|
DRAIN BAG 96 LGTH 8MM ADAPTER
|
Facility
|
OP
|
$40.25
|
|
| Hospital Charge Code |
270660057
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$20.12 |
| Rate for Payer: Aetna Commercial |
$12.07
|
| Rate for Payer: Aetna Medicare Advantage |
$12.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.26
|
| Rate for Payer: Cigna Commercial |
$20.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.23
|
| Rate for Payer: Oxford Commercial |
$20.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.04
|
| Rate for Payer: UnitedHealthcare Commercial |
$20.12
|
|
|
DRAIN BLAKE *****
|
Facility
|
IP
|
$44.00
|
|
| Hospital Charge Code |
1810001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$6.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.60
|
|
|
DRAIN BLAKE *****
|
Facility
|
OP
|
$44.00
|
|
| Hospital Charge Code |
1810001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$22.00 |
| Rate for Payer: Aetna Commercial |
$13.20
|
| Rate for Payer: Aetna Medicare Advantage |
$13.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$11.22
|
| Rate for Payer: Cigna Commercial |
$22.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.72
|
| Rate for Payer: Oxford Commercial |
$22.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$22.00
|
|
|
DRAIN BLAKE 10FR ROUN H
|
Facility
|
OP
|
$77.45
|
|
| Hospital Charge Code |
270600376
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$38.73 |
| Rate for Payer: Aetna Commercial |
$23.23
|
| Rate for Payer: Aetna Medicare Advantage |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.75
|
| Rate for Payer: Cigna Commercial |
$38.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.07
|
| Rate for Payer: Oxford Commercial |
$38.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.62
|
| Rate for Payer: UnitedHealthcare Commercial |
$38.73
|
|
|
DRAIN BLAKE 10FR ROUN H
|
Facility
|
IP
|
$77.45
|
|
| Hospital Charge Code |
270600376
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.62 |
| Max. Negotiated Rate |
$11.62 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.62
|
|
|
DRAIN BLAKE 19 FR
|
Facility
|
IP
|
$123.11
|
|
| Hospital Charge Code |
270655051
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.47 |
| Max. Negotiated Rate |
$18.47 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.47
|
|
|
DRAIN BLAKE 19 FR
|
Facility
|
OP
|
$123.11
|
|
| Hospital Charge Code |
270655051
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$61.55 |
| Rate for Payer: Aetna Commercial |
$36.93
|
| Rate for Payer: Aetna Medicare Advantage |
$36.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$31.39
|
| Rate for Payer: Cigna Commercial |
$61.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.00
|
| Rate for Payer: Oxford Commercial |
$61.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.47
|
| Rate for Payer: UnitedHealthcare Commercial |
$61.55
|
|
|
DRAIN BLAKE HUBLESS 19fr ROUND
|
Facility
|
IP
|
$82.15
|
|
| Hospital Charge Code |
270646027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$12.32 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.32
|
|
|
DRAIN BLAKE HUBLESS 19fr ROUND
|
Facility
|
OP
|
$82.15
|
|
| Hospital Charge Code |
270646027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.68 |
| Max. Negotiated Rate |
$41.08 |
| Rate for Payer: Aetna Commercial |
$24.64
|
| Rate for Payer: Aetna Medicare Advantage |
$24.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20.95
|
| Rate for Payer: Cigna Commercial |
$41.08
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.68
|
| Rate for Payer: Oxford Commercial |
$41.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$41.08
|
|
|
DRAIN BLAKE J VAC 19FR
|
Facility
|
OP
|
$198.18
|
|
| Hospital Charge Code |
270650812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.76 |
| Max. Negotiated Rate |
$99.09 |
| Rate for Payer: Aetna Commercial |
$59.45
|
| Rate for Payer: Aetna Medicare Advantage |
$59.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$50.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$50.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$50.54
|
| Rate for Payer: Cigna Commercial |
$99.09
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$25.76
|
| Rate for Payer: Oxford Commercial |
$99.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$99.09
|
|
|
DRAIN BLAKE J VAC 19FR
|
Facility
|
IP
|
$198.18
|
|
| Hospital Charge Code |
270650812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.73 |
| Max. Negotiated Rate |
$29.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.73
|
|
|
DRAIN BLAKE KIT
|
Facility
|
IP
|
$95.18
|
|
| Hospital Charge Code |
270600245
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$14.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.28
|
|
|
DRAIN BLAKE KIT
|
Facility
|
OP
|
$95.18
|
|
| Hospital Charge Code |
270600245
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.37 |
| Max. Negotiated Rate |
$47.59 |
| Rate for Payer: Aetna Commercial |
$28.55
|
| Rate for Payer: Aetna Medicare Advantage |
$28.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$24.27
|
| Rate for Payer: Cigna Commercial |
$47.59
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.37
|
| Rate for Payer: Oxford Commercial |
$47.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$47.59
|
|
|
DRAIN BL W/CATH INSERTION
|
Facility
|
OP
|
$16,211.70
|
|
|
Service Code
|
HCPCS 51102
|
| Hospital Charge Code |
1600000475
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$5,529.00 |
| Rate for Payer: Aetna Commercial |
