|
BLADE TREPHINE 7.0MM 9709
|
Facility
|
IP
|
$422.45
|
|
| Hospital Charge Code |
270600191
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.37 |
| Max. Negotiated Rate |
$63.37 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.37
|
|
|
BLADE TREPHINE 7.0MM 9709
|
Facility
|
OP
|
$422.45
|
|
| Hospital Charge Code |
270600191
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.92 |
| Max. Negotiated Rate |
$211.22 |
| Rate for Payer: Aetna Commercial |
$126.73
|
| Rate for Payer: Aetna Medicare Advantage |
$126.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$107.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$107.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$107.72
|
| Rate for Payer: Cigna Commercial |
$211.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.92
|
| Rate for Payer: Oxford Commercial |
$211.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$211.22
|
|
|
BLADE TREPHINE 7.2MM 9719
|
Facility
|
IP
|
$422.45
|
|
| Hospital Charge Code |
270600192
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.37 |
| Max. Negotiated Rate |
$63.37 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.37
|
|
|
BLADE TREPHINE 7.2MM 9719
|
Facility
|
OP
|
$422.45
|
|
| Hospital Charge Code |
270600192
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.92 |
| Max. Negotiated Rate |
$211.22 |
| Rate for Payer: Aetna Commercial |
$126.73
|
| Rate for Payer: Aetna Medicare Advantage |
$126.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$107.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$107.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$107.72
|
| Rate for Payer: Cigna Commercial |
$211.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.92
|
| Rate for Payer: Oxford Commercial |
$211.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$211.22
|
|
|
BLADE TREPHINE 7.5MM 9711
|
Facility
|
IP
|
$422.45
|
|
| Hospital Charge Code |
270600194
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.37 |
| Max. Negotiated Rate |
$63.37 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.37
|
|
|
BLADE TREPHINE 7.5MM 9711
|
Facility
|
OP
|
$422.45
|
|
| Hospital Charge Code |
270600194
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.92 |
| Max. Negotiated Rate |
$211.22 |
| Rate for Payer: Aetna Commercial |
$126.73
|
| Rate for Payer: Aetna Medicare Advantage |
$126.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$107.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$107.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$107.72
|
| Rate for Payer: Cigna Commercial |
$211.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.92
|
| Rate for Payer: Oxford Commercial |
$211.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$211.22
|
|
|
BLADE TREPHINE 7.7MM 9722
|
Facility
|
IP
|
$422.45
|
|
| Hospital Charge Code |
270600196
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.37 |
| Max. Negotiated Rate |
$63.37 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.37
|
|
|
BLADE TREPHINE 7.7MM 9722
|
Facility
|
OP
|
$422.45
|
|
| Hospital Charge Code |
270600196
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.92 |
| Max. Negotiated Rate |
$211.22 |
| Rate for Payer: Aetna Commercial |
$126.73
|
| Rate for Payer: Aetna Medicare Advantage |
$126.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$107.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$107.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$107.72
|
| Rate for Payer: Cigna Commercial |
$211.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.92
|
| Rate for Payer: Oxford Commercial |
$211.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$211.22
|
|
|
BLADE TREPHINE 8.0MM 9713
|
Facility
|
OP
|
$422.45
|
|
| Hospital Charge Code |
270600198
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.92 |
| Max. Negotiated Rate |
$211.22 |
| Rate for Payer: Aetna Commercial |
$126.73
|
| Rate for Payer: Aetna Medicare Advantage |
$126.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$107.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$107.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$107.72
|
| Rate for Payer: Cigna Commercial |
$211.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.92
|
| Rate for Payer: Oxford Commercial |
$211.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$211.22
|
|
|
BLADE TREPHINE 8.0MM 9713
|
Facility
|
IP
|
$422.45
|
|
| Hospital Charge Code |
270600198
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.37 |
| Max. Negotiated Rate |
$63.37 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.37
|
|
|
BLADE TREPHINE 8.0MM K2-8022
|
Facility
|
IP
|
$225.00
|
|
| Hospital Charge Code |
270600197
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
BLADE TREPHINE 8.0MM K2-8022
|
Facility
|
OP
|
$225.00
|
|
| Hospital Charge Code |
270600197
|
|
Hospital Revenue Code
|
272
|
| 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
|
|
|
BLADE TREPHINE 8.25MM 9727
|
Facility
|
IP
|
$422.45
|
|
| Hospital Charge Code |
270600199
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.37 |
| Max. Negotiated Rate |
$63.37 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.37
|
|
|
BLADE TREPHINE 8.25MM 9727
|
Facility
|
OP
|
$422.45
|
|
| Hospital Charge Code |
