|
KIT CATH INTRO 13.5 & 14FR****
|
Facility
|
IP
|
$932.00
|
|
| Hospital Charge Code |
1604271
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.80 |
| Max. Negotiated Rate |
$225.54 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$186.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$225.54
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$205.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$139.80
|
|
|
KIT CATH NEPHROMAX BALN 210117
|
Facility
|
IP
|
$1,215.00
|
|
| Hospital Charge Code |
270614843
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$182.25 |
| Max. Negotiated Rate |
$182.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$182.25
|
|
|
KIT CATH NEPHROMAX BALN 210117
|
Facility
|
OP
|
$1,215.00
|
|
| Hospital Charge Code |
270614843
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.28 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Aetna Commercial |
$461.70
|
| Rate for Payer: Aetna Medicare Advantage |
$364.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$309.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$309.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$309.82
|
| Rate for Payer: Cigna Commercial |
$607.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$364.50
|
| Rate for Payer: Oxford Commercial |
$243.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$182.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$243.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$29.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$32.20
|
|
|
KIT CATH PERIT CURL 2CUFF 57CM
|
Facility
|
OP
|
$618.41
|
|
| Hospital Charge Code |
270607726
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$309.20 |
| Rate for Payer: Aetna Commercial |
$235.00
|
| Rate for Payer: Aetna Medicare Advantage |
$185.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$157.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$157.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$157.69
|
| Rate for Payer: Cigna Commercial |
$309.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$185.52
|
| Rate for Payer: Oxford Commercial |
$123.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$92.76
|
| Rate for Payer: UnitedHealthcare Commercial |
$123.68
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.39
|
|
|
KIT CATH PERIT CURL 2CUFF 57CM
|
Facility
|
IP
|
$618.41
|
|
| Hospital Charge Code |
270607726
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$92.76 |
| Max. Negotiated Rate |
$92.76 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$92.76
|
|
|
KIT CHAIR TRIMANO BEACH
|
Facility
|
OP
|
$375.00
|
|
| Hospital Charge Code |
270648819
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna Medicare Advantage |
$112.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$95.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$95.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$95.62
|
| Rate for Payer: Cigna Commercial |
$187.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$112.50
|
| Rate for Payer: Oxford Commercial |
$75.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$75.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.94
|
|
|
KIT CHAIR TRIMANO BEACH
|
Facility
|
IP
|
$375.00
|
|
| Hospital Charge Code |
270648819
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
|
|
KIT CLOSURE DEVICE M-CLOSE
|
Facility
|
OP
|
$449.95
|
|
| Hospital Charge Code |
270696983
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.84 |
| Max. Negotiated Rate |
$224.97 |
| Rate for Payer: Aetna Commercial |
$170.98
|
| Rate for Payer: Aetna Medicare Advantage |
$134.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$114.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$114.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$114.74
|
| Rate for Payer: Cigna Commercial |
$224.97
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$134.99
|
| Rate for Payer: Oxford Commercial |
$89.99
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.49
|
| Rate for Payer: UnitedHealthcare Commercial |
$89.99
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.92
|
|
|
KIT CLOSURE DEVICE M-CLOSE
|
Facility
|
IP
|
$449.95
|
|
| Hospital Charge Code |
270696983
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.49 |
| Max. Negotiated Rate |
$67.49 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.49
|
|
|
KIT COLOSTOMY/ILEOSTOMY 4
|
Facility
|
IP
|
$14.28
|
|
| Hospital Charge Code |
270654223
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$2.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.14
|
|
|
KIT COLOSTOMY/ILEOSTOMY 4
|
Facility
|
OP
|
$14.28
|
|
| Hospital Charge Code |
270654223
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$7.14 |
| Rate for Payer: Aetna Commercial |
$5.43
|
| Rate for Payer: Aetna Medicare Advantage |
$4.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.64
|
| Rate for Payer: Cigna Commercial |
$7.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.28
|
| Rate for Payer: Oxford Commercial |
$2.86
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.86
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.38
|
|
|
KIT CRAINOPLASTY 431050
|
Facility
|
IP
|
$1,488.00
|
|
| Hospital Charge Code |
270607324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$360.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$297.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$360.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$327.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$223.20
|
|
|
KIT CRAINOPLASTY 431050
|
Facility
|
OP
|
$1,488.00
|
|
| Hospital Charge Code |
270607324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.86 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna Commercial |
$565.44
|
| Rate for Payer: Aetna Medicare Advantage |
$446.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$379.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$379.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$297.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$379.44
