 45 2.5 030425
|
Facility
|
IP
|
$439.47
|
|
| Hospital Charge Code |
270608865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.92 |
| Max. Negotiated Rate |
$65.92 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$65.92
|
|
|
DLU ENDO GIA II 45 2.5 030425
|
Facility
|
OP
|
$439.47
|
|
| Hospital Charge Code |
270608865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.13 |
| Max. Negotiated Rate |
$219.74 |
| Rate for Payer: Aetna Commercial |
$131.84
|
| Rate for Payer: Aetna Medicare Advantage |
$131.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$112.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$112.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$112.06
|
| Rate for Payer: Cigna Commercial |
$219.74
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$57.13
|
| Rate for Payer: Oxford Commercial |
$219.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$65.92
|
| Rate for Payer: UnitedHealthcare Commercial |
$219.74
|
|
|
DLU ENDO GIA II 45 4.8 030423
|
Facility
|
OP
|
$737.65
|
|
| Hospital Charge Code |
270608867
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.89 |
| Max. Negotiated Rate |
$368.82 |
| Rate for Payer: Aetna Commercial |
$221.29
|
| Rate for Payer: Aetna Medicare Advantage |
$221.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$188.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$188.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$188.10
|
| Rate for Payer: Cigna Commercial |
$368.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$95.89
|
| Rate for Payer: Oxford Commercial |
$368.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$110.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$368.82
|
|
|
DLU ENDO GIA II 45 4.8 030423
|
Facility
|
IP
|
$737.65
|
|
| Hospital Charge Code |
270608867
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.65 |
| Max. Negotiated Rate |
$110.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$110.65
|
|
|
DLU ENDO GIA II 60 2.5 030412
|
Facility
|
OP
|
$760.00
|
|
| Hospital Charge Code |
270608868
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna Commercial |
$228.00
|
| Rate for Payer: Aetna Medicare Advantage |
$228.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$193.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$193.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$193.80
|
| Rate for Payer: Cigna Commercial |
$380.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$98.80
|
| Rate for Payer: Oxford Commercial |
$380.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$114.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$380.00
|
|
|
DLU ENDO GIA II 60 2.5 030412
|
Facility
|
IP
|
$760.00
|
|
| Hospital Charge Code |
270608868
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$114.00
|
|
|
DLU ENDO GIA II 60 3.5 030414
|
Facility
|
IP
|
$665.58
|
|
| Hospital Charge Code |
270608869
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.84 |
| Max. Negotiated Rate |
$99.84 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.84
|
|
|
DLU ENDO GIA II 60 3.5 030414
|
Facility
|
OP
|
$665.58
|
|
| Hospital Charge Code |
270608869
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$86.53 |
| Max. Negotiated Rate |
$332.79 |
| Rate for Payer: Aetna Commercial |
$199.67
|
| Rate for Payer: Aetna Medicare Advantage |
$199.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$169.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$169.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$169.72
|
| Rate for Payer: Cigna Commercial |
$332.79
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$86.53
|
| Rate for Payer: Oxford Commercial |
$332.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.84
|
| Rate for Payer: UnitedHealthcare Commercial |
$332.79
|
|
|
DLU ENDO GIA II 60 4.8 030415
|
Facility
|
OP
|
$659.13
|
|
| Hospital Charge Code |
270608870
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.69 |
| Max. Negotiated Rate |
$329.56 |
| Rate for Payer: Aetna Commercial |
$197.74
|
| Rate for Payer: Aetna Medicare Advantage |
$197.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$168.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$168.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$168.08
|
| Rate for Payer: Cigna Commercial |
$329.56
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$85.69
|
| Rate for Payer: Oxford Commercial |
$329.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$98.87
|
| Rate for Payer: UnitedHealthcare Commercial |
$329.56
|
|
|
DLU ENDO GIA II 60 4.8 030415
|
Facility
|
IP
|
$659.13
|
|
| Hospital Charge Code |
270608870
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.87 |
| Max. Negotiated Rate |
$98.87 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$98.87
|
|
|
DLU ENDO HERNIA 4.8 174007
|
Facility
|
IP
|
$354.45
|
|
| Hospital Charge Code |
270600086
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.17 |
| Max. Negotiated Rate |
$53.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.17
|
|
|
DLU ENDO HERNIA 4.8 174007
|
Facility
|
OP
|
$354.45
|
|
| Hospital Charge Code |
270600086
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.08 |
| Max. Negotiated Rate |
$177.22 |
| Rate for Payer: Aetna Commercial |
$106.33
|
| Rate for Payer: Aetna Medicare Advantage |
$106.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$90.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$90.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$90.38
|
| Rate for Payer: Cigna Commercial |
$177.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.08
|
| Rate for Payer: Oxford Commercial |
$177.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$177.22
|
|
|
DLU ENDO HERNIA 4.O 174015
|
Facility
|
IP
|
$338.45
|
|
| Hospital Charge Code |
270600087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.77 |
| Max. Negotiated Rate |
$50.77 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.77
|
|
|
DLU ENDO HERNIA 4.O 174015
|
Facility
|
OP
|
$338.45
|
|
| Hospital Charge Code |
270600087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$169.22 |
| Rate for Payer: Aetna Commercial |
$101.53
|
| Rate for Payer: Aetna Medicare Advantage |
$101.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$86.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$86.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$86.30
|
| Rate for Payer: Cigna Commercial |
$169.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$44.00
|
| Rate for Payer: Oxford Commercial |
$169.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.77
|
| Rate for Payer: UnitedHealthcare Commercial |
$169.22
|
|
|
DLU ENDO TA 30 2.5 010911
|
Facility
|
IP
|
$836.85
|
|
| Hospital Charge Code |
270600127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.53 |
| Max. Negotiated Rate |
$125.53 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.53
|
|
|
DLU ENDO TA 30 2.5 010911
|
Facility
|
OP
|
$836.85
|
|
| Hospital Charge Code |
270600127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.79 |
| Max. Negotiated Rate |
$418.43 |
| Rate for Payer: Aetna Commercial |
$251.06
|
| Rate for Payer: Aetna Medicare Advantage |
$251.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$213.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$213.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$213.40
|
| Rate for Payer: Cigna Commercial |
$418.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$108.79
|
| Rate for Payer: Oxford Commercial |
$418.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.53
|
| Rate for Payer: UnitedHealthcare Commercial |
$418.43
|
|
|
DLU ENDO TA 30 3.5 010913
|
Facility
|
IP
|
$836.85
|
|
| Hospital Charge Code |
270600129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.53 |
| Max. Negotiated Rate |
$125.53 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.53
|
|
|
DLU ENDO TA 30 3.5 010913
|
Facility
|
OP
|
$836.85
|
|
| Hospital Charge Code |
270600129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.79 |
| Max. Negotiated Rate |
$418.43 |
| Rate for Payer: Aetna Commercial |
$251.06
|
| Rate for Payer: Aetna Medicare Advantage |
$251.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$213.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$213.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$213.40
|
| Rate for Payer: Cigna Commercial |
$418.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$108.79
|
| Rate for Payer: Oxford Commercial |
$418.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.53
|
| Rate for Payer: UnitedHealthcare Commercial |
$418.43
|
|
|
DLU ENDO UNIV 65 4.0 173054
|
Facility
|
IP
|
$1,660.00
|
|
| Hospital Charge Code |
270600085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$249.00 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$249.00
|
|