$4,863.51
|
| Rate for Payer: Aetna Medicare Advantage |
$4,863.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,133.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,133.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,133.98
|
| Rate for Payer: Cigna Commercial |
$4,978.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,107.52
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,431.76
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,529.00
|
|
|
DRAIN BL W/CATH INSERTION
|
Facility
|
IP
|
$16,211.70
|
|
|
Service Code
|
HCPCS 51102
|
| Hospital Charge Code |
1600000475
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,431.76 |
| Max. Negotiated Rate |
$2,431.76 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,431.76
|
|
|
DRAIN CEREBRO SPINAL FLUID
|
Facility
|
OP
|
$4,204.50
|
|
|
Service Code
|
HCPCS 62272
|
| Hospital Charge Code |
16000592
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$546.59 |
| Max. Negotiated Rate |
$2,575.00 |
| Rate for Payer: Aetna Commercial |
$1,261.35
|
| Rate for Payer: Aetna Medicare Advantage |
$1,261.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,072.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,072.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,072.15
|
| Rate for Payer: Cigna Commercial |
$1,680.99
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$546.59
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$630.67
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,575.00
|
|
|
DRAIN CEREBRO SPINAL FLUID
|
Facility
|
IP
|
$4,204.50
|
|
|
Service Code
|
HCPCS 62272
|
| Hospital Charge Code |
16000592
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$630.67 |
| Max. Negotiated Rate |
$630.67 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$630.67
|
|
|
DRAIN CHEST EXPRESS MOBILE MIN
|
Facility
|
IP
|
$306.50
|
|
| Hospital Charge Code |
270677020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.98 |
| Max. Negotiated Rate |
$45.98 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.98
|
|
|
DRAIN CHEST EXPRESS MOBILE MIN
|
Facility
|
OP
|
$306.50
|
|
| Hospital Charge Code |
270677020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.84 |
| Max. Negotiated Rate |
$153.25 |
| Rate for Payer: Aetna Commercial |
$91.95
|
| Rate for Payer: Aetna Medicare Advantage |
$91.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$78.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$78.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$78.16
|
| Rate for Payer: Cigna Commercial |
$153.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$39.84
|
| Rate for Payer: Oxford Commercial |
$153.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.98
|
| Rate for Payer: UnitedHealthcare Commercial |
$153.25
|
|
|
DRAIN FEURESTEIN SPLIT
|
Facility
|
OP
|
$111.25
|
|
| Hospital Charge Code |
270060720
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.46 |
| Max. Negotiated Rate |
$55.62 |
| Rate for Payer: Aetna Commercial |
$33.38
|
| Rate for Payer: Aetna Medicare Advantage |
$33.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$28.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$28.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$28.37
|
| Rate for Payer: Cigna Commercial |
$55.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.46
|
| Rate for Payer: Oxford Commercial |
$55.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$55.62
|
|
|
DRAIN FEURESTEIN SPLIT
|
Facility
|
IP
|
$111.25
|
|
| Hospital Charge Code |
270060720
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.69 |
| Max. Negotiated Rate |
$16.69 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.69
|
|
|
DRAIN FEURSTEIN SPLIT 140250
|
Facility
|
OP
|
$52.65
|
|
| Hospital Charge Code |
270617095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.84 |
| Max. Negotiated Rate |
$26.32 |
| Rate for Payer: Aetna Commercial |
$15.79
|
| Rate for Payer: Aetna Medicare Advantage |
$15.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.43
|
| Rate for Payer: Cigna Commercial |
$26.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.84
|
| Rate for Payer: Oxford Commercial |
$26.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$26.32
|
|
|
DRAIN FEURSTEIN SPLIT 140250
|
Facility
|
IP
|
$52.65
|
|
| Hospital Charge Code |
270617095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.90 |
| Max. Negotiated Rate |
$7.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.90
|
|
|
DRAIN FINGER ABSC,COMPLICATED
|
Facility
|
IP
|
$10,031.10
|
|
|
Service Code
|
HCPCS 26011
|
| Hospital Charge Code |
16000554
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,504.66 |
| Max. Negotiated Rate |
$1,504.66 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,504.66
|
|
|
DRAIN FINGER ABSC,COMPLICATED
|
Facility
|
OP
|
$10,031.10
|
|
|
Service Code
|
HCPCS 26011
|
| Hospital Charge Code |
16000554
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,304.04 |
| Max. Negotiated Rate |
$3,933.12 |
| Rate for Payer: Aetna Commercial |
$3,009.33
|
| Rate for Payer: Aetna Medicare Advantage |
$3,009.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,557.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,557.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,557.93
|
| Rate for Payer: Cigna Commercial |
$3,933.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,304.04
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,504.66
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,687.00
|
|