|
| Rate for Payer: Cigna Commercial |
$744.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$360.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$327.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$223.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$39.43
|
|
|
KIT CRANIOPLASTIC 43-1050
|
Facility
|
OP
|
$2,760.85
|
|
| Hospital Charge Code |
270600729
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.54 |
| Max. Negotiated Rate |
$1,380.42 |
| Rate for Payer: Aetna Commercial |
$1,049.12
|
| Rate for Payer: Aetna Medicare Advantage |
$828.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$704.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$704.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$704.02
|
| Rate for Payer: Cigna Commercial |
$1,380.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$828.25
|
| Rate for Payer: Oxford Commercial |
$552.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$414.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$552.17
|
| Rate for Payer: UnitedHealthcare Community & State |
$66.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$73.16
|
|
|
KIT CRANIOPLASTIC 43-1050
|
Facility
|
IP
|
$2,760.85
|
|
| Hospital Charge Code |
270600729
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$414.13 |
| Max. Negotiated Rate |
$414.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$414.13
|
|
|
KIT CURETTE TITANIUM PROBE
|
Facility
|
OP
|
$2,225.00
|
|
| Hospital Charge Code |
270663201
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.62 |
| Max. Negotiated Rate |
$1,112.50 |
| Rate for Payer: Aetna Commercial |
$845.50
|
| Rate for Payer: Aetna Medicare Advantage |
$667.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$567.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$567.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$567.38
|
| Rate for Payer: Cigna Commercial |
$1,112.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$667.50
|
| Rate for Payer: Oxford Commercial |
$445.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$333.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$445.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$53.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$58.96
|
|
|
KIT CURETTE TITANIUM PROBE
|
Facility
|
IP
|
$2,225.00
|
|
| Hospital Charge Code |
270663201
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$333.75 |
| Max. Negotiated Rate |
$333.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$333.75
|
|
|
KIT CUSTOM INFLATION
|
Facility
|
IP
|
$175.00
|
|
| Hospital Charge Code |
270663111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.25
|
|
|
KIT CUSTOM INFLATION
|
Facility
|
IP
|
$175.00
|
|
| Hospital Charge Code |
270663111S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.25
|
|
|
KIT CUSTOM INFLATION
|
Facility
|
OP
|
$175.00
|
|
| Hospital Charge Code |
270663111S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: Aetna Commercial |
$66.50
|
| Rate for Payer: Aetna Medicare Advantage |
$52.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$44.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$44.62
|
| Rate for Payer: Cigna Commercial |
$87.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$52.50
|
| Rate for Payer: Oxford Commercial |
$35.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$35.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.64
|
|
|
KIT CUSTOM INFLATION
|
Facility
|
OP
|
$175.00
|
|
| Hospital Charge Code |
270663111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: Aetna Commercial |
$66.50
|
| Rate for Payer: Aetna Medicare Advantage |
$52.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$44.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$44.62
|
| Rate for Payer: Cigna Commercial |
$87.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$52.50
|
| Rate for Payer: Oxford Commercial |
$35.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$35.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.64
|
|
|
KIT CUSTOM INFLATION IN4909
|
Facility
|
OP
|
$1,830.00
|
|
| Hospital Charge Code |
270646784
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$915.00 |
| Rate for Payer: Aetna Commercial |
$695.40
|
| Rate for Payer: Aetna Medicare Advantage |
$549.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$466.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$466.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$466.65
|
| Rate for Payer: Cigna Commercial |
$915.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$549.00
|
| Rate for Payer: Oxford Commercial |
$366.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$274.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$366.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$44.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$48.49
|
|
|
KIT CUSTOM INFLATION IN4909
|
Facility
|
IP
|
$1,830.00
|
|
| Hospital Charge Code |
270646784
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$274.50 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$274.50
|
|
|
KIT CUSTOM INFLATION (PTCA)
|
Facility
|
IP
|
$150.00
|
|
| Hospital Charge Code |
270646784N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.50
|
|
|
KIT CUSTOM INFLATION (PTCA)
|
Facility
|
OP
|
$150.00
|
|
| Hospital Charge Code |
270646784N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$57.00
|
| Rate for Payer: Aetna Medicare Advantage |
$45.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$38.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$38.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$38.25
|
| Rate for Payer: Cigna Commercial |
$75.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$45.00
|
| Rate for Payer: Oxford Commercial |
$30.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$30.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.98
|
|