|
ENDO BABCOCK 10 MM ****
|
Facility
|
IP
|
$519.00
|
|
| Hospital Charge Code |
1603380
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.85 |
| Max. Negotiated Rate |
$77.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.85
|
|
|
ENDO BABCOCK 174001
|
Facility
|
IP
|
$879.25
|
|
| Hospital Charge Code |
270600100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.89 |
| Max. Negotiated Rate |
$131.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.89
|
|
|
ENDO BABCOCK 174001
|
Facility
|
OP
|
$879.25
|
|
| Hospital Charge Code |
270600100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.30 |
| Max. Negotiated Rate |
$439.62 |
| Rate for Payer: Aetna Commercial |
$263.77
|
| Rate for Payer: Aetna Medicare Advantage |
$263.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$224.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$224.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$224.21
|
| Rate for Payer: Cigna Commercial |
$439.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$114.30
|
| Rate for Payer: Oxford Commercial |
$439.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$439.62
|
|
|
ENDO BABCOCK 1MM CLAMP
|
Facility
|
OP
|
$567.00
|
|
| Hospital Charge Code |
270330811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.71 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| Rate for Payer: Aetna Medicare Advantage |
$170.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$144.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$144.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$144.59
|
| Rate for Payer: Cigna Commercial |
$283.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$73.71
|
| Rate for Payer: Oxford Commercial |
$283.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$85.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$283.50
|
|
|
ENDO BABCOCK 1MM CLAMP
|
Facility
|
IP
|
$567.00
|
|
| Hospital Charge Code |
270330811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.05 |
| Max. Negotiated Rate |
$85.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$85.05
|
|
|
ENDO BEDSIDE TUBE PROCEDURE
|
Facility
|
IP
|
$500.00
|
|
| Hospital Charge Code |
2500263
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
|
|
ENDO BEDSIDE TUBE PROCEDURE
|
Facility
|
OP
|
$500.00
|
|
| Hospital Charge Code |
2500263
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$150.00
|
| Rate for Payer: Aetna Medicare Advantage |
$150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$127.50
|
| 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 |
$127.50
|
| Rate for Payer: Cigna Commercial |
$250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$65.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
|
|
ENDO BIOPSY FORCEPS
|
Facility
|
OP
|
$229.00
|
|
| Hospital Charge Code |
270325602
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.77 |
| Max. Negotiated Rate |
$114.50 |
| Rate for Payer: Aetna Commercial |
$68.70
|
| Rate for Payer: Aetna Medicare Advantage |
$68.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$58.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$58.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$58.40
|
| Rate for Payer: Cigna Commercial |
$114.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.77
|
| Rate for Payer: Oxford Commercial |
$114.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$34.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.50
|
|
|
ENDO BIOPSY FORCEPS
|
Facility
|
IP
|
$229.00
|
|
| Hospital Charge Code |
270325602
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.35 |
| Max. Negotiated Rate |
$34.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$34.35
|
|
|
ENDOBLADE
|
Facility
|
IP
|
$4,475.00
|
|
| Hospital Charge Code |
270681170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$671.25 |
| Max. Negotiated Rate |
$671.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$671.25
|
|
|
ENDOBLADE
|
Facility
|
OP
|
$4,475.00
|
|
| Hospital Charge Code |
270681170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$581.75 |
| Max. Negotiated Rate |
$2,237.50 |
| Rate for Payer: Aetna Commercial |
$1,342.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,342.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,141.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,141.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,141.12
|
| Rate for Payer: Cigna Commercial |
$2,237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$581.75
|
| Rate for Payer: Oxford Commercial |
$2,237.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$671.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,237.50
|
|
|
ENDOBLADE PLANTAR X2
|
Facility
|
OP
|
$4,475.00
|
|
| Hospital Charge Code |
270689930
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$581.75 |
| Max. Negotiated Rate |
$2,237.50 |
| Rate for Payer: Aetna Commercial |
$1,342.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,342.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,141.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,141.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,141.12
|
| Rate for Payer: Cigna Commercial |
$2,237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$581.75
|
| Rate for Payer: Oxford Commercial |
$2,237.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$671.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,237.50
|
|
|
ENDOBLADE PLANTAR X2
|
Facility
|
IP
|
$4,475.00
|
|
| Hospital Charge Code |
270689930
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$671.25 |
| Max. Negotiated Rate |
$671.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$671.25
