|
BARRIERSKIN STOM MOLDABL 2-1/4
|
Facility
|
OP
|
$14.78
|
|
| Hospital Charge Code |
270650525
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$7.39 |
| Rate for Payer: Aetna Commercial |
$5.62
|
| 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 |
$3.84
|
| Rate for Payer: Oxford Commercial |
$2.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.22
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.96
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.42
|
|
|
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
|
OP
|
$350.00
|
|
| Hospital Charge Code |
270662308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$133.00
|
| 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 |
$91.00
|
| Rate for Payer: Oxford Commercial |
$70.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$70.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.94
|
|
|
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 7.25MM
|
Facility
|
OP
|
$425.00
|
|
| Hospital Charge Code |
270671095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.07 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Aetna Commercial |
$161.50
|
| 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 |
$110.50
|
| Rate for Payer: Oxford Commercial |
$85.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$85.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.07
|
|
|
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 7.5MM
|
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 7.5MM
|
Facility
|
OP
|
$330.00
|
|
| Hospital Charge Code |
270654851
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.37 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna Commercial |
$125.40
|
| 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 |
$85.80
|
| Rate for Payer: Oxford Commercial |
$66.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$66.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.37
|
|
|
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 7.75MM
|
Facility
|
OP
|
$425.00
|
|
| Hospital Charge Code |
270671097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.07 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Aetna Commercial |
$161.50
|
| 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 |
$110.50
|
| Rate for Payer: Oxford Commercial |
$85.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$85.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.07
|
|
|
BARRON CORNEAL PUNCH 9.25MM
|
Facility
|
OP
|
$425.00
|
|
| Hospital Charge Code |
270671098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.07 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Aetna Commercial |
$161.50
|
| 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 |
$110.50
|
| Rate for Payer: Oxford Commercial |
$85.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$85.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.07
|
|
|
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
|
OP
|
$330.00
|
|
| Hospital Charge Code |
270660738
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.37 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna Commercial |
$125.40
|
| 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 |
$85.80
|
| Rate for Payer: Oxford Commercial |
$66.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$66.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.37
|
|
|
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 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
|
|
|
BARRON CORNEA PUNCH 9.5MM DIA
|
Facility
|
OP
|
$330.00
|
|
| Hospital Charge Code |
270673281
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.37 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna Commercial |
$125.40
|
| 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 |
$85.80
|
| Rate for Payer: Oxford Commercial |
$66.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$66.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.37
|
|
|
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 |
$850.91 |
| Max. Negotiated Rate |
$13,950.60 |
| Rate for Payer: Aetna Commercial |
$10,460.55
|
| Rate for Payer: Aetna Medicare Advantage |
$12,460.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,950.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,950.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,845.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,950.60
|
| Rate for Payer: Cigna Commercial |
$7,708.87
|
| Rate for Payer: Cigna Medicare Advantage |
$3,845.79
|
| Rate for Payer: Clover Medicare Advantage |
$3,653.50
|
| Rate for Payer: EmblemHealth Commercial |
$11,537.37
|
| Rate for Payer: Humana Medicare Advantage |
$3,961.16
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,845.79
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,790.04
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,494.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$946.79
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,845.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,845.79
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$850.91
|
|
|
BAR TIBIAL LOCKING
|
Facility
|
OP
|
$1,160.00
|
|
| Hospital Charge Code |
270619033
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.94 |
| Max. Negotiated Rate |
$580.00 |
| Rate for Payer: Aetna Commercial |
$440.80
|
| Rate for Payer: Aetna Medicare Advantage |
$348.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$295.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$295.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$295.80
|
| Rate for Payer: Cigna Commercial |
$580.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$301.60
|
| Rate for Payer: Oxford Commercial |
$232.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$174.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$232.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$36.66
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$32.94
|
|
|
BAR TIBIAL LOCKING
|
Facility
|
IP
|
$1,160.00
|
|
| Hospital Charge Code |
270619033
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$174.00
|
|
|
BAR TO BAR CLAMP
|
Facility
|
IP
|
$540.00
|
|
| Hospital Charge Code |
270339499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$81.00
|
|
|
BAR TO BAR CLAMP
|
Facility
|
OP
|
$540.00
|
|
| Hospital Charge Code |
270339499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$205.20
|
| Rate for Payer: Aetna Medicare Advantage |
$162.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$137.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$137.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$137.70
|
| Rate for Payer: Cigna Commercial |
$270.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$140.40
|
| Rate for Payer: Oxford Commercial |
$108.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$81.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$108.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.34
|
|
|
BARTONELLA AB(IGG,M)W/RFL I
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 8661191
|
| Hospital Charge Code |
39990083A
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
BARTONELLA AB(IGG,M)W/RFL I
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 8661191
|
| Hospital Charge Code |
39990083A
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$148.20
|
| Rate for Payer: Aetna Medicare Advantage |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$99.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$99.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$99.45
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| 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 |
$12.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
BARTONELLA AB(IGG,M)W/RFL II
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 8661191
|
| Hospital Charge Code |
39990083B
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|