|
PAD FOAM*******
|
Facility
|
IP
|
$77.00
|
|
| Hospital Charge Code |
8000713
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$11.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.55
|
|
|
PAD FOAM SLF-ADHERNG HI SUPPT
|
Facility
|
OP
|
$12.05
|
|
| Hospital Charge Code |
270654315
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$6.03 |
| Rate for Payer: Aetna Commercial |
$3.62
|
| Rate for Payer: Aetna Medicare Advantage |
$3.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.07
|
| Rate for Payer: Cigna Commercial |
$6.03
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.57
|
| Rate for Payer: Oxford Commercial |
$6.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.81
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.03
|
|
|
PAD FOAM SLF-ADHERNG HI SUPPT
|
Facility
|
IP
|
$12.05
|
|
| Hospital Charge Code |
270654315
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.81
|
|
|
PAD FOAM SLF-ADHERNG MED SUPPT
|
Facility
|
OP
|
$8.80
|
|
| Hospital Charge Code |
270677706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$4.40 |
| Rate for Payer: Aetna Commercial |
$2.64
|
| Rate for Payer: Aetna Medicare Advantage |
$2.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.24
|
| Rate for Payer: Cigna Commercial |
$4.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.14
|
| Rate for Payer: Oxford Commercial |
$4.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.40
|
|
|
PAD FOAM SLF-ADHERNG MED SUPPT
|
Facility
|
IP
|
$8.80
|
|
| Hospital Charge Code |
270677706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$1.32 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.32
|
|
|
PAD FOG FOR LAPAROSC PROC ****
|
Facility
|
IP
|
$99.00
|
|
| Hospital Charge Code |
1605914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.85 |
| Max. Negotiated Rate |
$14.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.85
|
|
|
PAD FOG FOR LAPAROSC PROC ****
|
Facility
|
OP
|
$99.00
|
|
| Hospital Charge Code |
1605914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Aetna Commercial |
$29.70
|
| Rate for Payer: Aetna Medicare Advantage |
$29.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$25.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$25.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$25.25
|
| Rate for Payer: Cigna Commercial |
$49.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.87
|
| Rate for Payer: Oxford Commercial |
$49.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$49.50
|
|
|
PAD FOOT
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
270670484
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna Commercial |
$232.50
|
| Rate for Payer: Aetna Medicare Advantage |
$232.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$197.62
|
| Rate for Payer: Cigna Commercial |
$387.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$100.75
|
| Rate for Payer: Oxford Commercial |
$387.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$387.50
|
|
|
PAD FOOT
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
270670484
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$116.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
PAD FOOT HUGGER 10028-C
|
Facility
|
IP
|
$2,261.65
|
|
| Hospital Charge Code |
270616254
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$339.25 |
| Max. Negotiated Rate |
$339.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$339.25
|
|
|
PAD FOOT HUGGER 10028-C
|
Facility
|
OP
|
$2,261.65
|
|
| Hospital Charge Code |
270616254
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$294.01 |
| Max. Negotiated Rate |
$1,130.83 |
| Rate for Payer: Aetna Commercial |
$678.50
|
| Rate for Payer: Aetna Medicare Advantage |
$678.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$576.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$576.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$576.72
|
| Rate for Payer: Cigna Commercial |
$1,130.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$294.01
|
| Rate for Payer: Oxford Commercial |
$1,130.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$339.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,130.83
|
|
|
PAD FOOT SUPPORT FT1
|
Facility
|
IP
|
$644.85
|
|
| Hospital Charge Code |
270632633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.73 |
| Max. Negotiated Rate |
$96.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.73
|
|
|
PAD FOOT SUPPORT FT1
|
Facility
|
OP
|
$644.85
|
|
| Hospital Charge Code |
270632633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.83 |
| Max. Negotiated Rate |
$322.43 |
| Rate for Payer: Aetna Commercial |
$193.46
|
| Rate for Payer: Aetna Medicare Advantage |
