|
BURR PIN-SHAPED L 2.1MMx12MM
|
Facility
|
OP
|
$430.50
|
|
| Hospital Charge Code |
270674508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$215.25 |
| Rate for Payer: Aetna Commercial |
$163.59
|
| 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 |
$111.93
|
| Rate for Payer: Oxford Commercial |
$86.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$86.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.23
|
|
|
BURR PIN-SHAPED M 1.4MMx6.0MM
|
Facility
|
IP
|
$430.50
|
|
| Hospital Charge Code |
270674504
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
|
|
BURR PIN-SHAPED M 1.4MMx6.0MM
|
Facility
|
OP
|
$430.50
|
|
| Hospital Charge Code |
270674504
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$215.25 |
| Rate for Payer: Aetna Commercial |
$163.59
|
| 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 |
$111.93
|
| Rate for Payer: Oxford Commercial |
$86.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$86.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.23
|
|
|
BURR PIN-SHAPED M 2.1MMx12MM
|
Facility
|
OP
|
$430.50
|
|
| Hospital Charge Code |
270674507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$215.25 |
| Rate for Payer: Aetna Commercial |
$163.59
|
| 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 |
$111.93
|
| Rate for Payer: Oxford Commercial |
$86.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$86.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.23
|
|
|
BURR PIN-SHAPED M 2.1MMx12MM
|
Facility
|
IP
|
$430.50
|
|
| Hospital Charge Code |
270674507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
|
|
BURR PIN-SHAPED S 1.4MMx6.0MM
|
Facility
|
OP
|
$430.50
|
|
| Hospital Charge Code |
270674503
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$215.25 |
| Rate for Payer: Aetna Commercial |
$163.59
|
| 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 |
$111.93
|
| Rate for Payer: Oxford Commercial |
$86.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$86.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.23
|
|
|
BURR PIN-SHAPED S 1.4MMx6.0MM
|
Facility
|
IP
|
$430.50
|
|
| Hospital Charge Code |
270674503
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
|
|
BURR PIN-SHAPED S 2.1MMx12MM
|
Facility
|
OP
|
$430.50
|
|
| Hospital Charge Code |
270674506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$215.25 |
| Rate for Payer: Aetna Commercial |
$163.59
|
| 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 |
$111.93
|
| Rate for Payer: Oxford Commercial |
$86.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$86.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.23
|
|
|
BURR PIN-SHAPED S 2.1MMx12MM
|
Facility
|
IP
|
$430.50
|
|
| Hospital Charge Code |
270674506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
|
|
BURR RD LG R STYLE 5.5 505881
|
Facility
|
OP
|
$220.00
|
|
| Hospital Charge Code |
270630489
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna Commercial |
$83.60
|
| Rate for Payer: Aetna Medicare Advantage |
$66.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$56.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$56.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$56.10
|
| Rate for Payer: Cigna Commercial |
$110.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$57.20
|
| Rate for Payer: Oxford Commercial |
$44.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$44.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.25
|
|
|
BURR RD LG R STYLE 5.5 505881
|
Facility
|
IP
|
$220.00
|
|
| Hospital Charge Code |
270630489
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.00
|
|
|
BURR RND DIAMOND LNG 4MM
|
Facility
|
OP
|
$195.65
|
|
| Hospital Charge Code |
270680028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$97.83 |
| Rate for Payer: Aetna Commercial |
$74.35
|
| Rate for Payer: Aetna Medicare Advantage |
$58.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49.89
|
| Rate for Payer: Cigna Commercial |
$97.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$50.87
|
| Rate for Payer: Oxford Commercial |
$39.13
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$39.13
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.56
|
|
|
BURR RND DIAMOND LNG 4MM
|
Facility
|
IP
|
$195.65
|
|
| Hospital Charge Code |
270680028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.35 |
| Max. Negotiated Rate |
$29.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.35
|
|
|
BURR RND DIAMOND XL 5.5MM
|
Facility
|
IP
|
$865.20
|
|
| Hospital Charge Code |
270679827
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$129.78 |
| Max. Negotiated Rate |
$129.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$129.78
|
|
|
BURR RND DIAMOND XL 5.5MM
|
Facility
|
OP
|
$865.20
|
|
| Hospital Charge Code |
270679827
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$432.60 |
| Rate for Payer: Aetna Commercial |
$328.78
|
| Rate for Payer: Aetna Medicare Advantage |
$259.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$220.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$220.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$220.63
|
| Rate for Payer: Cigna Commercial |
$432.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$224.95
|
| Rate for Payer: Oxford Commercial |
$173.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$129.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$173.04
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.57
|
|
|
BURR ROUND 10 FLUTE 3.0 MM
|
Facility
|
OP
|
$330.00
|
|
| Hospital Charge Code |
270690972
|
|
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
|
|
|
BURR ROUND 10 FLUTE 3.0 MM
|
Facility
|
IP
|
$330.00
|
|
| Hospital Charge Code |
270690972
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.50
|
|
|
BURR ROUND 12-FLUTE 5.5mm
|
Facility
|
IP
|
$190.00
|
|
| Hospital Charge Code |
270601423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.50 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.50
|
|
|
BURR ROUND 12-FLUTE 5.5mm
|
Facility
|
OP
|
$190.00
|
|
| Hospital Charge Code |
270601423
|
|
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
|
|
|
BURR ROUND 1.5MM
|
Facility
|
OP
|
$48.40
|
|
| Hospital Charge Code |
270679264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$24.20 |
| Rate for Payer: Aetna Commercial |
$18.39
|
| Rate for Payer: Aetna Medicare Advantage |
$14.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.34
|
| Rate for Payer: Cigna Commercial |
$24.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.58
|
| Rate for Payer: Oxford Commercial |
$9.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$9.68
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.37
|
|
|
BURR ROUND 1.5MM
|
Facility
|
IP
|
$48.40
|
|
| Hospital Charge Code |
270679264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$7.26 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.26
|
|
|
BURR ROUND 3.0x28MM MINI QC
|
Facility
|
IP
|
$381.50
|
|
| Hospital Charge Code |
270674540
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.23 |
| Max. Negotiated Rate |
$57.23 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.23
|
|
|
BURR ROUND 3.0x28MM MINI QC
|
Facility
|
OP
|
$381.50
|
|
| Hospital Charge Code |
270674540
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.83 |
| Max. Negotiated Rate |
$190.75 |
| Rate for Payer: Aetna Commercial |
$144.97
|
| 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 |
$99.19
|
| Rate for Payer: Oxford Commercial |
$76.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$76.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.83
|
|
|
BURR ROUND 3.0x45MM MINI QC
|
Facility
|
IP
|
$381.50
|
|
| Hospital Charge Code |
270674541
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.23 |
| Max. Negotiated Rate |
$57.23 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.23
|
|
|
BURR ROUND 3.0x45MM MINI QC
|
Facility
|
OP
|
$381.50
|
|
| Hospital Charge Code |
270674541
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.83 |
| Max. Negotiated Rate |
$190.75 |
| Rate for Payer: Aetna Commercial |
$144.97
|
| 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 |
$99.19
|
| Rate for Payer: Oxford Commercial |
$76.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$76.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.83
|
|