270600199
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.92 |
| Max. Negotiated Rate |
$211.22 |
| Rate for Payer: Aetna Commercial |
$126.73
|
| Rate for Payer: Aetna Medicare Advantage |
$126.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$107.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$107.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$107.72
|
| Rate for Payer: Cigna Commercial |
$211.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.92
|
| Rate for Payer: Oxford Commercial |
$211.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$211.22
|
|
|
BLADE TREPHINE 8.5MM 9715
|
Facility
|
OP
|
$225.00
|
|
| Hospital Charge Code |
270600200
|
|
Hospital Revenue Code
|
272
|
| 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
|
|
|
BLADE TREPHINE 8.5MM 9715
|
Facility
|
IP
|
$225.00
|
|
| Hospital Charge Code |
270600200
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
BLADE TREPHINE 8.7MM 9723
|
Facility
|
OP
|
$422.45
|
|
| Hospital Charge Code |
270600202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.92 |
| Max. Negotiated Rate |
$211.22 |
| Rate for Payer: Aetna Commercial |
$126.73
|
| Rate for Payer: Aetna Medicare Advantage |
$126.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$107.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$107.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$107.72
|
| Rate for Payer: Cigna Commercial |
$211.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.92
|
| Rate for Payer: Oxford Commercial |
$211.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$211.22
|
|
|
BLADE TREPHINE 8.7MM 9723
|
Facility
|
IP
|
$422.45
|
|
| Hospital Charge Code |
270600202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.37 |
| Max. Negotiated Rate |
$63.37 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.37
|
|
|
BLADE TREPHINE 9.0MM 9717
|
Facility
|
IP
|
$422.45
|
|
| Hospital Charge Code |
270600203
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.37 |
| Max. Negotiated Rate |
$63.37 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.37
|
|
|
BLADE TREPHINE 9.0MM 9717
|
Facility
|
OP
|
$422.45
|
|
| Hospital Charge Code |
270600203
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.92 |
| Max. Negotiated Rate |
$211.22 |
| Rate for Payer: Aetna Commercial |
$126.73
|
| Rate for Payer: Aetna Medicare Advantage |
$126.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$107.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$107.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$107.72
|
| Rate for Payer: Cigna Commercial |
$211.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.92
|
| Rate for Payer: Oxford Commercial |
$211.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$211.22
|
|
|
BLADE TREPHINE DISP 6.0MM N/S
|
Facility
|
IP
|
$310.00
|
|
| Hospital Charge Code |
270667422
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.50 |
| Max. Negotiated Rate |
$46.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.50
|
|
|
BLADE TREPHINE DISP 6.0MM N/S
|
Facility
|
OP
|
$310.00
|
|
| Hospital Charge Code |
270667422
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.30 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna Commercial |
$93.00
|
| Rate for Payer: Aetna Medicare Advantage |
$93.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$79.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$79.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$79.05
|
| Rate for Payer: Cigna Commercial |
$155.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$40.30
|
| Rate for Payer: Oxford Commercial |
$155.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$155.00
|
|
|
BLADE TREPHINE DISP7.0MM N/S
|
Facility
|
IP
|
$310.00
|
|
| Hospital Charge Code |
270667423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.50 |
| Max. Negotiated Rate |
$46.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.50
|
|
|
BLADE TREPHINE DISP7.0MM N/S
|
Facility
|
OP
|
$310.00
|
|
| Hospital Charge Code |
270667423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.30 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna Commercial |
$93.00
|
| Rate for Payer: Aetna Medicare Advantage |
$93.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$79.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$79.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$79.05
|
| Rate for Payer: Cigna Commercial |
$155.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$40.30
|
| Rate for Payer: Oxford Commercial |
$155.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$155.00
|
|
|
BLADE TREPHINE DISP 7.25MM N/S
|
Facility
|
OP
|
$310.00
|
|
| Hospital Charge Code |
270667424
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.30 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna Commercial |
$93.00
|
| Rate for Payer: Aetna Medicare Advantage |
$93.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$79.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$79.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$79.05
|
| Rate for Payer: Cigna Commercial |
$155.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$40.30
|
| Rate for Payer: Oxford Commercial |
$155.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$155.00
|
|