|
ELECTRODE MTK THERM 3.5 225101
|
Facility
|
OP
|
$1,441.65
|
|
| Hospital Charge Code |
270619911
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.74 |
| Max. Negotiated Rate |
$720.83 |
| Rate for Payer: Aetna Commercial |
$547.83
|
| Rate for Payer: Aetna Medicare Advantage |
$432.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$367.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$367.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$367.62
|
| Rate for Payer: Cigna Commercial |
$720.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$432.50
|
| Rate for Payer: Oxford Commercial |
$288.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$216.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$288.33
|
| Rate for Payer: UnitedHealthcare Community & State |
$34.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.20
|
|
|
ELECTRODE MTK VAPO 2.3 225201
|
Facility
|
IP
|
$1,112.85
|
|
| Hospital Charge Code |
270619166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.93 |
| Max. Negotiated Rate |
$166.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$166.93
|
|
|
ELECTRODE MTK VAPO 2.3 225201
|
Facility
|
OP
|
$1,112.85
|
|
| Hospital Charge Code |
270619166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.82 |
| Max. Negotiated Rate |
$556.42 |
| Rate for Payer: Aetna Commercial |
$422.88
|
| Rate for Payer: Aetna Medicare Advantage |
$333.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$283.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$283.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$283.78
|
| Rate for Payer: Cigna Commercial |
$556.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$333.86
|
| Rate for Payer: Oxford Commercial |
$222.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$166.93
|
| Rate for Payer: UnitedHealthcare Commercial |
$222.57
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.49
|
|
|
ELECTRODE NEUTRAL SELF-ADHESIV
|
Facility
|
IP
|
$130.15
|
|
| Hospital Charge Code |
270650127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.52 |
| Max. Negotiated Rate |
$19.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.52
|
|
|
ELECTRODE NEUTRAL SELF-ADHESIV
|
Facility
|
OP
|
$130.15
|
|
| Hospital Charge Code |
270650127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$65.08 |
| Rate for Payer: Aetna Commercial |
$49.46
|
| Rate for Payer: Aetna Medicare Advantage |
$39.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$33.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$33.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$33.19
|
| Rate for Payer: Cigna Commercial |
$65.08
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$39.05
|
| Rate for Payer: Oxford Commercial |
$26.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$26.03
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.45
|
|
|
ELECTRODE PACING
|
Facility
|
IP
|
$453.65
|
|
| Hospital Charge Code |
270600755
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$68.05 |
| Max. Negotiated Rate |
$68.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$68.05
|
|
|
ELECTRODE PACING
|
Facility
|
OP
|
$453.65
|
|
| Hospital Charge Code |
270600755
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.93 |
| Max. Negotiated Rate |
$226.82 |
| Rate for Payer: Aetna Commercial |
$172.39
|
| Rate for Payer: Aetna Medicare Advantage |
$136.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$115.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$115.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$115.68
|
| Rate for Payer: Cigna Commercial |
$226.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$136.09
|
| Rate for Payer: Oxford Commercial |
$90.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$68.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$90.73
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.93
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.02
|
|
|
ELECTRODE PACING BI BALLON FLO
|
Facility
|
IP
|
$905.00
|
|
| Hospital Charge Code |
2707400048
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.75 |
| Max. Negotiated Rate |
$135.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.75
|
|
|
ELECTRODE PACING BI BALLON FLO
|
Facility
|
OP
|
$905.00
|
|
| Hospital Charge Code |
2707400048
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.81 |
| Max. Negotiated Rate |
$452.50 |
| Rate for Payer: Aetna Commercial |
$343.90
|
| Rate for Payer: Aetna Medicare Advantage |
$271.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$230.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$230.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$230.78
|
| Rate for Payer: Cigna Commercial |
$452.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.50
|
| Rate for Payer: Oxford Commercial |
$181.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$181.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.98
|
|
|
ELECTRODE PACING BI BALLOON FL
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
270655417S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.75 |
| Max. Negotiated Rate |
$223.85 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$185.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$223.85
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$203.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$138.75
|
|
|
ELECTRODE PACING BI BALLOON FL
|
Facility
|
IP
|
$905.00
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
270655417N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.75 |
| Max. Negotiated Rate |
$219.01 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$181.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.01
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$199.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.75
|
|
|
ELECTRODE PACING BI BALLOON FL
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
270655417S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.29 |
| Max. Negotiated Rate |
$462.50 |
| Rate for Payer: Aetna Commercial |
$351.50
|
| Rate for Payer: Aetna Medicare Advantage |
$277.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$235.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$235.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$185.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$235.88
|
| Rate for Payer: Cigna Commercial |
$462.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$223.85
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$203.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$138.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.51
