|
RESP PULSE OX-CONTINOUS
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
HCPCS 9476159
|
| Hospital Charge Code |
9507020
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$2,770.00 |
| Rate for Payer: Aetna Commercial |
$118.94
|
| Rate for Payer: Aetna Medicare Advantage |
$93.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$79.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$79.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$79.81
|
| Rate for Payer: Cigna Commercial |
$156.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$81.38
|
| Rate for Payer: Oxford Commercial |
$2,184.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,770.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.89
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.89
|
|
|
RESP PULSE OX-CONTINOUS
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
HCPCS 9476159
|
| Hospital Charge Code |
9507020
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$46.95 |
| Max. Negotiated Rate |
$46.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.95
|
|
|
RESP RAW
|
Facility
|
OP
|
$6,100.00
|
|
|
Service Code
|
HCPCS 94728
|
| Hospital Charge Code |
9509025
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$20.48 |
| Max. Negotiated Rate |
$2,770.00 |
| Rate for Payer: Aetna Commercial |
$415.81
|
| Rate for Payer: Aetna Medicare Advantage |
$495.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$554.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$554.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$152.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$20.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$554.54
|
| Rate for Payer: Cigna Commercial |
$306.43
|
| Rate for Payer: Cigna Medicare Advantage |
$152.87
|
| Rate for Payer: Clover Medicare Advantage |
$145.23
|
| Rate for Payer: EmblemHealth Commercial |
$458.61
|
| Rate for Payer: Humana Medicare Advantage |
$157.46
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$152.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,586.00
|
| Rate for Payer: Oxford Commercial |
$2,184.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$915.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,770.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$192.76
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$152.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$152.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$173.24
|
|
|
RESP RAW
|
Facility
|
IP
|
$6,100.00
|
|
|
Service Code
|
HCPCS 94728
|
| Hospital Charge Code |
9509025
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$915.00 |
| Max. Negotiated Rate |
$915.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$915.00
|
|
|
RESP RT-ARTERIAL BLOOD GASES
|
Facility
|
IP
|
$733.49
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
9508010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$110.02 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$110.02
|
|
|
RESP RT-ARTERIAL BLOOD GASES
|
Facility
|
OP
|
$733.49
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
9508010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.83 |
| Max. Negotiated Rate |
$366.75 |
| Rate for Payer: Aetna Commercial |
$70.91
|
| Rate for Payer: Aetna Medicare Advantage |
$84.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$94.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$94.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$26.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$94.57
|
| Rate for Payer: Cigna Commercial |
$366.75
|
| Rate for Payer: Cigna Medicare Advantage |
$26.07
|
| Rate for Payer: Clover Medicare Advantage |
$24.77
|
| Rate for Payer: EmblemHealth Commercial |
$78.21
|
| Rate for Payer: Humana Medicare Advantage |
$26.85
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$26.07
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$190.71
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$110.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.86
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$26.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$26.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20.83
|
|
|
RESP RT-CARBOXY HEMOGLOBIN
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82375
|
| Hospital Charge Code |
9508005
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.86 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$33.51
|
| Rate for Payer: Aetna Medicare Advantage |
$39.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$44.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$44.69
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.32
|
| Rate for Payer: Clover Medicare Advantage |
$11.70
|
| Rate for Payer: EmblemHealth Commercial |
$36.96
|
| Rate for Payer: Humana Medicare Advantage |
$12.69
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.40
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.86
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
RESP RT-CARBOXY HEMOGLOBIN
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82375
|
| Hospital Charge Code |
9508005
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
RESP RT-NEBUPENT
|
Facility
|
OP
|
$585.00
|
|
|
Service Code
|
HCPCS 94642
|
| Hospital Charge Code |
9507005
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$707.61
|
| Rate for Payer: Aetna Medicare Advantage |
$842.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$943.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$943.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$260.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$108.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$943.69
|
| Rate for Payer: Cigna Commercial |
$521.47
|
| Rate for Payer: Cigna Medicare Advantage |
$260.15
|
| Rate for Payer: Clover Medicare Advantage |
$247.14
|
| Rate for Payer: EmblemHealth Commercial |
$780.45
|
| Rate for Payer: Humana Medicare Advantage |
$267.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$260.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$152.10
|
| Rate for Payer: Oxford Commercial |
$1,367.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$87.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,440.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.49
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$260.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$260.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.61
|
|
|
RESP RT-NEBUPENT
|
Facility
|
IP
|
$585.00
|
|
|
Service Code
|
HCPCS 94642
|
| Hospital Charge Code |
9507005
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$87.75 |
| Max. Negotiated Rate |
$87.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$87.75
|
|
|
RESP SURFACTANT ADM-INTRAPULMO
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
HCPCS 94610
|
| Hospital Charge Code |
9507001
|
|
Hospital Revenue Code
|
469
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$2,770.00 |
| Rate for Payer: Aetna Commercial |
$707.61
|
| Rate for Payer: Aetna Medicare Advantage |
$842.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$943.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$943.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$260.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$943.69
|
| Rate for Payer: Cigna Commercial |
$521.47
|
| Rate for Payer: Cigna Medicare Advantage |
$260.15
|
| Rate for Payer: Clover Medicare Advantage |
$247.14
|
| Rate for Payer: EmblemHealth Commercial |
$780.45
|
| Rate for Payer: Humana Medicare Advantage |
$267.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$260.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$44.46
|
| Rate for Payer: Oxford Commercial |
$2,184.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,770.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.40
