|
CORD ELECTRO TUR *********
|
Facility
|
OP
|
$15.00
|
|
| Hospital Charge Code |
1600642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| 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 |
$1.95
|
| Rate for Payer: Oxford Commercial |
$7.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$7.50
|
|
|
CORD ELECTRO TUR E0503
|
Facility
|
OP
|
$16.41
|
|
| Hospital Charge Code |
270608043
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$8.21 |
| Rate for Payer: Aetna Commercial |
$4.92
|
| Rate for Payer: Aetna Medicare Advantage |
$4.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.18
|
| Rate for Payer: Cigna Commercial |
$8.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.13
|
| Rate for Payer: Oxford Commercial |
$8.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.46
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.21
|
|
|
CORD ELECTRO TUR E0503
|
Facility
|
IP
|
$16.41
|
|
| Hospital Charge Code |
270608043
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.46
|
|
|
COR DISPOSABLE KIT W/PERP
|
Facility
|
IP
|
$6,880.00
|
|
| Hospital Charge Code |
270673199
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,032.00 |
| Max. Negotiated Rate |
$1,032.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,032.00
|
|
|
COR DISPOSABLE KIT W/PERP
|
Facility
|
OP
|
$6,880.00
|
|
| Hospital Charge Code |
270673199
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$894.40 |
| Max. Negotiated Rate |
$3,440.00 |
| Rate for Payer: Aetna Commercial |
$2,064.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,064.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,754.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,754.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,754.40
|
| Rate for Payer: Cigna Commercial |
$3,440.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$894.40
|
| Rate for Payer: Oxford Commercial |
$3,440.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,032.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,440.00
|
|
|
CORDIS PTA DILATION CATHETER
|
Facility
|
IP
|
$785.00
|
|
| Hospital Charge Code |
270335507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$117.75 |
| Max. Negotiated Rate |
$189.97 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$157.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$189.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$117.75
|
|
|
CORDIS PTA DILATION CATHETER
|
Facility
|
OP
|
$785.00
|
|
| Hospital Charge Code |
270335507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$117.75 |
| Max. Negotiated Rate |
$392.50 |
| Rate for Payer: Aetna Commercial |
$235.50
|
| Rate for Payer: Aetna Medicare Advantage |
$235.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$200.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$200.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$157.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$200.18
|
| Rate for Payer: Cigna Commercial |
$392.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$189.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$117.75
|
|
|
CORDIS TRAPESE VENA CAVA FILTE
|
Facility
|
OP
|
$6,630.00
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
270657201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$994.50 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Aetna Commercial |
$1,989.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,989.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,690.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,690.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,326.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,690.65
|
| Rate for Payer: Cigna Commercial |
$3,315.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,604.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$994.50
|
|
|
CORDIS TRAPESE VENA CAVA FILTE
|
Facility
|
IP
|
$6,630.00
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
270657201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$994.50 |
| Max. Negotiated Rate |
$1,604.46 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,326.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,604.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$994.50
|
|
|
CORD KS BIPOL 12FT DISP 104000
|
Facility
|
OP
|
$22.45
|
|
| Hospital Charge Code |
270618273
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Aetna Commercial |
$6.74
|
| Rate for Payer: Aetna Medicare Advantage |
$6.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5.72
|
| Rate for Payer: Cigna Commercial |
$11.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.92
|
| Rate for Payer: Oxford Commercial |
$11.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.22
|
|
|
CORD KS BIPOL 12FT DISP 104000
|
Facility
|
IP
|
$22.45
|
|
| Hospital Charge Code |
270618273
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.37
|
|
|
CORD PROBE EXTENSION
|
Facility
|
OP
|
$82.15
|
|
| Hospital Charge Code |
270666118
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.68 |
| Max. Negotiated Rate |
$41.08 |
| Rate for Payer: Aetna Commercial |
$24.64
|
| Rate for Payer: Aetna Medicare Advantage |
$24.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20.95
|
| Rate for Payer: Cigna Commercial |
$41.08
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.68
|
| Rate for Payer: Oxford Commercial |
$41.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$41.08
|
|
|
CORD PROBE EXTENSION
|
Facility
|
IP
|
$82.15
|
|
| Hospital Charge Code |
270666118
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$12.32 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.32
|
|
|
CORD STZ BIPOLAR 26176LA
|
Facility
|
OP
|
$1,112.85
|
|
| Hospital Charge Code |
270616695
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.67 |