|
|
|
ENDO BLADE SAMURAI
|
Facility
|
OP
|
$1,225.00
|
|
| Hospital Charge Code |
270668507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$159.25 |
| Max. Negotiated Rate |
$612.50 |
| Rate for Payer: Aetna Commercial |
$367.50
|
| Rate for Payer: Aetna Medicare Advantage |
$367.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$312.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$312.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$312.38
|
| Rate for Payer: Cigna Commercial |
$612.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$159.25
|
| Rate for Payer: Oxford Commercial |
$612.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$183.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$612.50
|
|
|
ENDO BLADE SAMURAI
|
Facility
|
IP
|
$1,225.00
|
|
| Hospital Charge Code |
270668507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$183.75 |
| Max. Negotiated Rate |
$183.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$183.75
|
|
|
ENDO BOWEL *****
|
Facility
|
OP
|
$519.00
|
|
| Hospital Charge Code |
1603364
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.47 |
| Max. Negotiated Rate |
$259.50 |
| Rate for Payer: Aetna Commercial |
$155.70
|
| Rate for Payer: Aetna Medicare Advantage |
$155.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$132.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$132.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$132.34
|
| Rate for Payer: Cigna Commercial |
$259.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$67.47
|
| Rate for Payer: Oxford Commercial |
$259.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$259.50
|
|
|
ENDO BOWEL *****
|
Facility
|
IP
|
$519.00
|
|
| Hospital Charge Code |
1603364
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.85 |
| Max. Negotiated Rate |
$77.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.85
|
|
|
ENDO BOWEL 10MM 174307
|
Facility
|
OP
|
$916.85
|
|
| Hospital Charge Code |
270600095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.19 |
| Max. Negotiated Rate |
$458.43 |
| Rate for Payer: Aetna Commercial |
$275.06
|
| Rate for Payer: Aetna Medicare Advantage |
$275.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$233.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$233.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$233.80
|
| Rate for Payer: Cigna Commercial |
$458.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$119.19
|
| Rate for Payer: Oxford Commercial |
$458.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$137.53
|
| Rate for Payer: UnitedHealthcare Commercial |
$458.43
|
|
|
ENDO BOWEL 10MM 174307
|
Facility
|
IP
|
$916.85
|
|
| Hospital Charge Code |
270600095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$137.53 |
| Max. Negotiated Rate |
$137.53 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$137.53
|
|
|
ENDOBRONCHIAL BLOCKER ARNDT 9F
|
Facility
|
IP
|
$1,305.20
|
|
| Hospital Charge Code |
270663829
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$195.78 |
| Max. Negotiated Rate |
$195.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$195.78
|
|
|
ENDOBRONCHIAL BLOCKER ARNDT 9F
|
Facility
|
OP
|
$1,305.20
|
|
| Hospital Charge Code |
270663829
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$169.68 |
| Max. Negotiated Rate |
$652.60 |
| Rate for Payer: Aetna Commercial |
$391.56
|
| Rate for Payer: Aetna Medicare Advantage |
$391.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$332.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$332.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$332.83
|
| Rate for Payer: Cigna Commercial |
$652.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$169.68
|
| Rate for Payer: Oxford Commercial |
$652.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$195.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$652.60
|
|
|
ENDO CANNULA FLOWPORT II
|
Facility
|
IP
|
$1,445.00
|
|
| Hospital Charge Code |
270668508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$216.75 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$216.75
|
|
|
ENDO CANNULA FLOWPORT II
|
Facility
|
OP
|
$1,445.00
|
|
| Hospital Charge Code |
270668508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.85 |
| Max. Negotiated Rate |
$722.50 |
| Rate for Payer: Aetna Commercial |
$433.50
|
| Rate for Payer: Aetna Medicare Advantage |
$433.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$368.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$368.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$368.48
|
| Rate for Payer: Cigna Commercial |
$722.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.85
|
| Rate for Payer: Oxford Commercial |
$722.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$216.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$722.50
|
|
|
ENDO CANNULA TRANSPORT
|
Facility
|
OP
|
$450.00
|
|
| Hospital Charge Code |
270668506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna Commercial |
$135.00
|
| Rate for Payer: Aetna Medicare Advantage |
$135.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$114.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$114.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$114.75
|
| Rate for Payer: Cigna Commercial |
$225.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$58.50
|
| Rate for Payer: Oxford Commercial |
$225.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$225.00
|
|
|
ENDO CANNULA TRANSPORT
|
Facility
|
IP
|
$450.00
|
|
| Hospital Charge Code |
270668506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.50 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.50
|
|