|
DRESSING MEDIHONEY CA ALGI 2X2
|
Facility
|
OP
|
$18.95
|
|
| Hospital Charge Code |
270666019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$9.47 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: Aetna Medicare Advantage |
$5.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.83
|
| Rate for Payer: Cigna Commercial |
$9.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.93
|
| Rate for Payer: Oxford Commercial |
$3.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.84
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.79
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.54
|
|
|
DRESSING MEDIHONEY CA ALGI 2X2
|
Facility
|
IP
|
$18.95
|
|
| Hospital Charge Code |
270666019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.84
|
|
|
DRESSING MEDIHONEY COLLIOD 2X2
|
Facility
|
OP
|
$19.04
|
|
| Hospital Charge Code |
270669979
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$9.52 |
| Rate for Payer: Aetna Commercial |
$7.24
|
| Rate for Payer: Aetna Medicare Advantage |
$5.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.86
|
| Rate for Payer: Cigna Commercial |
$9.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.95
|
| Rate for Payer: Oxford Commercial |
$3.81
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.86
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.81
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.54
|
|
|
DRESSING MEDIHONEY COLLIOD 2X2
|
Facility
|
IP
|
$19.04
|
|
| Hospital Charge Code |
270669979
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$2.86 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.86
|
|
|
DRESSING MEDIHONEY COLLOID 4X5
|
Facility
|
OP
|
$43.27
|
|
| Hospital Charge Code |
270669978
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$21.64 |
| Rate for Payer: Aetna Commercial |
$16.44
|
| Rate for Payer: Aetna Medicare Advantage |
$12.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$11.03
|
| Rate for Payer: Cigna Commercial |
$21.64
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.25
|
| Rate for Payer: Oxford Commercial |
$8.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.49
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.65
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.23
|
|
|
DRESSING MEDIHONEY COLLOID 4X5
|
Facility
|
IP
|
$43.27
|
|
| Hospital Charge Code |
270669978
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$6.49 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.49
|
|
|
DRESSING MEDIHONEY GEL 0.5 OZ
|
Facility
|
IP
|
$26.64
|
|
| Hospital Charge Code |
270666020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.00
|
|
|
DRESSING MEDIHONEY GEL 0.5 OZ
|
Facility
|
OP
|
$26.64
|
|
| Hospital Charge Code |
270666020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna Commercial |
$10.12
|
| Rate for Payer: Aetna Medicare Advantage |
$7.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6.79
|
| Rate for Payer: Cigna Commercial |
$13.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.93
|
| Rate for Payer: Oxford Commercial |
$5.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.33
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.76
|
|
|
DRESSING MEPILEX BORDER 4INX4I
|
Facility
|
IP
|
$15.00
|
|
| Hospital Charge Code |
270685348
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.25
|
|
|
DRESSING MEPILEX BORDER 4INX4I
|
Facility
|
OP
|
$15.00
|
|
| Hospital Charge Code |
270685348
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Aetna Commercial |
$5.70
|
| Rate for Payer: Aetna Medicare Advantage |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.83
|
| Rate for Payer: Cigna Commercial |
$7.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.90
|
| Rate for Payer: Oxford Commercial |
$3.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.43
|
|
|
DRESSING MEPILEX BORDER 6INX6I
|
Facility
|
IP
|
$67.01
|
|
| Hospital Charge Code |
270685349
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$10.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.05
|
|
|
DRESSING MEPILEX BORDER 6INX6I
|
Facility
|
OP
|
$67.01
|
|
| Hospital Charge Code |
270685349
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$33.51 |
| Rate for Payer: Aetna Commercial |
$25.46
|
| Rate for Payer: Aetna Medicare Advantage |
$20.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.09
|
| Rate for Payer: Cigna Commercial |
$33.51
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17.42
|
| Rate for Payer: Oxford Commercial |
$13.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$13.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.90
|
|
|
DRESSING MEPILEX HEEL 22 x23CM
|
Facility
|
IP
|
$54.05
|
|
| Hospital Charge Code |
270685380
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$8.11 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.11
|
|
|
DRESSING MEPILEX HEEL 22 x23CM
|
Facility
