|
CABLE SLEEVE 3.0MM
|
Facility
|
IP
|
$5,050.00
|
|
| Hospital Charge Code |
270662021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$757.50 |
| Max. Negotiated Rate |
$1,222.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,010.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,222.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,111.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$757.50
|
|
|
CABLE SLEEVE SET 1.6MM BEADED
|
Facility
|
IP
|
$2,205.00
|
|
| Hospital Charge Code |
270669190
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$330.75 |
| Max. Negotiated Rate |
$330.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$330.75
|
|
|
CABLE SLEEVE SET 1.6MM BEADED
|
Facility
|
OP
|
$2,205.00
|
|
| Hospital Charge Code |
270669190
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.14 |
| Max. Negotiated Rate |
$1,102.50 |
| Rate for Payer: Aetna Commercial |
$837.90
|
| Rate for Payer: Aetna Medicare Advantage |
$661.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$562.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$562.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$562.27
|
| Rate for Payer: Cigna Commercial |
$1,102.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$661.50
|
| Rate for Payer: Oxford Commercial |
$441.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$330.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$441.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$53.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$58.43
|
|
|
CABLE SMART GS CORE
|
Facility
|
OP
|
$12,250.00
|
|
| Hospital Charge Code |
270691740
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$295.23 |
| Max. Negotiated Rate |
$6,125.00 |
| Rate for Payer: Aetna Commercial |
$4,655.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,675.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,123.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,123.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,123.75
|
| Rate for Payer: Cigna Commercial |
$6,125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,675.00
|
| Rate for Payer: Oxford Commercial |
$2,450.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,837.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,450.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$295.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$324.62
|
|
|
CABLE SMART GS CORE
|
Facility
|
IP
|
$12,250.00
|
|
| Hospital Charge Code |
270691740
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,837.50 |
| Max. Negotiated Rate |
$1,837.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,837.50
|
|
|
CABLE STERILE CONNECTOR PUMP
|
Facility
|
IP
|
$2,000.00
|
|
| Hospital Charge Code |
270681571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$484.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$484.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$440.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
CABLE STERILE CONNECTOR PUMP
|
Facility
|
OP
|
$2,000.00
|
|
| Hospital Charge Code |
270681571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$48.20 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$760.00
|
| Rate for Payer: Aetna Medicare Advantage |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$510.00
|
| Rate for Payer: Cigna Commercial |
$1,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$484.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$440.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$48.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$53.00
|
|
|
CABLE SURGICAL 12FT DISPOSABLE
|
Facility
|
OP
|
$1,518.75
|
|
| Hospital Charge Code |
270635176S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.60 |
| Max. Negotiated Rate |
$759.38 |
| Rate for Payer: Aetna Commercial |
$577.12
|
| Rate for Payer: Aetna Medicare Advantage |
$455.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$387.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$387.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$387.28
|
| Rate for Payer: Cigna Commercial |
$759.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$455.62
|
| Rate for Payer: Oxford Commercial |
$303.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$227.81
|
| Rate for Payer: UnitedHealthcare Commercial |
$303.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$36.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$40.25
|
|
|
CABLE SURGICAL 12FT DISPOSABLE
|
Facility
|
OP
|
$375.00
|
|
| Hospital Charge Code |
270635176
|
|
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
|
|
|
CABLE SURGICAL 12FT DISPOSABLE
|
Facility
|
IP
|
$375.00
|
|
| Hospital Charge Code |
270635176
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
|
|
CABLE SURGICAL 12FT DISPOSABLE
|
Facility
|
IP
|
$1,518.75
|
|
| Hospital Charge Code |
270635176S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.81 |
| Max. Negotiated Rate |
$227.81 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$227.81
|
|
|
CABLE SURGICAL 12FT DISPOSABLE
|
Facility
|
IP
|
$1,518.75
|
|
| Hospital Charge Code |
270635176N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.81 |
| Max. Negotiated Rate |
$227.81 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$227.81
|
|
|
CABLE SURGICAL 12FT DISPOSABLE
|
Facility
|
OP
|
$1,518.75
|
|
| Hospital Charge Code |
270635176N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.60 |
| Max. Negotiated Rate |
$759.38 |
| Rate for Payer: Aetna Commercial |
$577.12
|
| Rate for Payer: Aetna Medicare Advantage |
$455.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$387.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$387.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$387.28
|
| Rate for Payer: Cigna Commercial |
$759.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$455.62
|
| Rate for Payer: Oxford Commercial |
$303.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$227.81
|
| Rate for Payer: UnitedHealthcare Commercial |