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$260.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$260.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.86
|
|
|
RESP SURFACTANT ADM-INTRAPULMO
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
HCPCS 94610
|
| Hospital Charge Code |
9507001
|
|
Hospital Revenue Code
|
469
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$25.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.65
|
|
|
RESP. SYNCYTIAL VIRUS AG
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 87807
|
| Hospital Charge Code |
3036055
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$35.63
|
| Rate for Payer: Aetna Medicare Advantage |
$42.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$20.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47.52
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$13.10
|
| Rate for Payer: Clover Medicare Advantage |
$12.45
|
| Rate for Payer: EmblemHealth Commercial |
$39.30
|
| Rate for Payer: Humana Medicare Advantage |
$13.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$173.57
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.96
|
|
|
RESP. SYNCYTIAL VIRUS AG
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 87807
|
| Hospital Charge Code |
3036055
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
RESTORAT ADM/MDM 28/52MM SZ46F
|
Facility
|
IP
|
$3,361.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270699691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.21 |
| Max. Negotiated Rate |
$813.46 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$672.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$813.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$504.21
|
|
|
RESTORAT ADM/MDM 28/52MM SZ46F
|
Facility
|
OP
|
$3,361.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270699691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.46 |
| Max. Negotiated Rate |
$1,680.70 |
| Rate for Payer: Aetna Commercial |
$1,277.33
|
| Rate for Payer: Aetna Medicare Advantage |
$1,008.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$857.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$857.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$672.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$857.16
|
| Rate for Payer: Cigna Commercial |
$1,680.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$813.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$504.21
|
| Rate for Payer: UnitedHealthcare Community & State |
$106.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$95.46
|
|
|
RESTORIGIN AMNIOT FLUID XL 2ML
|
Facility
|
IP
|
$7,475.00
|
|
|
Service Code
|
HCPCS Q4192
|
| Hospital Charge Code |
270694943
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,121.25 |
| Max. Negotiated Rate |
$1,808.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,495.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,808.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,121.25
|
|
|
RESTORIGIN AMNIOT FLUID XL 2ML
|
Facility
|
OP
|
$7,475.00
|
|
|
Service Code
|
HCPCS Q4192
|
| Hospital Charge Code |
270694943
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$212.29 |
| Max. Negotiated Rate |
$3,737.50 |
| Rate for Payer: Aetna Commercial |
$2,840.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,242.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,906.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,906.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,495.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,906.12
|
| Rate for Payer: Cigna Commercial |
$3,737.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,808.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,121.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$236.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$212.29
|
|
|
RESTORIS MCK BI INLAY
|
Facility
|
OP
|
$22,770.00
|
|
| Hospital Charge Code |
270668065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$646.67 |
| Max. Negotiated Rate |
$11,385.00 |
| Rate for Payer: Aetna Commercial |
$8,652.60
|
| Rate for Payer: Aetna Medicare Advantage |
$6,831.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,806.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,806.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,554.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,806.35
|
| Rate for Payer: Cigna Commercial |
$11,385.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,510.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,415.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$719.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$646.67
|
|
|
RESTORIS MCK BI INLAY
|
Facility
|
IP
|
$22,770.00
|
|
| Hospital Charge Code |
270668065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,415.50 |
| Max. Negotiated Rate |
$5,510.34 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,554.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,510.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,415.50
|
|
|
RESTORIS MCK BI ONLAY PRE PLOY
|
Facility
|
OP
|
$28,845.00
|
|
| Hospital Charge Code |
270668067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$819.20 |
| Max. Negotiated Rate |
$14,422.50 |
| Rate for Payer: Aetna Commercial |
$10,961.10
|
| Rate for Payer: Aetna Medicare Advantage |
$8,653.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,355.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,355.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,769.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,355.48
|
| Rate for Payer: Cigna Commercial |
$14,422.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,980.49
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,326.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$911.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$819.20
|
|
|
RESTORIS MCK BI ONLAY PRE PLOY
|
Facility
|
IP
|
$28,845.00
|
|
| Hospital Charge Code |
270668067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,326.75 |
| Max. Negotiated Rate |
$6,980.49 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,769.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,980.49
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,326.75
|
|
|
RESTORIS MCK BI ONLAY STD PLOY
|
Facility
|
IP
|
$27,270.00
|
|
| Hospital Charge Code |
270668066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,090.50 |
| Max. Negotiated Rate |
$6,599.34 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,454.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,599.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,090.50
|
|
|
RESTORIS MCK BI ONLAY STD PLOY
|
Facility
|
OP
|
$27,270.00
|
|
| Hospital Charge Code |
270668066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$774.47 |
| Max. Negotiated Rate |
$13,635.00 |
| Rate for Payer: Aetna Commercial |
$10,362.60
|
| Rate for Payer: Aetna Medicare Advantage |
$8,181.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,953.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,953.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,454.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,953.85
|
| Rate for Payer: Cigna Commercial |
$13,635.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,599.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,090.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$861.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$774.47
|
|
|
RESTORIS MCK CONSUMABLES
|
Facility
|
IP
|
$4,330.00
|
|
| Hospital Charge Code |
270668070
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$649.50 |
| Max. Negotiated Rate |
$1,047.86 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$866.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,047.86
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$649.50
|
|
