|
BURR DRUM L 9.1MM HD LTH 7.9MM
|
Facility
|
IP
|
$430.50
|
|
| Hospital Charge Code |
270674484
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
|
|
BURR DRUM M 4.7MM HD LTH 7.9MM
|
Facility
|
OP
|
$430.50
|
|
| Hospital Charge Code |
270674633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.97 |
| Max. Negotiated Rate |
$215.25 |
| Rate for Payer: Aetna Commercial |
$129.15
|
| Rate for Payer: Aetna Medicare Advantage |
$129.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$109.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$109.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$109.78
|
| Rate for Payer: Cigna Commercial |
$215.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.97
|
| Rate for Payer: Oxford Commercial |
$215.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$215.25
|
|
|
BURR DRUM M 4.7MM HD LTH 7.9MM
|
Facility
|
IP
|
$430.50
|
|
| Hospital Charge Code |
270674633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
|
|
BURR DRUM M 6.0MM HD LTH 7.9MM
|
Facility
|
IP
|
$430.50
|
|
| Hospital Charge Code |
270674480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
|
|
BURR DRUM M 6.0MM HD LTH 7.9MM
|
Facility
|
OP
|
$430.50
|
|
| Hospital Charge Code |
270674480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.97 |
| Max. Negotiated Rate |
$215.25 |
| Rate for Payer: Aetna Commercial |
$129.15
|
| Rate for Payer: Aetna Medicare Advantage |
$129.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$109.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$109.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$109.78
|
| Rate for Payer: Cigna Commercial |
$215.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.97
|
| Rate for Payer: Oxford Commercial |
$215.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$215.25
|
|
|
BURR DRUM M 9.1MM HD LTH 7.9MM
|
Facility
|
IP
|
$430.50
|
|
| Hospital Charge Code |
270674483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
|
|
BURR DRUM M 9.1MM HD LTH 7.9MM
|
Facility
|
OP
|
$430.50
|
|
| Hospital Charge Code |
270674483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.97 |
| Max. Negotiated Rate |
$215.25 |
| Rate for Payer: Aetna Commercial |
$129.15
|
| Rate for Payer: Aetna Medicare Advantage |
$129.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$109.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$109.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$109.78
|
| Rate for Payer: Cigna Commercial |
$215.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.97
|
| Rate for Payer: Oxford Commercial |
$215.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$215.25
|
|
|
BURR DRUM S 4.7MM HD LTH 7.9MM
|
Facility
|
IP
|
$430.50
|
|
| Hospital Charge Code |
270674632
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
|
|
BURR DRUM S 4.7MM HD LTH 7.9MM
|
Facility
|
OP
|
$430.50
|
|
| Hospital Charge Code |
270674632
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.97 |
| Max. Negotiated Rate |
$215.25 |
| Rate for Payer: Aetna Commercial |
$129.15
|
| Rate for Payer: Aetna Medicare Advantage |
$129.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$109.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$109.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$109.78
|
| Rate for Payer: Cigna Commercial |
$215.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.97
|
| Rate for Payer: Oxford Commercial |
$215.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$215.25
|
|
|
BURR DRUM S 6.0MM HD LTH 7.9MM
|
Facility
|
IP
|
$430.50
|
|
| Hospital Charge Code |
270674479
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
|
|
BURR DRUM S 6.0MM HD LTH 7.9MM
|
Facility
|
OP
|
$430.50
|
|
| Hospital Charge Code |
270674479
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.97 |
| Max. Negotiated Rate |
$215.25 |
| Rate for Payer: Aetna Commercial |
$129.15
|
| Rate for Payer: Aetna Medicare Advantage |
$129.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$109.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$109.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$109.78
|
| Rate for Payer: Cigna Commercial |
$215.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.97
|
| Rate for Payer: Oxford Commercial |
$215.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$215.25
|
|
|
BURR DRUM S 9.1MM HD LTH 7.9MM
|
Facility
|
OP
|
$430.50
|
|
| Hospital Charge Code |
270674482
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.97 |
| Max. Negotiated Rate |
$215.25 |
| Rate for Payer: Aetna Commercial |
$129.15
|
| Rate for Payer: Aetna Medicare Advantage |
$129.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$109.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$109.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$109.78
|
| Rate for Payer: Cigna Commercial |
$215.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.97
|
| Rate for Payer: Oxford Commercial |
$215.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$215.25
|
|
|
BURR DRUM S 9.1MM HD LTH 7.9MM
|
Facility
|
IP
|
$430.50
|
|
