|
ELECTRODE TP PAC 5F 647308556P
|
Facility
|
OP
|
$668.00
|
|
| Hospital Charge Code |
270634587
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.10 |
| Max. Negotiated Rate |
$334.00 |
| Rate for Payer: Aetna Commercial |
$253.84
|
| Rate for Payer: Aetna Medicare Advantage |
$200.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$170.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$170.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$170.34
|
| Rate for Payer: Cigna Commercial |
$334.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$200.40
|
| Rate for Payer: Oxford Commercial |
$133.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$133.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.70
|
|
|
ELECTRODE TP PAC 5F 647308556P
|
Facility
|
IP
|
$668.00
|
|
| Hospital Charge Code |
270634587
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.20 |
| Max. Negotiated Rate |
$100.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.20
|
|
|
ELECTRODE TRIGGER FLEX
|
Facility
|
OP
|
$2,975.00
|
|
| Hospital Charge Code |
270670841
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.70 |
| Max. Negotiated Rate |
$1,487.50 |
| Rate for Payer: Aetna Commercial |
$1,130.50
|
| Rate for Payer: Aetna Medicare Advantage |
$892.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$758.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$758.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$758.62
|
| Rate for Payer: Cigna Commercial |
$1,487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$892.50
|
| Rate for Payer: Oxford Commercial |
$595.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$446.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$595.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$71.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$78.84
|
|
|
ELECTRODE TRIGGER FLEX
|
Facility
|
IP
|
$2,975.00
|
|
| Hospital Charge Code |
270670841
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$446.25 |
| Max. Negotiated Rate |
$446.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$446.25
|
|
|
ELECTRODE VAPR S50 50DEG
|
Facility
|
OP
|
$1,560.00
|
|
| Hospital Charge Code |
270640024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.60 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: Aetna Commercial |
$592.80
|
| Rate for Payer: Aetna Medicare Advantage |
$468.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$397.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$397.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$397.80
|
| Rate for Payer: Cigna Commercial |
$780.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$468.00
|
| Rate for Payer: Oxford Commercial |
$312.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$234.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$312.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$37.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$41.34
|
|
|
ELECTRODE VAPR S50 50DEG
|
Facility
|
IP
|
$1,560.00
|
|
| Hospital Charge Code |
270640024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$234.00
|
|
|
ELECTRODE VAPR S90 4.0mm 90deg
|
Facility
|
IP
|
$1,230.00
|
|
| Hospital Charge Code |
270636213
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.50 |
| Max. Negotiated Rate |
$184.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$184.50
|
|
|
ELECTRODE VAPR S90 4.0mm 90deg
|
Facility
|
OP
|
$1,230.00
|
|
| Hospital Charge Code |
270636213
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.64 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: Aetna Commercial |
$467.40
|
| Rate for Payer: Aetna Medicare Advantage |
$369.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$313.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$313.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$313.65
|
| Rate for Payer: Cigna Commercial |
$615.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$369.00
|
| Rate for Payer: Oxford Commercial |
$246.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$184.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$246.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$29.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$32.59
|
|
|
ELECTRODE VL DISP LS1100
|
Facility
|
IP
|
$1,824.00
|
|
| Hospital Charge Code |
270623967
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.60 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$273.60
|
|
|
ELECTRODE VL DISP LS1100
|
Facility
|
OP
|
$1,824.00
|
|
| Hospital Charge Code |
270623967
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.96 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Aetna Commercial |
$693.12
|
| Rate for Payer: Aetna Medicare Advantage |
$547.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$465.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$465.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$465.12
|
| Rate for Payer: Cigna Commercial |
$912.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$547.20
|
| Rate for Payer: Oxford Commercial |
$364.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$273.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$364.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$43.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$48.34
|
|
|
ELECTRODE VL EXTD LS3111
|
Facility
|
IP
|
$965.60
|
|
| Hospital Charge Code |
270623966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.84 |
| Max. Negotiated Rate |
$144.84 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$144.84
|
|
|
ELECTRODE VL EXTD LS3111
|
Facility
|
OP
|
$965.60
|
|
| Hospital Charge Code |
270623966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.27 |
| Max. Negotiated Rate |
$482.80 |
| Rate for Payer: Aetna Commercial |
$366.93
|
| Rate for Payer: Aetna Medicare Advantage |
$289.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$246.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$246.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$246.23
|
| Rate for Payer: Cigna Commercial |
$482.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$289.68
|
| Rate for Payer: Oxford Commercial |
$193.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$144.84