|
|
|
ELECTRODE PACING BI BALLOON FL
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
270655417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.29 |
| Max. Negotiated Rate |
$462.50 |
| Rate for Payer: Aetna Commercial |
$351.50
|
| Rate for Payer: Aetna Medicare Advantage |
$277.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$235.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$235.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$185.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$235.88
|
| Rate for Payer: Cigna Commercial |
$462.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$223.85
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$203.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$138.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.51
|
|
|
ELECTRODE PACING BI BALLOON FL
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
270655417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.75 |
| Max. Negotiated Rate |
$223.85 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$185.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$223.85
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$203.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$138.75
|
|
|
ELECTRODE PACING BI BALLOON FL
|
Facility
|
OP
|
$905.00
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
270655417N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.81 |
| Max. Negotiated Rate |
$452.50 |
| Rate for Payer: Aetna Commercial |
$343.90
|
| Rate for Payer: Aetna Medicare Advantage |
$271.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$230.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$230.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$181.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$230.78
|
| Rate for Payer: Cigna Commercial |
$452.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.01
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$199.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.98
|
|
|
ELECTRODE PAIRED 4-CHANNEL
|
Facility
|
IP
|
$445.00
|
|
| Hospital Charge Code |
270678075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.75 |
| Max. Negotiated Rate |
$66.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.75
|
|
|
ELECTRODE PAIRED 4-CHANNEL
|
Facility
|
OP
|
$445.00
|
|
| Hospital Charge Code |
270678075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.72 |
| Max. Negotiated Rate |
$222.50 |
| Rate for Payer: Aetna Commercial |
$169.10
|
| Rate for Payer: Aetna Medicare Advantage |
$133.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$113.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$113.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$113.47
|
| Rate for Payer: Cigna Commercial |
$222.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.50
|
| Rate for Payer: Oxford Commercial |
$89.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$89.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.72
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.79
|
|
|
ELECTRODE PEDIATRIC M2248-50
|
Facility
|
IP
|
$42.58
|
|
| Hospital Charge Code |
270649179
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.39 |
| Max. Negotiated Rate |
$6.39 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.39
|
|
|
ELECTRODE PEDIATRIC M2248-50
|
Facility
|
OP
|
$42.58
|
|
| Hospital Charge Code |
270649179
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$21.29 |
| Rate for Payer: Aetna Commercial |
$16.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.86
|
| Rate for Payer: Cigna Commercial |
$21.29
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.77
|
| Rate for Payer: Oxford Commercial |
$8.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.39
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.52
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.13
|
|
|
ELECTRODE PREWIRED RADIO
|
Facility
|
OP
|
$12.16
|
|
| Hospital Charge Code |
270649795
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$6.08 |
| Rate for Payer: Aetna Commercial |
$4.62
|
| Rate for Payer: Aetna Medicare Advantage |
$3.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.10
|
| Rate for Payer: Cigna Commercial |
$6.08
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.65
|
| Rate for Payer: Oxford Commercial |
$2.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.82
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.43
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.32
|
|
|
ELECTRODE PREWIRED RADIO
|
Facility
|
IP
|
$12.16
|
|
| Hospital Charge Code |
270649795
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.82
|
|
|
ELECTRODE QUICK COMBO 11996
|
Facility
|
OP
|
$134.45
|
|
| Hospital Charge Code |
270627213
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$67.22 |
| Rate for Payer: Aetna Commercial |
$51.09
|
| Rate for Payer: Aetna Medicare Advantage |
$40.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.28
|
| Rate for Payer: Cigna Commercial |
$67.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$40.34
|
| Rate for Payer: Oxford Commercial |
$26.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$26.89
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.56
|
|
|
ELECTRODE QUICK COMBO 11996
|
Facility
|
IP
|
$134.45
|
|
| Hospital Charge Code |
270627213
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.17 |
| Max. Negotiated Rate |
$20.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.17
|
|
|
ELECTRODE QUICK PACE DISP
|
Facility
|
OP
|
$158.45
|
|
| Hospital Charge Code |
270603375
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$79.22 |
| Rate for Payer: Aetna Commercial |
$60.21
|
| Rate for Payer: Aetna Medicare Advantage |
$47.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$40.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$40.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$40.40
|
| Rate for Payer: Cigna Commercial |
$79.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.53
|
| Rate for Payer: Oxford Commercial |
$31.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.77
|
| Rate for Payer: UnitedHealthcare Commercial |
$31.69
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.20
|
|
|
ELECTRODE QUICK PACE DISP
|
Facility
|
IP
|
$158.45
|
|
| Hospital Charge Code |
270603375
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.77 |
| Max. Negotiated Rate |
$23.77 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.77
|
|
