|
GLOVE SURG SENSICARE SZ 7.5
|
Facility
|
OP
|
$8.94
|
|
| Hospital Charge Code |
270060935C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$4.47 |
| Rate for Payer: Aetna Commercial |
$2.68
|
| Rate for Payer: Aetna Medicare Advantage |
$2.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.28
|
| Rate for Payer: Cigna Commercial |
$4.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.16
|
| Rate for Payer: Oxford Commercial |
$4.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.47
|
|
|
GLOVE SURG SENSICARE SZ 8.5
|
Facility
|
IP
|
$8.94
|
|
| Hospital Charge Code |
270060945C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.34
|
|
|
GLOVE SURG SENSICARE SZ 8.5
|
Facility
|
OP
|
$8.94
|
|
| Hospital Charge Code |
270060945C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$4.47 |
| Rate for Payer: Aetna Commercial |
$2.68
|
| Rate for Payer: Aetna Medicare Advantage |
$2.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.28
|
| Rate for Payer: Cigna Commercial |
$4.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.16
|
| Rate for Payer: Oxford Commercial |
$4.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.47
|
|
|
GLOVE SURG TRIFLEX STER SZ 6
|
Facility
|
IP
|
$1.70
|
|
| Hospital Charge Code |
270649557
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.26
|
|
|
GLOVE SURG TRIFLEX STER SZ 6
|
Facility
|
OP
|
$1.70
|
|
| Hospital Charge Code |
270649557
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Aetna Commercial |
$0.51
|
| Rate for Payer: Aetna Medicare Advantage |
$0.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.43
|
| Rate for Payer: Cigna Commercial |
$0.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.22
|
| Rate for Payer: Oxford Commercial |
$0.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.85
|
|
|
GLOVE SURG TRIFLEX STER SZ 6.5
|
Facility
|
IP
|
$1.70
|
|
| Hospital Charge Code |
270649569
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.26
|
|
|
GLOVE SURG TRIFLEX STER SZ 6.5
|
Facility
|
OP
|
$1.70
|
|
| Hospital Charge Code |
270649569
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Aetna Commercial |
$0.51
|
| Rate for Payer: Aetna Medicare Advantage |
$0.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.43
|
| Rate for Payer: Cigna Commercial |
$0.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.22
|
| Rate for Payer: Oxford Commercial |
$0.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.85
|
|
|
GLOVE SURG TRIFLEX STER SZ 7
|
Facility
|
OP
|
$1.70
|
|
| Hospital Charge Code |
270649558
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Aetna Commercial |
$0.51
|
| Rate for Payer: Aetna Medicare Advantage |
$0.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.43
|
| Rate for Payer: Cigna Commercial |
$0.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.22
|
| Rate for Payer: Oxford Commercial |
$0.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.85
|
|
|
GLOVE SURG TRIFLEX STER SZ 7
|
Facility
|
IP
|
$1.70
|
|
| Hospital Charge Code |
270649558
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.26
|
|
|
GLOVE SURG TRIFLEX STER SZ 7.5
|
Facility
|
IP
|
$1.70
|
|
| Hospital Charge Code |
270650502
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.26
|
|
|
GLOVE SURG TRIFLEX STER SZ 7.5
|
Facility
|
OP
|
$1.70
|
|
| Hospital Charge Code |
270650502
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Aetna Commercial |
$0.51
|
| Rate for Payer: Aetna Medicare Advantage |
$0.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.43
|
| Rate for Payer: Cigna Commercial |
$0.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.22
|
| Rate for Payer: Oxford Commercial |
$0.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.85
|
|
|
GLOVE SURG TRIFLEX STER SZ 8
|
Facility
|
OP
|
$1.70
|
|
| Hospital Charge Code |
270649559
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Aetna Commercial |
$0.51
|
| Rate for Payer: Aetna Medicare Advantage |
$0.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.43
|
| Rate for Payer: Cigna Commercial |
$0.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.22
|
| Rate for Payer: Oxford Commercial |
$0.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.85
|
|
|
GLOVE SURG TRIFLEX STER SZ 8
|
Facility
|
IP
|
$1.70
|
|
| Hospital Charge Code |
270649559
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.26
|
|
|
GLOVE SURG TRIFLEX STER SZ 8.5
|
Facility
|
IP
|
$1.70
|
|
| Hospital Charge Code |
270649561
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.26
|
|
|
GLOVE SURG TRIFLEX STER SZ 8.5
|
Facility
|
OP
|
$1.70
|
|
| Hospital Charge Code |
