|
DRAPE LAP CHOLE 89225
|
Facility
|
OP
|
$140.00
|
|
| Hospital Charge Code |
270609215
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna Commercial |
$42.00
|
| Rate for Payer: Aetna Medicare Advantage |
$42.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$35.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$35.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$35.70
|
| Rate for Payer: Cigna Commercial |
$70.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.20
|
| Rate for Payer: Oxford Commercial |
$70.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$70.00
|
|
|
DRAPE LAP PELVI 89222
|
Facility
|
IP
|
$69.65
|
|
| Hospital Charge Code |
270620009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.45 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.45
|
|
|
DRAPE LAP PELVI 89222
|
Facility
|
OP
|
$69.65
|
|
| Hospital Charge Code |
270620009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$34.83 |
| Rate for Payer: Aetna Commercial |
$20.89
|
| Rate for Payer: Aetna Medicare Advantage |
$20.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.76
|
| Rate for Payer: Cigna Commercial |
$34.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.05
|
| Rate for Payer: Oxford Commercial |
$34.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$34.83
|
|
|
DRAPE LASER ARM 21-12050
|
Facility
|
IP
|
$124.85
|
|
| Hospital Charge Code |
270600244
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.73 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.73
|
|
|
DRAPE LASER ARM 21-12050
|
Facility
|
OP
|
$124.85
|
|
| Hospital Charge Code |
270600244
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.23 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$37.45
|
| Rate for Payer: Aetna Medicare Advantage |
$37.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$31.84
|
| Rate for Payer: Cigna Commercial |
$62.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.23
|
| Rate for Payer: Oxford Commercial |
$62.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$62.42
|
|
|
DRAPE LEGGINGS 8420
|
Facility
|
OP
|
$11.48
|
|
| Hospital Charge Code |
270649148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Aetna Medicare Advantage |
$3.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.93
|
| Rate for Payer: Cigna Commercial |
$5.74
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.49
|
| Rate for Payer: Oxford Commercial |
$5.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.72
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.74
|
|
|
DRAPE LEGGINGS 8420
|
Facility
|
IP
|
$11.48
|
|
| Hospital Charge Code |
270649148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$1.72 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.72
|
|
|
DRAPE LG W/REVERSE FOLD 89122
|
Facility
|
OP
|
$20.85
|
|
| Hospital Charge Code |
270609200
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$10.43 |
| Rate for Payer: Aetna Commercial |
$6.25
|
| Rate for Payer: Aetna Medicare Advantage |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5.32
|
| Rate for Payer: Cigna Commercial |
$10.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.71
|
| Rate for Payer: Oxford Commercial |
$10.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$10.43
|
|
|
DRAPE LG W/REVERSE FOLD 89122
|
Facility
|
IP
|
$20.85
|
|
| Hospital Charge Code |
270609200
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.13
|
|
|
DRAPE LOWER EXTREMITY 89276
|
Facility
|
IP
|
$54.45
|
|
| Hospital Charge Code |
270620422
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$8.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.17
|
|
|
DRAPE LOWER EXTREMITY 89276
|
Facility
|
OP
|
$54.45
|
|
| Hospital Charge Code |
270620422
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$27.23 |
| Rate for Payer: Aetna Commercial |
$16.34
|
| Rate for Payer: Aetna Medicare Advantage |
$16.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.88
|
| Rate for Payer: Cigna Commercial |
$27.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.08
|
| Rate for Payer: Oxford Commercial |
$27.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$27.23
|
|
|
DRAPE MAGNETIC 30/CS
|
Facility
|
OP
|
$20.65
|
|
| Hospital Charge Code |
270655944
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$10.32 |
| Rate for Payer: Aetna Commercial |
$6.20
|
| Rate for Payer: Aetna Medicare Advantage |
$6.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5.27
|
| Rate for Payer: Cigna Commercial |
$10.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.68
|
| Rate for Payer: Oxford Commercial |
$10.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$10.32
|
|
|