$303.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$36.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$40.25
|
|
|
CABLE SURVEY TACH I/O C******
|
Facility
|
IP
|
$590.00
|
|
| Hospital Charge Code |
270606089
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$88.50 |
| Max. Negotiated Rate |
$88.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$88.50
|
|
|
CABLE SURVEY TACH I/O C******
|
Facility
|
OP
|
$590.00
|
|
| Hospital Charge Code |
270606089
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.22 |
| Max. Negotiated Rate |
$295.00 |
| Rate for Payer: Aetna Commercial |
$224.20
|
| Rate for Payer: Aetna Medicare Advantage |
$177.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$150.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$150.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$150.45
|
| Rate for Payer: Cigna Commercial |
$295.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$177.00
|
| Rate for Payer: Oxford Commercial |
$118.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$88.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$118.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.63
|
|
|
CABLE TEMP PACEMAKER
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
270661504S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$437.50 |
| Rate for Payer: Aetna Commercial |
$332.50
|
| Rate for Payer: Aetna Medicare Advantage |
$262.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$223.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$223.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$223.12
|
| Rate for Payer: Cigna Commercial |
$437.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$262.50
|
| Rate for Payer: Oxford Commercial |
$175.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.19
|
|
|
CABLE TEMP PACEMAKER
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
270661504S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$131.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.25
|
|
|
CABLE TRIAL LEAD
|
Facility
|
OP
|
$1,500.00
|
|
| Hospital Charge Code |
270683668
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.15 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$570.00
|
| Rate for Payer: Aetna Medicare Advantage |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$382.50
|
| Rate for Payer: Cigna Commercial |
$750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$450.00
|
| Rate for Payer: Oxford Commercial |
$300.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$300.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$36.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$39.75
|
|
|
CABLE TRIAL LEAD
|
Facility
|
IP
|
$1,500.00
|
|
| Hospital Charge Code |
270683668
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
|
|
CABLE TROCH 2.0 750MM 120002
|
Facility
|
OP
|
$2,170.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270611651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.30 |
| Max. Negotiated Rate |
$1,085.00 |
| Rate for Payer: Aetna Commercial |
$824.60
|
| Rate for Payer: Aetna Medicare Advantage |
$651.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$553.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$553.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$434.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$553.35
|
| Rate for Payer: Cigna Commercial |
$1,085.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$525.14
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$477.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$325.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$52.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$57.51
|
|
|
CABLE TROCH 2.0 750MM 120002
|
Facility
|
IP
|
$2,170.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270611651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$325.50 |
| Max. Negotiated Rate |
$525.14 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$434.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$525.14
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$477.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$325.50
|
|
|
CABLE ZIM CERC 22 2232-02-18
|
Facility
|
OP
|
$1,595.25
|
|
| Hospital Charge Code |
270620704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.45 |
| Max. Negotiated Rate |
$797.62 |
| Rate for Payer: Aetna Commercial |
$606.20
|
| Rate for Payer: Aetna Medicare Advantage |
$478.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$406.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$406.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$319.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$406.79
|
| Rate for Payer: Cigna Commercial |
$797.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$386.05
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$350.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$239.29
|
| Rate for Payer: UnitedHealthcare Community & State |
$38.45
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$42.27
|
|
|
CABLE ZIM CERC 22 2232-02-18
|
Facility
|
IP
|
$1,595.25
|
|
| Hospital Charge Code |
270620704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$239.29 |
| Max. Negotiated Rate |
$386.05 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$319.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$386.05
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$350.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$239.29
|
|
|
CADASIL
|
Facility
|
IP
|
$390.00
|
|
| Hospital Charge Code |
3035094X
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CADASIL
|
Facility
|
OP
|
$128.00
|
|
| Hospital Charge Code |
3035094O
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$48.64
|
| Rate for Payer: Aetna Medicare Advantage |
$38.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$32.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$32.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$32.64
|
| Rate for Payer: Cigna Commercial |
$64.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$38.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.39
|
|