| Max. Negotiated Rate |
$556.42 |
| Rate for Payer: Aetna Commercial |
$333.86
|
| 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 |
$144.67
|
| Rate for Payer: Oxford Commercial |
$556.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$166.93
|
| Rate for Payer: UnitedHealthcare Commercial |
$556.42
|
|
|
CORD STZ BIPOLAR 26176LA
|
Facility
|
IP
|
$1,112.85
|
|
| Hospital Charge Code |
270616695
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.93 |
| Max. Negotiated Rate |
$166.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$166.93
|
|
|
CORD STZ BIPOLAR DISP 26176LD
|
Facility
|
OP
|
$102.50
|
|
| Hospital Charge Code |
270616247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$51.25 |
| Rate for Payer: Aetna Commercial |
$30.75
|
| Rate for Payer: Aetna Medicare Advantage |
$30.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$26.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$26.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$26.14
|
| Rate for Payer: Cigna Commercial |
$51.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.32
|
| Rate for Payer: Oxford Commercial |
$51.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$51.25
|
|
|
CORD STZ BIPOLAR DISP 26176LD
|
Facility
|
IP
|
$102.50
|
|
| Hospital Charge Code |
270616247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.38 |
| Max. Negotiated Rate |
$15.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.38
|
|
|
CORD TRACTION 230 ROLL 967-03
|
Facility
|
OP
|
$484.00
|
|
| Hospital Charge Code |
270300735
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$62.92 |
| Max. Negotiated Rate |
$242.00 |
| Rate for Payer: Aetna Commercial |
$145.20
|
| Rate for Payer: Aetna Medicare Advantage |
$145.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$123.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$123.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$123.42
|
| Rate for Payer: Cigna Commercial |
$242.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$62.92
|
| Rate for Payer: Oxford Commercial |
$242.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$72.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$242.00
|
|
|
CORD TRACTION 230 ROLL 967-03
|
Facility
|
IP
|
$484.00
|
|
| Hospital Charge Code |
270300735
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$72.60 |
| Max. Negotiated Rate |
$72.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$72.60
|
|
|
CORD TRACTION ZIMCODE
|
Facility
|
IP
|
$190.40
|
|
| Hospital Charge Code |
270654050
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.56 |
| Max. Negotiated Rate |
$28.56 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.56
|
|
|
CORD TRACTION ZIMCODE
|
Facility
|
OP
|
$190.40
|
|
| Hospital Charge Code |
270654050
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Aetna Commercial |
$57.12
|
| Rate for Payer: Aetna Medicare Advantage |
$57.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$48.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$48.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$48.55
|
| Rate for Payer: Cigna Commercial |
$95.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24.75
|
| Rate for Payer: Oxford Commercial |
$95.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.56
|
| Rate for Payer: UnitedHealthcare Commercial |
$95.20
|
|
|
CORE DEVICE 14GA SPRING
|
Facility
|
OP
|
$460.75
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270697942
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.90 |
| Max. Negotiated Rate |
$230.38 |
| Rate for Payer: Aetna Commercial |
$138.22
|
| Rate for Payer: Aetna Medicare Advantage |
$138.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$117.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$117.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$117.49
|
| Rate for Payer: Cigna Commercial |
$230.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.90
|
| Rate for Payer: Oxford Commercial |
$230.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.11
|
| Rate for Payer: UnitedHealthcare Commercial |
$230.38
|
|
|
CORE DEVICE 14GA SPRING
|
Facility
|
IP
|
$460.75
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270697942
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.11 |
| Max. Negotiated Rate |
$69.11 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.11
|
|
|
CORE NDL BX LNG/MED PERQ W/IMG
|
Facility
|
OP
|
$8,499.00
|
|
|
Service Code
|
HCPCS 32408
|
| Hospital Charge Code |
404232408
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,104.87 |
| Max. Negotiated Rate |
$3,933.12 |
| Rate for Payer: Aetna Commercial |
$2,549.70
|
| Rate for Payer: Aetna Medicare Advantage |
$2,549.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,167.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,167.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,167.24
|
| Rate for Payer: Cigna Commercial |
$3,933.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,104.87
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,274.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,687.00
|
|
|
CORE NDL BX LNG/MED PERQ W/IMG
|
Facility
|
OP
|
$8,499.00
|
|
|
Service Code
|
HCPCS 3240850
|
| Hospital Charge Code |
404632408B
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,104.87 |
| Max. Negotiated Rate |
$4,249.50 |
| Rate for Payer: Aetna Commercial |
$2,549.70
|
| Rate for Payer: Aetna Medicare Advantage |
$2,549.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,167.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,167.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,167.24
|
| Rate for Payer: Cigna Commercial |
$4,249.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,104.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,274.85
|
|