|
| Rate for Payer: UnitedHealthcare Commercial |
$193.12
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.59
|
|
|
ELECTRODE VL MAX LS3091
|
Facility
|
IP
|
$912.20
|
|
| Hospital Charge Code |
270623963
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.83 |
| Max. Negotiated Rate |
$136.83 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.83
|
|
|
ELECTRODE VL MAX LS3091
|
Facility
|
OP
|
$912.20
|
|
| Hospital Charge Code |
270623963
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.98 |
| Max. Negotiated Rate |
$456.10 |
| Rate for Payer: Aetna Commercial |
$346.64
|
| Rate for Payer: Aetna Medicare Advantage |
$273.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$232.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$232.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$232.61
|
| Rate for Payer: Cigna Commercial |
$456.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$273.66
|
| Rate for Payer: Oxford Commercial |
$182.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.83
|
| Rate for Payer: UnitedHealthcare Commercial |
$182.44
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.17
|
|
|
ELECTRODE VL STD LS2071
|
Facility
|
OP
|
$912.20
|
|
| Hospital Charge Code |
270623964
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.98 |
| Max. Negotiated Rate |
$456.10 |
| Rate for Payer: Aetna Commercial |
$346.64
|
| Rate for Payer: Aetna Medicare Advantage |
$273.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$232.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$232.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$232.61
|
| Rate for Payer: Cigna Commercial |
$456.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$273.66
|
| Rate for Payer: Oxford Commercial |
$182.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.83
|
| Rate for Payer: UnitedHealthcare Commercial |
$182.44
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.17
|
|
|
ELECTRODE VL STD LS2071
|
Facility
|
IP
|
$912.20
|
|
| Hospital Charge Code |
270623964
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.83 |
| Max. Negotiated Rate |
$136.83 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.83
|
|
|
ELECTRODE W/BALL TIP 8FR
|
Facility
|
OP
|
$253.00
|
|
| Hospital Charge Code |
270330918
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$126.50 |
| Rate for Payer: Aetna Commercial |
$96.14
|
| Rate for Payer: Aetna Medicare Advantage |
$75.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.52
|
| Rate for Payer: Cigna Commercial |
$126.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$75.90
|
| Rate for Payer: Oxford Commercial |
$50.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$50.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.70
|
|
|
ELECTRODE W/BALL TIP 8FR
|
Facility
|
IP
|
$253.00
|
|
| Hospital Charge Code |
270330918
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.95 |
| Max. Negotiated Rate |
$37.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.95
|
|
|
ELECTRODE WIDE LOOP
|
Facility
|
OP
|
$58.00
|
|
| Hospital Charge Code |
270605214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$29.00 |
| Rate for Payer: Aetna Commercial |
$22.04
|
| Rate for Payer: Aetna Medicare Advantage |
$17.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.79
|
| Rate for Payer: Cigna Commercial |
$29.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17.40
|
| Rate for Payer: Oxford Commercial |
$11.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.54
|
|
|
ELECTRODE WIDE LOOP
|
Facility
|
IP
|
$58.00
|
|
| Hospital Charge Code |
270605214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$8.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.70
|
|
|
ELECTRODE WIDE LOOP ******
|
Facility
|
OP
|
$58.00
|
|
| Hospital Charge Code |
1608132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$29.00 |
| Rate for Payer: Aetna Commercial |
$22.04
|
| Rate for Payer: Aetna Medicare Advantage |
$17.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.79
|
| Rate for Payer: Cigna Commercial |
$29.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17.40
|
| Rate for Payer: Oxford Commercial |
$11.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.54
|
|
|
ELECTRODE WIDE LOOP ******
|
Facility
|
IP
|
$58.00
|
|
| Hospital Charge Code |
1608132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$8.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.70
|
|
|
ELECTROENCEPHALOGRAM AWAKE/DRO
|
Facility
|
OP
|
$1,491.00
|
|
|
Service Code
|
HCPCS 95816
|
| Hospital Charge Code |
36540006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$35.93 |
| Max. Negotiated Rate |
$5,944.00 |
| Rate for Payer: Aetna Commercial |
$697.73
|
| Rate for Payer: Aetna Medicare Advantage |
$831.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$256.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$495.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$925.96
|
| Rate for Payer: Cigna Commercial |
$514.20
|
| Rate for Payer: Cigna Medicare Advantage |
$256.52
|
| Rate for Payer: Clover Medicare Advantage |
$243.69
|
| Rate for Payer: EmblemHealth Commercial |
$769.56
|
| Rate for Payer: Humana Medicare Advantage |
$264.22
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$256.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$447.30
|
| Rate for Payer: Oxford Commercial |
$3,390.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$223.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,944.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.93
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$39.51
|
|
|
ELECTROENCEPHALOGRAM AWAKE/DRO
|
Facility
|
IP
|
$1,491.00
|
|
|
Service Code
|
HCPCS 95816
|
| Hospital Charge Code |
36540006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$223.65 |
| Max. Negotiated Rate |
$223.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$223.65
|
|
|
ELECTROHYDRAULLIC LITH PROBE
|
Facility
|
IP
|
$5,775.00
|
|
| Hospital Charge Code |
270652097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$866.25 |
| Max. Negotiated Rate |
$866.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$866.25
|
|