| Hospital Charge Code |
270674482
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
|
|
BURR DYONICS ELITE 4.0MM
|
Facility
|
OP
|
$250.00
|
|
| Hospital Charge Code |
270696201
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna Commercial |
$75.00
|
| Rate for Payer: Aetna Medicare Advantage |
$75.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$63.75
|
| Rate for Payer: Cigna Commercial |
$125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.50
|
| Rate for Payer: Oxford Commercial |
$125.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$125.00
|
|
|
BURR DYONICS ELITE 4.0MM
|
Facility
|
IP
|
$250.00
|
|
| Hospital Charge Code |
270696201
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.50
|
|
|
BURR DYONICS ELITE ACROM 5.5MM
|
Facility
|
OP
|
$1,500.00
|
|
| Hospital Charge Code |
270693726
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$450.00
|
| Rate for Payer: Aetna Medicare Advantage |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$382.50
|
| Rate for Payer: Cigna Commercial |
$750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$195.00
|
| Rate for Payer: Oxford Commercial |
$750.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$750.00
|
|
|
BURR DYONICS ELITE ACROM 5.5MM
|
Facility
|
IP
|
$1,500.00
|
|
| Hospital Charge Code |
270693726
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
|
|
BURR EGG 7.0MMx28MM MINI QC
|
Facility
|
IP
|
$381.50
|
|
| Hospital Charge Code |
270674543
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.23 |
| Max. Negotiated Rate |
$57.23 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.23
|
|
|
BURR EGG 7.0MMx28MM MINI QC
|
Facility
|
OP
|
$381.50
|
|
| Hospital Charge Code |
270674543
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.59 |
| Max. Negotiated Rate |
$190.75 |
| Rate for Payer: Aetna Commercial |
$114.45
|
| Rate for Payer: Aetna Medicare Advantage |
$114.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$97.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$97.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$97.28
|
| Rate for Payer: Cigna Commercial |
$190.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$49.59
|
| Rate for Payer: Oxford Commercial |
$190.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$190.75
|
|
|
BURR EGG 7.0MMx45MM MINI QC
|
Facility
|
IP
|
$381.50
|
|
| Hospital Charge Code |
270674544
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.23 |
| Max. Negotiated Rate |
$57.23 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.23
|
|
|
BURR EGG 7.0MMx45MM MINI QC
|
Facility
|
OP
|
$381.50
|
|
| Hospital Charge Code |
270674544
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.59 |
| Max. Negotiated Rate |
$190.75 |
| Rate for Payer: Aetna Commercial |
$114.45
|
| Rate for Payer: Aetna Medicare Advantage |
$114.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$97.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$97.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$97.28
|
| Rate for Payer: Cigna Commercial |
$190.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$49.59
|
| Rate for Payer: Oxford Commercial |
$190.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$190.75
|
|
|
BURR EGG 8.0MMx28MM MINI QC
|
Facility
|
IP
|
$381.50
|
|
| Hospital Charge Code |
270674545
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.23 |
| Max. Negotiated Rate |
$57.23 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.23
|
|
|
BURR EGG 8.0MMx28MM MINI QC
|
Facility
|
OP
|
$381.50
|
|
| Hospital Charge Code |
270674545
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.59 |
| Max. Negotiated Rate |
$190.75 |
| Rate for Payer: Aetna Commercial |
$114.45
|
| Rate for Payer: Aetna Medicare Advantage |
$114.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$97.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$97.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$97.28
|
| Rate for Payer: Cigna Commercial |
$190.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$49.59
|
| Rate for Payer: Oxford Commercial |
$190.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$190.75
|
|
|
BURR EGG 8.0MMx45MM MINI QC
|
Facility
|
OP
|
$381.50
|
|
| Hospital Charge Code |
270674546
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.59 |
| Max. Negotiated Rate |
$190.75 |
| Rate for Payer: Aetna Commercial |
$114.45
|
| Rate for Payer: Aetna Medicare Advantage |
$114.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$97.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$97.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$97.28
|
| Rate for Payer: Cigna Commercial |
$190.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$49.59
|
| Rate for Payer: Oxford Commercial |
$190.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$190.75
|
|
|
BURR EGG 8.0MMx45MM MINI QC
|
Facility
|
IP
|
$381.50
|
|
| Hospital Charge Code |
270674546
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.23 |
| Max. Negotiated Rate |
$57.23 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.23
|
|