|
BARRIER INCISE DRAPE 10 x 16
|
Facility
|
OP
|
$48.00
|
|
| Hospital Charge Code |
270331785
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$14.40
|
| Rate for Payer: Aetna Medicare Advantage |
$14.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.24
|
| Rate for Payer: Cigna Commercial |
$24.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.24
|
| Rate for Payer: Oxford Commercial |
$24.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$24.00
|
|
|
BARRIER SKIN STOMACHESIVE1-3/4
|
Facility
|
IP
|
$5.47
|
|
| Hospital Charge Code |
270650520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.82
|
|
|
BARRIER SKIN STOMACHESIVE1-3/4
|
Facility
|
OP
|
$5.47
|
|
| Hospital Charge Code |
270650520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$2.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.82
|
| Rate for Payer: Aetna Commercial |
$1.64
|
| Rate for Payer: Aetna Medicare Advantage |
$1.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.39
|
| Rate for Payer: Cigna Commercial |
$2.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.71
|
| Rate for Payer: Oxford Commercial |
$2.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.73
|
|
|
BARRIER SKIN STOMHESIVE MOLDBL
|
Facility
|
IP
|
$14.78
|
|
| Hospital Charge Code |
270650275
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.22
|
|
|
BARRIER SKIN STOMHESIVE MOLDBL
|
Facility
|
OP
|
$14.78
|
|
| Hospital Charge Code |
270650275
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$7.39 |
| Rate for Payer: Aetna Commercial |
$4.43
|
| Rate for Payer: Aetna Medicare Advantage |
$4.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.77
|
| Rate for Payer: Cigna Commercial |
$7.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.92
|
| Rate for Payer: Oxford Commercial |
$7.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.22
|
| Rate for Payer: UnitedHealthcare Commercial |
$7.39
|
|
|
BARRIERSKIN STOM MOLDABL 2-1/4
|
Facility
|
OP
|
$14.78
|
|
| Hospital Charge Code |
270650525
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$7.39 |
| Rate for Payer: Aetna Commercial |
$4.43
|
| Rate for Payer: Aetna Medicare Advantage |
$4.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.77
|
| Rate for Payer: Cigna Commercial |
$7.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.92
|
| Rate for Payer: Oxford Commercial |
$7.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.22
|
| Rate for Payer: UnitedHealthcare Commercial |
$7.39
|
|
|
BARRIERSKIN STOM MOLDABL 2-1/4
|
Facility
|
IP
|
$14.78
|
|
| Hospital Charge Code |
270650525
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.22
|
|
|
BARRON CORNEAL PUNCH 7.0MM
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
270662308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.50
|
|
|
BARRON CORNEAL PUNCH 7.0MM
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
270662308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$105.00
|
| Rate for Payer: Aetna Medicare Advantage |
$105.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$89.25
|
| Rate for Payer: Cigna Commercial |
$175.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$45.50
|
| Rate for Payer: Oxford Commercial |
$175.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
|
|
BARRON CORNEAL PUNCH 7.25MM
|
Facility
|
IP
|
$425.00
|
|
| Hospital Charge Code |
270671095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
|
|
BARRON CORNEAL PUNCH 7.25MM
|
Facility
|
OP
|
$425.00
|
|
| Hospital Charge Code |
270671095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: Aetna Medicare Advantage |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$108.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$108.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$108.38
|
| Rate for Payer: Cigna Commercial |
$212.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.25
|
| Rate for Payer: Oxford Commercial |
$212.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$212.50
|
|
|
BARRON CORNEAL PUNCH 7.5MM
|
Facility
|
OP
|
$330.00
|
|
| Hospital Charge Code |
270654851
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.90 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: Aetna Medicare Advantage |
$99.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$84.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$84.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$84.15
|
| Rate for Payer: Cigna Commercial |
$165.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.90
|
| Rate for Payer: Oxford Commercial |
$165.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$165.00
|
|
|
BARRON CORNEAL PUNCH 7.5MM
|
Facility
|
IP
|
$330.00
|
|
| Hospital Charge Code |
270654851
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.50
|
|
|
BARRON CORNEAL PUNCH 7.75MM
|
Facility
|
OP
|
$425.00
|
|
