|
BAG URINARY URIMETER
|
Facility
|
IP
|
$38.45
|
|
| Hospital Charge Code |
270300147
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.77 |
| Max. Negotiated Rate |
$5.77 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.77
|
|
|
BAG URINARY URIMETER *******
|
Facility
|
IP
|
$34.00
|
|
| Hospital Charge Code |
8002115
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.10
|
|
|
BAG URINARY URIMETER *******
|
Facility
|
OP
|
$34.00
|
|
| Hospital Charge Code |
8002115
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: Aetna Medicare Advantage |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.67
|
| Rate for Payer: Cigna Commercial |
$17.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.42
|
| Rate for Payer: Oxford Commercial |
$17.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$17.00
|
|
|
BAG URINE 24 HR***
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
8001273
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: Aetna Medicare Advantage |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.65
|
| Rate for Payer: Cigna Commercial |
$15.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.90
|
| Rate for Payer: Oxford Commercial |
$15.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$15.00
|
|
|
BAG URINE 24 HR***
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
8001273
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.50
|
|
|
BAG URINE COLLECT PEDS NONSTER
|
Facility
|
IP
|
$11.25
|
|
| Hospital Charge Code |
270300130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$1.69 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.69
|
|
|
BAG URINE COLLECT PEDS NONSTER
|
Facility
|
OP
|
$11.25
|
|
| Hospital Charge Code |
270300130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Aetna Medicare Advantage |
$3.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.87
|
| Rate for Payer: Cigna Commercial |
$5.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.46
|
| Rate for Payer: Oxford Commercial |
$5.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.62
|
|
|
BAG URINE COLLECT PEDS STER
|
Facility
|
IP
|
$7.95
|
|
| Hospital Charge Code |
270300135
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.19
|
|
|
BAG URINE COLLECT PEDS STER
|
Facility
|
OP
|
$7.95
|
|
| Hospital Charge Code |
270300135
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$3.98 |
| Rate for Payer: Aetna Commercial |
$2.38
|
| Rate for Payer: Aetna Medicare Advantage |
$2.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.03
|
| Rate for Payer: Cigna Commercial |
$3.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.03
|
| Rate for Payer: Oxford Commercial |
$3.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.98
|
|
|
BAG URIN LATXFREE W/CHA 154102
|
Facility
|
OP
|
$23.92
|
|
| Hospital Charge Code |
270612395
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$11.96 |
| Rate for Payer: Aetna Commercial |
$7.18
|
| Rate for Payer: Aetna Medicare Advantage |
$7.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6.10
|
| Rate for Payer: Cigna Commercial |
$11.96
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.11
|
| Rate for Payer: Oxford Commercial |
$11.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.59
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.96
|
|
|
BAG URIN LATXFREE W/CHA 154102
|
Facility
|
IP
|
$23.92
|
|
| Hospital Charge Code |
270612395
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$3.59 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.59
|
|
|
BAG URO FLUID COLLECTOR N/STE-
|
Facility
|
OP
|
$68.51
|
|
| Hospital Charge Code |
270646305
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$34.26 |
| Rate for Payer: Aetna Commercial |
$20.55
|
| Rate for Payer: Aetna Medicare Advantage |
$20.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.47
|
| Rate for Payer: Cigna Commercial |
$34.26
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.91
|
| Rate for Payer: Oxford Commercial |
$34.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$34.26
|
|
|
BAG URO FLUID COLLECTOR N/STE-
|
Facility
|
IP
|
$68.51
|
|
| Hospital Charge Code |
270646305
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.28 |
| Max. Negotiated Rate |
$10.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.28
|
|
|
BAG URO FLUID COLLECTOR STER
|
Facility
|
IP
|
$82.94
|
|
| Hospital Charge Code |
270685327
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.44 |
| Max. Negotiated Rate |
$12.44 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.44
|
|
|
BAG URO FLUID COLLECTOR STER
|
Facility
|
OP
|
$82.94
|
|
| Hospital Charge Code |
270685327
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$41.47 |
| Rate for Payer: Aetna Commercial |
$24.88
|
| Rate for Payer: Aetna Medicare Advantage |
$24.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$21.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$21.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$21.15
|
| Rate for Payer: Cigna Commercial |
$41.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.78
|
| Rate for Payer: Oxford Commercial |
$41.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$41.47
|
|
|
BAG VI-DRAPE ISOLATION *****
|
Facility
|
IP
|
$41.00
|
|
| Hospital Charge Code |
1600600
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$6.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.15
|
|
|
BAG VI-DRAPE ISOLATION *****
|
Facility
|
OP
|
$41.00
|
|
| Hospital Charge Code |
1600600
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$20.50 |
| Rate for Payer: Aetna Commercial |
$12.30
|
| Rate for Payer: Aetna Medicare Advantage |
$12.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.46
|
| Rate for Payer: Cigna Commercial |
$20.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.33
|
| Rate for Payer: Oxford Commercial |
$20.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$20.50
|
|
|
BAG WASTE
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
2709003650
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: Aetna Medicare Advantage |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.65
|
| Rate for Payer: Cigna Commercial |
$15.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.90
|
| Rate for Payer: Oxford Commercial |
$15.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$15.00
|
|
|
BAG WASTE
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
2709003650
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.50
|
|
|
BAG WOUND DRNGE COLLECTION
|
Facility
|
IP
|
$52.00
|
|
| Hospital Charge Code |
270300395
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.80
|
|
|
BAG WOUND DRNGE COLLECTION
|
Facility
|
OP
|
$52.00
|
|
| Hospital Charge Code |
270300395
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Aetna Commercial |
$15.60
|
| Rate for Payer: Aetna Medicare Advantage |
$15.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.26
|
| Rate for Payer: Cigna Commercial |
$26.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.76
|
| Rate for Payer: Oxford Commercial |
$26.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$26.00
|
|
|
BAHA BP100 SOFT BLACK
|
Facility
|
OP
|
$17,500.00
|
|
| Hospital Charge Code |
270657055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,625.00 |
| Max. Negotiated Rate |
$8,750.00 |
| Rate for Payer: Aetna Commercial |
$5,250.00
|
| Rate for Payer: Aetna Medicare Advantage |
$5,250.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,462.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,462.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,462.50
|
| Rate for Payer: Cigna Commercial |
$8,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,235.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,625.00
|
|
|
BAHA BP100 SOFT BLACK
|
Facility
|
IP
|
$17,500.00
|
|
| Hospital Charge Code |
270657055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,625.00 |
| Max. Negotiated Rate |
$4,235.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,235.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,625.00
|
|
|
BAL AMP DE 2.5x120AME025120152
|
Facility
|
IP
|
$2,025.00
|
|
| Hospital Charge Code |
270636982V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$303.75 |
| Max. Negotiated Rate |
$490.05 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$405.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$490.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$303.75
|
|
|
BAL AMP DE 2.5x120AME025120152
|
Facility
|
OP
|
$2,025.00
|
|
| Hospital Charge Code |
270636982V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$303.75 |
| Max. Negotiated Rate |
$1,012.50 |
| Rate for Payer: Aetna Commercial |
$607.50
|
| Rate for Payer: Aetna Medicare Advantage |
$607.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$516.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$516.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$405.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$516.38
|
| Rate for Payer: Cigna Commercial |
$1,012.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$490.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$303.75
|
|