DRAPE MAGNETIC 30/CS
|
Facility
|
IP
|
$20.65
|
|
| Hospital Charge Code |
270655944
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.10
|
|
|
DRAPE MAGNETIC INST W/STAYS
|
Facility
|
IP
|
$20.65
|
|
| Hospital Charge Code |
270651665
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.10
|
|
|
DRAPE MAGNETIC INST W/STAYS
|
Facility
|
OP
|
$20.65
|
|
| Hospital Charge Code |
270651665
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$10.32 |
| Rate for Payer: Aetna Commercial |
$6.20
|
| Rate for Payer: Aetna Medicare Advantage |
$6.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5.27
|
| Rate for Payer: Cigna Commercial |
$10.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.68
|
| Rate for Payer: Oxford Commercial |
$10.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$10.32
|
|
|
DRAPE MAGNETIC SURGICAL PHRM**
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
1601053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna Medicare Advantage |
$3.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.31
|
| Rate for Payer: Cigna Commercial |
$6.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.69
|
| Rate for Payer: Oxford Commercial |
$6.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.50
|
|
|
DRAPE MAGNETIC SURGICAL PHRM**
|
Facility
|
IP
|
$13.00
|
|
| Hospital Charge Code |
1601053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.95
|
|
|
DRAPE MCRSCPE ZEIS46x80 4862CL
|
Facility
|
IP
|
$101.40
|
|
| Hospital Charge Code |
270641323
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.21 |
| Max. Negotiated Rate |
$15.21 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.21
|
|
|
DRAPE MCRSCPE ZEIS46x80 4862CL
|
Facility
|
OP
|
$101.40
|
|
| Hospital Charge Code |
270641323
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.18 |
| Max. Negotiated Rate |
$50.70 |
| Rate for Payer: Aetna Commercial |
$30.42
|
| Rate for Payer: Aetna Medicare Advantage |
$30.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$25.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$25.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$25.86
|
| Rate for Payer: Cigna Commercial |
$50.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.18
|
| Rate for Payer: Oxford Commercial |
$50.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.21
|
| Rate for Payer: UnitedHealthcare Commercial |
$50.70
|
|
|
DRAPE MICROSCOPE *****
|
Facility
|
IP
|
$98.00
|
|
| Hospital Charge Code |
1600717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$14.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.70
|
|
|
DRAPE MICROSCOPE *****
|
Facility
|
OP
|
$98.00
|
|
| Hospital Charge Code |
1600717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: Aetna Commercial |
$29.40
|
| Rate for Payer: Aetna Medicare Advantage |
$29.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$24.99
|
| Rate for Payer: Cigna Commercial |
$49.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.74
|
| Rate for Payer: Oxford Commercial |
$49.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$49.00
|
|
|
DRAPE MICROSCOPE*******
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
1608140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.30 |
| Max. Negotiated Rate |
$12.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.30
|
|
|
DRAPE MICROSCOPE*******
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
1608140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: Aetna Commercial |
$24.60
|
| Rate for Payer: Aetna Medicare Advantage |
$24.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20.91
|
| Rate for Payer: Cigna Commercial |
$41.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.66
|
| Rate for Payer: Oxford Commercial |
$41.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$41.00
|
|
|
DRAPE MICROSCOPE 41X64 M1071
|
Facility
|
OP
|
$256.00
|
|
| Hospital Charge Code |
270601099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.28 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: Aetna Commercial |
$76.80
|
| Rate for Payer: Aetna Medicare Advantage |
$76.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$65.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$65.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$65.28
|
| Rate for Payer: Cigna Commercial |
$128.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.28
|
| Rate for Payer: Oxford Commercial |
$128.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$128.00
|
|
|
DRAPE MICROSCOPE 41X64 M1071
|
Facility
|
IP
|
$256.00
|
|
| Hospital Charge Code |
270601099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$38.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.40
|
|