|
BURR ROUND L 2.0MM
|
Facility
|
IP
|
$283.50
|
|
| Hospital Charge Code |
270674619
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.52 |
| Max. Negotiated Rate |
$42.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.52
|
|
|
BURR ROUND L 2.0MM DIAMOND
|
Facility
|
IP
|
$430.50
|
|
| Hospital Charge Code |
270674417
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
|
|
BURR ROUND L 2.0MM DIAMOND
|
Facility
|
OP
|
$430.50
|
|
| Hospital Charge Code |
270674417
|
|
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 ROUND L 2.5MM
|
Facility
|
OP
|
$283.50
|
|
| Hospital Charge Code |
270674393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.05 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna Commercial |
$107.73
|
| Rate for Payer: Aetna Medicare Advantage |
$85.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$72.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$72.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$72.29
|
| Rate for Payer: Cigna Commercial |
$141.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$73.71
|
| Rate for Payer: Oxford Commercial |
$56.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$56.70
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.05
|
|
|
BURR ROUND L 2.5MM
|
Facility
|
IP
|
$283.50
|
|
| Hospital Charge Code |
270674393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.52 |
| Max. Negotiated Rate |
$42.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.52
|
|
|
BURR ROUND L 2.5MM DIAMOND
|
Facility
|
IP
|
$430.50
|
|
| Hospital Charge Code |
270674420
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
|
|
BURR ROUND L 2.5MM DIAMOND
|
Facility
|
OP
|
$430.50
|
|
| Hospital Charge Code |
270674420
|
|
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 ROUND L 3.0MM
|
Facility
|
OP
|
$283.50
|
|
| Hospital Charge Code |
270674396
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.05 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna Commercial |
$107.73
|
| Rate for Payer: Aetna Medicare Advantage |
$85.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$72.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$72.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$72.29
|
| Rate for Payer: Cigna Commercial |
$141.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$73.71
|
| Rate for Payer: Oxford Commercial |
$56.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$56.70
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.05
|
|
|
BURR ROUND L 3.0MM
|
Facility
|
IP
|
$283.50
|
|
| Hospital Charge Code |
270674396
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.52 |
| Max. Negotiated Rate |
$42.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.52
|
|
|
BURR ROUND L 3.0MM DIAMOND
|
Facility
|
IP
|
$430.50
|
|
| Hospital Charge Code |
270674423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
|
|
BURR ROUND L 3.0MM DIAMOND
|
Facility
|
OP
|
$430.50
|
|
| Hospital Charge Code |
270674423
|
|
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 ROUND L 3.5MM DIAMOND
|
Facility
|
OP
|
$430.50
|
|
| Hospital Charge Code |
270674426
|
|
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 ROUND L 3.5MM DIAMOND
|
Facility
|
IP
|
$430.50
|
|
| Hospital Charge Code |
270674426
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
|
|
BURR ROUND L 4.0MM
|
Facility
|
IP
|
$283.50
|
|
| Hospital Charge Code |
270674399
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.52 |
| Max. Negotiated Rate |
$42.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.52
|
|
|
BURR ROUND L 4.0MM
|
Facility
|
OP
|
$283.50
|
|
| Hospital Charge Code |
270674399
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.05 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna Commercial |
$107.73
|
| Rate for Payer: Aetna Medicare Advantage |
$85.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$72.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$72.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$72.29
|
| Rate for Payer: Cigna Commercial |
$141.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$73.71
|
| Rate for Payer: Oxford Commercial |
$56.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$56.70
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.05
|
|
|
BURR ROUND L 4.0MM DIAMOND
|
Facility
|
IP
|
$430.50
|
|
| Hospital Charge Code |
270674429
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
|
|
BURR ROUND L 4.0MM DIAMOND
|
Facility
|
OP
|
$430.50
|
|
| Hospital Charge Code |
270674429
|
|
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 ROUND L 5.0MM
|
Facility
|
IP
|
$283.50
|
|
| Hospital Charge Code |
270674402
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.52 |
| Max. Negotiated Rate |
$42.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.52
|
|
|
BURR ROUND L 5.0MM
|
Facility
|
OP
|
$283.50
|
|
| Hospital Charge Code |
270674402
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.05 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna Commercial |
$107.73
|
| Rate for Payer: Aetna Medicare Advantage |
$85.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$72.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$72.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$72.29
|
| Rate for Payer: Cigna Commercial |
$141.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$73.71
|
| Rate for Payer: Oxford Commercial |
$56.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$56.70
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.05
|
|
|
BURR ROUND L 5.0MM DIAMOND
|
Facility
|
OP
|
$430.50
|
|
| Hospital Charge Code |
270674432
|
|
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 ROUND L 5.0MM DIAMOND
|
Facility
|
IP
|
$430.50
|
|
| Hospital Charge Code |
270674432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
|
|
BURR ROUND L 6.0MM DIAMOND
|
Facility
|
IP
|
$430.50
|
|
| Hospital Charge Code |
270674435
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
|
|
BURR ROUND L 6.0MM DIAMOND
|
Facility
|
OP
|
$430.50
|
|
| Hospital Charge Code |
270674435
|
|
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 ROUND L 6.5MM
|
Facility
|
OP
|
$283.50
|
|
| Hospital Charge Code |
270674405
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.05 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna Commercial |
$107.73
|
| Rate for Payer: Aetna Medicare Advantage |
$85.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$72.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$72.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$72.29
|
| Rate for Payer: Cigna Commercial |
$141.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$73.71
|
| Rate for Payer: Oxford Commercial |
$56.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$56.70
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.05
|
|
|
BURR ROUND L 6.5MM
|
Facility
|
IP
|
$283.50
|
|
| Hospital Charge Code |
270674405
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.52 |
| Max. Negotiated Rate |
$42.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.52
|
|