|
DRAPE BAG VI ISOLATION
|
Facility
|
OP
|
$93.65
|
|
| Hospital Charge Code |
270060795
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.17 |
| Max. Negotiated Rate |
$46.83 |
| Rate for Payer: Aetna Commercial |
$28.09
|
| Rate for Payer: Aetna Medicare Advantage |
$28.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.88
|
| Rate for Payer: Cigna Commercial |
$46.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.17
|
| Rate for Payer: Oxford Commercial |
$46.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$46.83
|
|
|
DRAPE BARRIER CRANI/INC 0291
|
Facility
|
IP
|
$368.85
|
|
| Hospital Charge Code |
270601773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.33 |
| Max. Negotiated Rate |
$55.33 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$55.33
|
|
|
DRAPE BARRIER CRANI/INC 0291
|
Facility
|
OP
|
$368.85
|
|
| Hospital Charge Code |
270601773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.95 |
| Max. Negotiated Rate |
$184.43 |
| Rate for Payer: Aetna Commercial |
$110.66
|
| Rate for Payer: Aetna Medicare Advantage |
$110.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$94.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$94.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$94.06
|
| Rate for Payer: Cigna Commercial |
$184.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.95
|
| Rate for Payer: Oxford Commercial |
$184.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$55.33
|
| Rate for Payer: UnitedHealthcare Commercial |
$184.43
|
|
|
DRAPE BRACHIAL XR K12701715
|
Facility
|
OP
|
$180.00
|
|
| Hospital Charge Code |
270654308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Aetna Medicare Advantage |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$45.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$45.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$45.90
|
| Rate for Payer: Cigna Commercial |
$90.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$23.40
|
| Rate for Payer: Oxford Commercial |
$90.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$90.00
|
|
|
DRAPE BRACHIAL XR K12701715
|
Facility
|
IP
|
$180.00
|
|
| Hospital Charge Code |
270654308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.00
|
|
|
DRAPE C-ARM ******
|
Facility
|
IP
|
$37.00
|
|
| Hospital Charge Code |
1601194
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.55 |
| Max. Negotiated Rate |
$5.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.55
|
|
|
DRAPE C-ARM ******
|
Facility
|
OP
|
$37.00
|
|
| Hospital Charge Code |
1601194
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$18.50 |
| Rate for Payer: Aetna Commercial |
$11.10
|
| Rate for Payer: Aetna Medicare Advantage |
$11.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.44
|
| Rate for Payer: Cigna Commercial |
$18.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.81
|
| Rate for Payer: Oxford Commercial |
$18.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$18.50
|
|
|
DRAPE C-ARM STER 22-22505H
|
Facility
|
OP
|
$76.85
|
|
| Hospital Charge Code |
270060761
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$38.42 |
| Rate for Payer: Aetna Commercial |
$23.05
|
| Rate for Payer: Aetna Medicare Advantage |
$23.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.60
|
| Rate for Payer: Cigna Commercial |
$38.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.99
|
| Rate for Payer: Oxford Commercial |
$38.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.53
|
| Rate for Payer: UnitedHealthcare Commercial |
$38.42
|
|
|
DRAPE C-ARM STER 22-22505H
|
Facility
|
IP
|
$76.85
|
|
| Hospital Charge Code |
270060761
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$11.53 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.53
|
|
|
DRAPE C-ARM XR 17x70 2222505H
|
Facility
|
IP
|
$38.25
|
|
| Hospital Charge Code |
270632188
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.74
|
|
|
DRAPE C-ARM XR 17x70 2222505H
|
Facility
|
OP
|
$38.25
|
|
| Hospital Charge Code |
270632188
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.97 |
| Max. Negotiated Rate |
$19.12 |
| Rate for Payer: Aetna Commercial |
$11.47
|
| Rate for Payer: Aetna Medicare Advantage |
$11.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.75
|
| Rate for Payer: Cigna Commercial |
$19.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.97
|
| Rate for Payer: Oxford Commercial |
$19.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.74
|
| Rate for Payer: UnitedHealthcare Commercial |
$19.12
|
|
|
DRAPE CESAREAN IOBAN II 6697
|
Facility
|
IP
|
$149.65
|
|
| Hospital Charge Code |
270622870
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.45 |
| Max. Negotiated Rate |
$22.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.45
|
|
|
DRAPE CESAREAN IOBAN II 6697
|
Facility
|
OP
|
$149.65
|
|
| Hospital Charge Code |
270622870
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.45 |
| Max. Negotiated Rate |
$74.83 |
| Rate for Payer: Aetna Commercial |
$44.90
|
