|
BURR NEURO L 2.2MM HD LGTH 3.7
|
Facility
|
OP
|
$490.00
|
|
| Hospital Charge Code |
270674515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna Commercial |
$186.20
|
| Rate for Payer: Aetna Medicare Advantage |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$124.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$124.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$124.95
|
| Rate for Payer: Cigna Commercial |
$245.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$127.40
|
| Rate for Payer: Oxford Commercial |
$98.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$73.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$98.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.92
|
|
|
BURR NEURO L 2.9MM HD LGTH 3.8
|
Facility
|
IP
|
$490.00
|
|
| Hospital Charge Code |
270674518
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$73.50
|
|
|
BURR NEURO L 2.9MM HD LGTH 3.8
|
Facility
|
OP
|
$490.00
|
|
| Hospital Charge Code |
270674518
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna Commercial |
$186.20
|
| Rate for Payer: Aetna Medicare Advantage |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$124.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$124.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$124.95
|
| Rate for Payer: Cigna Commercial |
$245.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$127.40
|
| Rate for Payer: Oxford Commercial |
$98.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$73.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$98.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.92
|
|
|
BURR NEURO M 1.7MM HD LGTH 2.3
|
Facility
|
IP
|
$490.00
|
|
| Hospital Charge Code |
270674510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$73.50
|
|
|
BURR NEURO M 1.7MM HD LGTH 2.3
|
Facility
|
OP
|
$490.00
|
|
| Hospital Charge Code |
270674510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna Commercial |
$186.20
|
| Rate for Payer: Aetna Medicare Advantage |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$124.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$124.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$124.95
|
| Rate for Payer: Cigna Commercial |
$245.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$127.40
|
| Rate for Payer: Oxford Commercial |
$98.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$73.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$98.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.92
|
|
|
BURR NEURO M 2.2MM HD LGTH 3.7
|
Facility
|
OP
|
$490.00
|
|
| Hospital Charge Code |
270674514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna Commercial |
$186.20
|
| Rate for Payer: Aetna Medicare Advantage |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$124.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$124.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$124.95
|
| Rate for Payer: Cigna Commercial |
$245.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$127.40
|
| Rate for Payer: Oxford Commercial |
$98.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$73.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$98.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.92
|
|
|
BURR NEURO M 2.2MM HD LGTH 3.7
|
Facility
|
IP
|
$490.00
|
|
| Hospital Charge Code |
270674514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$73.50
|
|
|
BURR NEURO M 2.9MM HD LGTH 3.8
|
Facility
|
OP
|
$490.00
|
|
| Hospital Charge Code |
270674517
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna Commercial |
$186.20
|
| Rate for Payer: Aetna Medicare Advantage |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$124.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$124.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$124.95
|
| Rate for Payer: Cigna Commercial |
$245.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$127.40
|
| Rate for Payer: Oxford Commercial |
$98.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$73.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$98.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.92
|
|
|
BURR NEURO M 2.9MM HD LGTH 3.8
|
Facility
|
IP
|
$490.00
|
|
| Hospital Charge Code |
270674517
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$73.50
|
|
|
BURR NEURO S 1.7MM HD LGTH 2.3
|
Facility
|
OP
|
$490.00
|
|
| Hospital Charge Code |
270674509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna Commercial |
$186.20
|
| Rate for Payer: Aetna Medicare Advantage |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$124.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$124.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$124.95
|
| Rate for Payer: Cigna Commercial |
$245.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$127.40
|
| Rate for Payer: Oxford Commercial |
$98.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$73.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$98.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.92
|
|
|
BURR NEURO S 1.7MM HD LGTH 2.3
|
Facility
|
IP
|
$490.00
|
|
| Hospital Charge Code |
270674509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$73.50
|
|
|
BURR NEURO S 2.2MM HD LGHT 3.7
|
Facility
|
IP
|
$490.00
|
|
| Hospital Charge Code |
270674513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$73.50
|
|
|
BURR NEURO S 2.2MM HD LGHT 3.7
|
Facility
|
OP
|
$490.00
|
|
| Hospital Charge Code |
270674513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna Commercial |
$186.20
|
| Rate for Payer: Aetna Medicare Advantage |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$124.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$124.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$124.95