270649561
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Aetna Commercial |
$0.51
|
| Rate for Payer: Aetna Medicare Advantage |
$0.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.43
|
| Rate for Payer: Cigna Commercial |
$0.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.22
|
| Rate for Payer: Oxford Commercial |
$0.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.85
|
|
|
GLOVE SURG TRIFLEX STER SZ 9
|
Facility
|
OP
|
$67.85
|
|
| Hospital Charge Code |
270649570
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$33.92 |
| Rate for Payer: Aetna Commercial |
$20.36
|
| Rate for Payer: Aetna Medicare Advantage |
$20.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.30
|
| Rate for Payer: Cigna Commercial |
$33.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.82
|
| Rate for Payer: Oxford Commercial |
$33.92
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$33.92
|
|
|
GLOVE SURG TRIFLEX STER SZ 9
|
Facility
|
IP
|
$67.85
|
|
| Hospital Charge Code |
270649570
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$10.18 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.18
|
|
|
GLOVE SZ 6 1/2 TRIFLEX ORTHO
|
Facility
|
OP
|
$203.80
|
|
| Hospital Charge Code |
270665432
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.49 |
| Max. Negotiated Rate |
$101.90 |
| Rate for Payer: Aetna Commercial |
$61.14
|
| Rate for Payer: Aetna Medicare Advantage |
$61.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$51.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$51.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$51.97
|
| Rate for Payer: Cigna Commercial |
$101.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$26.49
|
| Rate for Payer: Oxford Commercial |
$101.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$101.90
|
|
|
GLOVE SZ 6 1/2 TRIFLEX ORTHO
|
Facility
|
IP
|
$203.80
|
|
| Hospital Charge Code |
270665432
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.57 |
| Max. Negotiated Rate |
$30.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.57
|
|
|
GLOVE SZ 7 1/2 TRIFLEX ORTHO
|
Facility
|
IP
|
$203.80
|
|
| Hospital Charge Code |
270665430
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.57 |
| Max. Negotiated Rate |
$30.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.57
|
|
|
GLOVE SZ 7 1/2 TRIFLEX ORTHO
|
Facility
|
OP
|
$203.80
|
|
| Hospital Charge Code |
270665430
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.49 |
| Max. Negotiated Rate |
$101.90 |
| Rate for Payer: Aetna Commercial |
$61.14
|
| Rate for Payer: Aetna Medicare Advantage |
$61.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$51.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$51.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$51.97
|
| Rate for Payer: Cigna Commercial |
$101.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$26.49
|
| Rate for Payer: Oxford Commercial |
$101.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$101.90
|
|
|
GLOVE SZ 7 TRIFLEX ORTHO
|
Facility
|
OP
|
$203.80
|
|
| Hospital Charge Code |
270665431
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.49 |
| Max. Negotiated Rate |
$101.90 |
| Rate for Payer: Aetna Commercial |
$61.14
|
| Rate for Payer: Aetna Medicare Advantage |
$61.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$51.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$51.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$51.97
|
| Rate for Payer: Cigna Commercial |
$101.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$26.49
|
| Rate for Payer: Oxford Commercial |
$101.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$101.90
|
|
|
GLOVE SZ 7 TRIFLEX ORTHO
|
Facility
|
IP
|
$203.80
|
|
| Hospital Charge Code |
270665431
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.57 |
| Max. Negotiated Rate |
$30.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.57
|
|
|
GLOVE TRIFLEX SURGICAL SZ 6.0
|
Facility
|
OP
|
$13.17
|
|
| Hospital Charge Code |
270655995
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$6.58 |
| Rate for Payer: Aetna Commercial |
$3.95
|
| Rate for Payer: Aetna Medicare Advantage |
$3.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.36
|
| Rate for Payer: Cigna Commercial |
$6.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.71
|
| Rate for Payer: Oxford Commercial |
$6.58
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.98
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.58
|
|
|
GLOVE TRIFLEX SURGICAL SZ 6.0
|
Facility
|
IP
|
$13.17
|
|
| Hospital Charge Code |
270655995
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.98
|
|