| Rate for Payer: Aetna Medicare Advantage |
$44.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$38.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$38.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$38.16
|
| Rate for Payer: Cigna Commercial |
$74.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.45
|
| Rate for Payer: Oxford Commercial |
$74.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$74.83
|
|
|
DRAPE CESAREAN IOBAN II 6697**
|
Facility
|
IP
|
$318.00
|
|
| Hospital Charge Code |
270130031
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.70 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$47.70
|
|
|
DRAPE CESAREAN IOBAN II 6697**
|
Facility
|
OP
|
$318.00
|
|
| Hospital Charge Code |
270130031
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.34 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: Aetna Commercial |
$95.40
|
| Rate for Payer: Aetna Medicare Advantage |
$95.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$81.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$81.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$81.09
|
| Rate for Payer: Cigna Commercial |
$159.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$41.34
|
| Rate for Payer: Oxford Commercial |
$159.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$47.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
|
|
DRAPE CHEST 89277
|
Facility
|
OP
|
$97.65
|
|
| Hospital Charge Code |
270609202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.69 |
| Max. Negotiated Rate |
$48.83 |
| Rate for Payer: Aetna Commercial |
$29.30
|
| Rate for Payer: Aetna Medicare Advantage |
$29.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$24.90
|
| Rate for Payer: Cigna Commercial |
$48.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.69
|
| Rate for Payer: Oxford Commercial |
$48.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$48.83
|
|
|
DRAPE CHEST 89277
|
Facility
|
IP
|
$97.65
|
|
| Hospital Charge Code |
270609202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.65 |
| Max. Negotiated Rate |
$14.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.65
|
|
|
DRAPE CRANIOTOMY 89062
|
Facility
|
IP
|
$226.45
|
|
| Hospital Charge Code |
270609209
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.97 |
| Max. Negotiated Rate |
$33.97 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.97
|
|
|
DRAPE CRANIOTOMY 89062
|
Facility
|
OP
|
$226.45
|
|
| Hospital Charge Code |
270609209
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.44 |
| Max. Negotiated Rate |
$113.22 |
| Rate for Payer: Aetna Commercial |
$67.94
|
| Rate for Payer: Aetna Medicare Advantage |
$67.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.74
|
| Rate for Payer: Cigna Commercial |
$113.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.44
|
| Rate for Payer: Oxford Commercial |
$113.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.97
|
| Rate for Payer: UnitedHealthcare Commercial |
$113.22
|
|
|
DRAPE ENT 89358
|
Facility
|
IP
|
$44.85
|
|
| Hospital Charge Code |
270620011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$6.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.73
|
|
|
DRAPE ENT 89358
|
Facility
|
OP
|
$44.85
|
|
| Hospital Charge Code |
270620011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$22.43 |
| Rate for Payer: Aetna Commercial |
$13.46
|
| Rate for Payer: Aetna Medicare Advantage |
$13.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$11.44
|
| Rate for Payer: Cigna Commercial |
$22.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.83
|
| Rate for Payer: Oxford Commercial |
$22.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$22.43
|
|
|
DRAPE ENT MICROSCOPE
|
Facility
|
OP
|
$40.79
|
|
| Hospital Charge Code |
270657784
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$20.39 |
| Rate for Payer: Aetna Commercial |
$12.24
|
| Rate for Payer: Aetna Medicare Advantage |
$12.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.40
|
| Rate for Payer: Cigna Commercial |
$20.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.30
|
| Rate for Payer: Oxford Commercial |
$20.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$20.39
|
|
|
DRAPE ENT MICROSCOPE
|
Facility
|
IP
|
$40.79
|
|
| Hospital Charge Code |
270657784
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$6.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.12
|
|
|
DRAPE FLUOROSCOPE 4509001012
|
Facility
|
OP
|
$4.00
|
|
| Hospital Charge Code |
270630333
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Aetna Commercial |
$1.20
|
| Rate for Payer: Aetna Medicare Advantage |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.02
|
| Rate for Payer: Cigna Commercial |
$2.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.52
|
| Rate for Payer: Oxford Commercial |
$2.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.00
|
|
|
DRAPE FLUOROSCOPE 4509001012
|
Facility
|
IP
|
$4.00
|
|
| Hospital Charge Code |
270630333
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
|