|
| Rate for Payer: Cigna Commercial |
$245.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$127.40
|
| Rate for Payer: Oxford Commercial |
$98.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$73.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$98.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.92
|
|
|
BURR NEURO S 2.9MM HD LGTH 3.8
|
Facility
|
IP
|
$490.00
|
|
| Hospital Charge Code |
270674516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$73.50
|
|
|
BURR NEURO S 2.9MM HD LGTH 3.8
|
Facility
|
OP
|
$490.00
|
|
| Hospital Charge Code |
270674516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna Commercial |
$186.20
|
| Rate for Payer: Aetna Medicare Advantage |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$124.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$124.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$124.95
|
| Rate for Payer: Cigna Commercial |
$245.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$127.40
|
| Rate for Payer: Oxford Commercial |
$98.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$73.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$98.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.92
|
|
|
BUR ROUND 12 FLUTE 4mm RMFG
|
Facility
|
OP
|
$190.00
|
|
| Hospital Charge Code |
270651703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna Commercial |
$72.20
|
| Rate for Payer: Aetna Medicare Advantage |
$57.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$48.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$48.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$48.45
|
| Rate for Payer: Cigna Commercial |
$95.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$49.40
|
| Rate for Payer: Oxford Commercial |
$38.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$38.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.40
|
|
|
BUR ROUND 12 FLUTE 4mm RMFG
|
Facility
|
IP
|
$190.00
|
|
| Hospital Charge Code |
270651703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.50 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.50
|
|
|
BUR ROUND 4.8x5.5MM 6-FLUTE
|
Facility
|
IP
|
$108.30
|
|
| Hospital Charge Code |
270673338
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$16.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.25
|
|
|
BUR ROUND 4.8x5.5MM 6-FLUTE
|
Facility
|
OP
|
$108.30
|
|
| Hospital Charge Code |
270673338
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Aetna Commercial |
$41.15
|
| Rate for Payer: Aetna Medicare Advantage |
$32.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$27.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$27.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$27.62
|
| Rate for Payer: Cigna Commercial |
$54.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$28.16
|
| Rate for Payer: Oxford Commercial |
$21.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$21.66
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.42
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.08
|
|
|
BUR ROUND 4x5.5MM 12-FLUTE
|
Facility
|
IP
|
$156.65
|
|
| Hospital Charge Code |
270673337
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$23.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.50
|
|
|
BUR ROUND 4x5.5MM 12-FLUTE
|
Facility
|
OP
|
$156.65
|
|
| Hospital Charge Code |
270673337
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$78.33 |
| Rate for Payer: Aetna Commercial |
$59.53
|
| Rate for Payer: Aetna Medicare Advantage |
$46.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$39.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$39.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$39.95
|
| Rate for Payer: Cigna Commercial |
$78.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$40.73
|
| Rate for Payer: Oxford Commercial |
$31.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$31.33
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.45
|
|
|
BUR ROUND 4x5.5MM 8-FLUTE
|
Facility
|
OP
|
$93.75
|
|
| Hospital Charge Code |
270673335
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$46.88 |
| Rate for Payer: Aetna Commercial |
$35.62
|
| Rate for Payer: Aetna Medicare Advantage |
$28.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.91
|
| Rate for Payer: Cigna Commercial |
$46.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24.38
|
| Rate for Payer: Oxford Commercial |
$18.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$18.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.66
|
|
|
BUR ROUND 4x5.5MM 8-FLUTE
|
Facility
|
IP
|
$93.75
|
|
| Hospital Charge Code |
270673335
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.06 |
| Max. Negotiated Rate |
$14.06 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.06
|
|
|
BUR ROUND 6.0MM
|
Facility
|
IP
|
$275.00
|
|
| Hospital Charge Code |
270673895
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.25
|
|
|
BUR ROUND 6.0MM
|
Facility
|
OP
|
$275.00
|
|
| Hospital Charge Code |
270673895
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$137.50 |
| Rate for Payer: Aetna Commercial |
$104.50
|
| Rate for Payer: Aetna Medicare Advantage |
$82.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$70.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$70.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$70.12
|
| Rate for Payer: Cigna Commercial |
$137.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$71.50
|
| Rate for Payer: Oxford Commercial |
$55.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$55.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.69
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.81
|
|