|
OP
|
$54.05
|
|
| Hospital Charge Code |
270685380
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$27.02 |
| Rate for Payer: Aetna Commercial |
$20.54
|
| Rate for Payer: Aetna Medicare Advantage |
$16.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.78
|
| Rate for Payer: Cigna Commercial |
$27.02
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.05
|
| Rate for Payer: Oxford Commercial |
$10.81
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.11
|
| Rate for Payer: UnitedHealthcare Commercial |
$10.81
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.71
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.54
|
|
|
DRESSING MEPITEL ONE 2x3
|
Facility
|
OP
|
$16.35
|
|
| Hospital Charge Code |
270677978
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$8.18 |
| Rate for Payer: Aetna Commercial |
$6.21
|
| Rate for Payer: Aetna Medicare Advantage |
$4.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.17
|
| Rate for Payer: Cigna Commercial |
$8.18
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.25
|
| Rate for Payer: Oxford Commercial |
$3.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.27
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.46
|
|
|
DRESSING MEPITEL ONE 2x3
|
Facility
|
IP
|
$16.35
|
|
| Hospital Charge Code |
270677978
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.45
|
|
|
DRESSING MEPLIEX XT 4x4IN
|
Facility
|
OP
|
$17.41
|
|
| Hospital Charge Code |
270685406
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$8.71 |
| Rate for Payer: Aetna Commercial |
$6.62
|
| Rate for Payer: Aetna Medicare Advantage |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.44
|
| Rate for Payer: Cigna Commercial |
$8.71
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.53
|
| Rate for Payer: Oxford Commercial |
$3.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.61
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.48
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.49
|
|
|
DRESSING MEPLIEX XT 4x4IN
|
Facility
|
IP
|
$17.41
|
|
| Hospital Charge Code |
270685406
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$2.61 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.61
|
|
|
DRESSING MEXTRA 5 x 5 IN
|
Facility
|
OP
|
$8.77
|
|
| Hospital Charge Code |
270685408
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$4.38 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Aetna Medicare Advantage |
$2.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.24
|
| Rate for Payer: Cigna Commercial |
$4.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.28
|
| Rate for Payer: Oxford Commercial |
$1.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.25
|
|
|
DRESSING MEXTRA 5 x 5 IN
|
Facility
|
IP
|
$8.77
|
|
| Hospital Charge Code |
270685408
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$1.32 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.32
|
|
|
DRESSING MINI ISLAND TELFA 2X3
|
Facility
|
IP
|
$2.00
|
|
| Hospital Charge Code |
270649163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.30
|
|
|
DRESSING MINI ISLAND TELFA 2X3
|
Facility
|
OP
|
$2.00
|
|
| Hospital Charge Code |
270649163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna Commercial |
$0.76
|
| Rate for Payer: Aetna Medicare Advantage |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.51
|
| Rate for Payer: Cigna Commercial |
$1.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.52
|
| Rate for Payer: Oxford Commercial |
$0.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.06
|
|
|
DRESSING NASAL 8 CM
|
Facility
|
IP
|
$1,475.00
|
|
| Hospital Charge Code |
270660192
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.25 |
| Max. Negotiated Rate |
$221.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$221.25
|
|
|
DRESSING NASAL 8 CM
|
Facility
|
OP
|
$1,475.00
|
|
| Hospital Charge Code |
270660192
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.89 |
| Max. Negotiated Rate |
$737.50 |
| Rate for Payer: Aetna Commercial |
$560.50
|
| Rate for Payer: Aetna Medicare Advantage |
$442.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$376.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$376.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$376.12
|
| Rate for Payer: Cigna Commercial |
$737.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$383.50
|
| Rate for Payer: Oxford Commercial |
$295.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$221.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$295.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$46.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$41.89
|
|
|
DRESSING NASAL RIEMANN
|
Facility
|
IP
|
$157.50
|
|
| Hospital Charge Code |
270628901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.62 |
| Max. Negotiated Rate |
$23.62 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.62
|
|