|
TIP HIGH FLOW
|
Facility
|
OP
|
$57.51
|
|
| Hospital Charge Code |
270681089
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$28.75 |
| Rate for Payer: Aetna Commercial |
$17.25
|
| Rate for Payer: Aetna Medicare Advantage |
$17.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.67
|
| Rate for Payer: Cigna Commercial |
$28.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.48
|
| Rate for Payer: Oxford Commercial |
$28.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.63
|
| Rate for Payer: UnitedHealthcare Commercial |
$28.75
|
|
|
TIP HIGH FLOW
|
Facility
|
IP
|
$57.51
|
|
| Hospital Charge Code |
270681089
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$8.63 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.63
|
|
|
TIP MINI FLAREDTURBO SONICS
|
Facility
|
OP
|
$375.00
|
|
| Hospital Charge Code |
270653349
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Aetna Commercial |
$112.50
|
| Rate for Payer: Aetna Medicare Advantage |
$112.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$95.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$95.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$75.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$95.62
|
| Rate for Payer: Cigna Commercial |
$187.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$90.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
|
|
TIP MINI FLAREDTURBO SONICS
|
Facility
|
IP
|
$375.00
|
|
| Hospital Charge Code |
270653349
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$90.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$75.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$90.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
|
|
TIP NEEDLE DOUBLE DIAMOND
|
Facility
|
IP
|
$695.00
|
|
| Hospital Charge Code |
270670712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.25 |
| Max. Negotiated Rate |
$104.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$104.25
|
|
|
TIP NEEDLE DOUBLE DIAMOND
|
Facility
|
OP
|
$695.00
|
|
| Hospital Charge Code |
270670712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.35 |
| Max. Negotiated Rate |
$347.50 |
| Rate for Payer: Aetna Commercial |
$208.50
|
| Rate for Payer: Aetna Medicare Advantage |
$208.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$177.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$177.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$177.22
|
| Rate for Payer: Cigna Commercial |
$347.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$90.35
|
| Rate for Payer: Oxford Commercial |
$347.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$104.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$347.50
|
|
|
TIP PHACO I/A TURBO 30KTS
|
Facility
|
OP
|
$325.00
|
|
| Hospital Charge Code |
270600240
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.25 |
| Max. Negotiated Rate |
$162.50 |
| Rate for Payer: Aetna Commercial |
$97.50
|
| Rate for Payer: Aetna Medicare Advantage |
$97.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$82.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$82.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$82.88
|
| Rate for Payer: Cigna Commercial |
$162.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.25
|
| Rate for Payer: Oxford Commercial |
$162.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$48.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$162.50
|
|
|
TIP PHACO I/A TURBO 30KTS
|
Facility
|
IP
|
$325.00
|
|
| Hospital Charge Code |
270600240
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.75 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$48.75
|
|
|
TIP PHACO I/A TURBO 9MM 30RTS
|
Facility
|
IP
|
$300.00
|
|
| Hospital Charge Code |
270600239
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
|
|
TIP PHACO I/A TURBO 9MM 30RTS
|
Facility
|
OP
|
$300.00
|
|
| Hospital Charge Code |
270600239
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$90.00
|
| Rate for Payer: Aetna Medicare Advantage |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$76.50
|
| Rate for Payer: Cigna Commercial |
$150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$39.00
|
| Rate for Payer: Oxford Commercial |
$150.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$150.00
|
|
|
TIP PROGEL APPLICTR SPRAY 16CM
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS C2615
|
| Hospital Charge Code |
270662137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$540.00
|
| Rate for Payer: Aetna Medicare Advantage |
$540.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$459.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$459.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$360.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$459.00
|
| Rate for Payer: Cigna Commercial |
$900.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$435.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$270.00
|
|
|
TIP PROGEL APPLICTR SPRAY 16CM
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS C2615
|
| Hospital Charge Code |