$193.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$164.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$164.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$164.44
|
| Rate for Payer: Cigna Commercial |
$322.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$83.83
|
| Rate for Payer: Oxford Commercial |
$322.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$322.43
|
|
|
PAD GROUNDING 72200015
|
Facility
|
OP
|
$82.50
|
|
| Hospital Charge Code |
270639099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.72 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Aetna Commercial |
$24.75
|
| Rate for Payer: Aetna Medicare Advantage |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$21.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$21.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$21.04
|
| Rate for Payer: Cigna Commercial |
$41.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.72
|
| Rate for Payer: Oxford Commercial |
$41.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$41.25
|
|
|
PAD GROUNDING 72200015
|
Facility
|
IP
|
$82.50
|
|
| Hospital Charge Code |
270639099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$12.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.38
|
|
|
PAD GROUNDING ELECTRO-SURGICAL
|
Facility
|
IP
|
$11.69
|
|
| Hospital Charge Code |
270649521S
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$1.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.75
|
|
|
PAD GROUNDING ELECTRO-SURGICAL
|
Facility
|
OP
|
$11.69
|
|
| Hospital Charge Code |
270649521
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$5.84 |
| Rate for Payer: Aetna Commercial |
$3.51
|
| Rate for Payer: Aetna Medicare Advantage |
$3.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.98
|
| Rate for Payer: Cigna Commercial |
$5.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.52
|
| Rate for Payer: Oxford Commercial |
$5.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.84
|
|
|
PAD GROUNDING ELECTRO-SURGICAL
|
Facility
|
IP
|
$11.65
|
|
| Hospital Charge Code |
270649521N
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$1.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.75
|
|
|
PAD GROUNDING ELECTRO-SURGICAL
|
Facility
|
IP
|
$11.69
|
|
| Hospital Charge Code |
270649521
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$1.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.75
|
|
|
PAD GROUNDING ELECTRO-SURGICAL
|
Facility
|
OP
|
$11.69
|
|
| Hospital Charge Code |
270649521S
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$5.84 |
| Rate for Payer: Aetna Commercial |
$3.51
|
| Rate for Payer: Aetna Medicare Advantage |
$3.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.98
|
| Rate for Payer: Cigna Commercial |
$5.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.52
|
| Rate for Payer: Oxford Commercial |
$5.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.84
|
|
|
PAD GROUNDING ELECTRO-SURGICAL
|
Facility
|
OP
|
$11.65
|
|
| Hospital Charge Code |
270649521N
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$5.83 |
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: Aetna Medicare Advantage |
$3.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.97
|
| Rate for Payer: Cigna Commercial |
$5.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.51
|
| Rate for Payer: Oxford Commercial |
$5.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.83
|
|
|
PAD HEATING
|
Facility
|
IP
|
$168.00
|
|
| Hospital Charge Code |
270649191
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.20
|
|
|
PAD HEATING
|
Facility
|
OP
|
$168.00
|
|
| Hospital Charge Code |
270649191
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna Commercial |
$50.40
|
| Rate for Payer: Aetna Medicare Advantage |
$50.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$42.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$42.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$42.84
|
| Rate for Payer: Cigna Commercial |
$84.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.84
|
| Rate for Payer: Oxford Commercial |
$84.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$84.00
|
|
|
PAD HIP HDS DISP
|
Facility
|
OP
|
$125.00
|
|
| Hospital Charge Code |
270677472
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$62.50 |
| Rate for Payer: Aetna Commercial |
$37.50
|
| Rate for Payer: Aetna Medicare Advantage |
$37.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$31.88
|
| Rate for Payer: Cigna Commercial |
$62.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.25
|
| Rate for Payer: Oxford Commercial |
$62.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$62.50
|
|
|
PAD HIP HDS DISP
|
Facility
|
IP
|
$125.00
|
|
| Hospital Charge Code |
270677472
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
|