| Hospital Charge Code |
270671097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: Aetna Medicare Advantage |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$108.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$108.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$108.38
|
| Rate for Payer: Cigna Commercial |
$212.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.25
|
| Rate for Payer: Oxford Commercial |
$212.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$212.50
|
|
|
BARRON CORNEAL PUNCH 7.75MM
|
Facility
|
IP
|
$425.00
|
|
| Hospital Charge Code |
270671097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
|
|
BARRON CORNEAL PUNCH 9.25MM
|
Facility
|
OP
|
$425.00
|
|
| Hospital Charge Code |
270671098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: Aetna Medicare Advantage |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$108.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$108.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$108.38
|
| Rate for Payer: Cigna Commercial |
$212.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.25
|
| Rate for Payer: Oxford Commercial |
$212.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$212.50
|
|
|
BARRON CORNEAL PUNCH 9.25MM
|
Facility
|
IP
|
$425.00
|
|
| Hospital Charge Code |
270671098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
|
|
BARRON CORNEA PUNCH 8.0MM DIA
|
Facility
|
IP
|
$330.00
|
|
| Hospital Charge Code |
270660738
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.50
|
|
|
BARRON CORNEA PUNCH 8.0MM DIA
|
Facility
|
OP
|
$330.00
|
|
| Hospital Charge Code |
270660738
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.90 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: Aetna Medicare Advantage |
$99.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$84.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$84.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$84.15
|
| Rate for Payer: Cigna Commercial |
$165.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.90
|
| Rate for Payer: Oxford Commercial |
$165.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$165.00
|
|
|
BARRON CORNEA PUNCH 9.5MM DIA
|
Facility
|
OP
|
$330.00
|
|
| Hospital Charge Code |
270673281
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.90 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: Aetna Medicare Advantage |
$99.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$84.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$84.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$84.15
|
| Rate for Payer: Cigna Commercial |
$165.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.90
|
| Rate for Payer: Oxford Commercial |
$165.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$165.00
|
|
|
BARRON CORNEA PUNCH 9.5MM DIA
|
Facility
|
IP
|
$330.00
|
|
| Hospital Charge Code |
270673281
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.50
|
|
|
BAR SYN CONN EX FX 80MM 39561
|
Facility
|
IP
|
$139.25
|
|
| Hospital Charge Code |
270601812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.89 |
| Max. Negotiated Rate |
$20.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.89
|
|
|
BAR SYN CONN EX FX 80MM 39561
|
Facility
|
OP
|
$139.25
|
|
| Hospital Charge Code |
270601812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$69.62 |
| Rate for Payer: Aetna Commercial |
$41.77
|
| Rate for Payer: Aetna Medicare Advantage |
$41.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$35.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$35.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$35.51
|
| Rate for Payer: Cigna Commercial |
$69.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.10
|
| Rate for Payer: Oxford Commercial |
$69.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$69.62
|
|
|
BARTHOLIN CYSTECTOMY
|
Facility
|
IP
|
$29,961.70
|
|
|
Service Code
|
HCPCS 56740
|
| Hospital Charge Code |
1600000383
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,494.26 |
| Max. Negotiated Rate |
$4,494.26 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,494.26
|
|
|
BARTHOLIN CYSTECTOMY
|
Facility
|
OP
|
$29,961.70
|
|
|
Service Code
|
HCPCS 56740
|
| Hospital Charge Code |
1600000383
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$8,988.51 |
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Aetna Commercial |
$8,988.51
|
| Rate for Payer: Aetna Medicare Advantage |
$8,988.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,640.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,640.23
|
| 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 |
$7,640.23
|
| Rate for Payer: Cigna Commercial |
$7,708.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,895.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,494.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,529.00
|
|