270662137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$435.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$360.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$435.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$270.00
|
|
|
TIP PROGEL APPLICTR SPRAY 29CM
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS C2615
|
| Hospital Charge Code |
270662138
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$540.00
|
| Rate for Payer: Aetna Medicare Advantage |
$540.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$459.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$459.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$360.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$459.00
|
| Rate for Payer: Cigna Commercial |
$900.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$435.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$270.00
|
|
|
TIP PROGEL APPLICTR SPRAY 29CM
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS C2615
|
| Hospital Charge Code |
270662138
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$435.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$360.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$435.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$270.00
|
|
|
TIP PROTECTOR SMALL ENDO BOOT
|
Facility
|
OP
|
$12.50
|
|
| Hospital Charge Code |
270669846
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$6.25 |
| Rate for Payer: Aetna Commercial |
$3.75
|
| Rate for Payer: Aetna Medicare Advantage |
$3.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.19
|
| Rate for Payer: Cigna Commercial |
$6.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.62
|
| Rate for Payer: Oxford Commercial |
$6.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.25
|
|
|
TIP PROTECTOR SMALL ENDO BOOT
|
Facility
|
IP
|
$12.50
|
|
| Hospital Charge Code |
270669846
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.88
|
|
|
TIP PULSAVAC FAN SPRAY
|
Facility
|
OP
|
$77.65
|
|
| Hospital Charge Code |
270600360
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$38.83 |
| Rate for Payer: Aetna Commercial |
$23.30
|
| Rate for Payer: Aetna Medicare Advantage |
$23.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.80
|
| Rate for Payer: Cigna Commercial |
$38.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.09
|
| Rate for Payer: Oxford Commercial |
$38.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$38.83
|
|
|
TIP PULSAVAC FAN SPRAY
|
Facility
|
IP
|
$77.65
|
|
| Hospital Charge Code |
270600360
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$11.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.65
|
|
|
TIP PULSAVAC IM 9
|
Facility
|
OP
|
$129.00
|
|
| Hospital Charge Code |
270600374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.77 |
| Max. Negotiated Rate |
$64.50 |
| Rate for Payer: Aetna Commercial |
$38.70
|
| Rate for Payer: Aetna Medicare Advantage |
$38.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$32.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$32.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$32.90
|
| Rate for Payer: Cigna Commercial |
$64.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.77
|
| Rate for Payer: Oxford Commercial |
$64.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$64.50
|
|
|
TIP PULSAVAC IM 9
|
Facility
|
IP
|
$129.00
|
|
| Hospital Charge Code |
270600374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$19.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.35
|
|
|
TIP ROUND 30 DEG 6/BX
|
Facility
|
OP
|
$225.00
|
|
| Hospital Charge Code |
270650891
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Medicare Advantage |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.38
|
| Rate for Payer: Cigna Commercial |
$112.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.25
|
| Rate for Payer: Oxford Commercial |
$112.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$112.50
|
|
|
TIP ROUND 30 DEG 6/BX
|
Facility
|
IP
|
$225.00
|
|
| Hospital Charge Code |
270650891
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
TIP, RUBBER GREY NIPPLES SMAL
|
Facility
|
IP
|
$43.00
|
|
| Hospital Charge Code |
270331539
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.45 |
| Max. Negotiated Rate |
$6.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.45
|
|
|
TIP, RUBBER GREY NIPPLES SMAL
|
Facility
|
OP
|
$43.00
|
|
| Hospital Charge Code |
270331539
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.59 |
| Max. Negotiated Rate |
$21.50 |
| Rate for Payer: Aetna Commercial |
$12.90
|
| Rate for Payer: Aetna Medicare Advantage |
$12.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.96
|
| Rate for Payer: Cigna Commercial |
$21.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.59
|
| Rate for Payer: Oxford Commercial |
$21.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$21.50
|
|
|
TIPS BARIUM ENEMA
|
Facility
|
IP
|
$11.87
|
|
| Hospital Charge Code |
270601327
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.78
|
|