|
CUBE TRUCK MDPE BLACK
|
Facility
|
OP
|
$2,235.30
|
|
| Hospital Charge Code |
270689583
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$290.59 |
| Max. Negotiated Rate |
$1,117.65 |
| Rate for Payer: Aetna Commercial |
$670.59
|
| Rate for Payer: Aetna Medicare Advantage |
$670.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$570.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$570.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$570.00
|
| Rate for Payer: Cigna Commercial |
$1,117.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$290.59
|
| Rate for Payer: Oxford Commercial |
$1,117.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$335.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,117.65
|
|
|
CUFF 34 SGLE TB DIS 607070106
|
Facility
|
OP
|
$151.19
|
|
| Hospital Charge Code |
270639240
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.65 |
| Max. Negotiated Rate |
$75.59 |
| Rate for Payer: Aetna Commercial |
$45.36
|
| Rate for Payer: Aetna Medicare Advantage |
$45.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$38.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$38.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$38.55
|
| Rate for Payer: Cigna Commercial |
$75.59
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.65
|
| Rate for Payer: Oxford Commercial |
$75.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$75.59
|
|
|
CUFF 34 SGLE TB DIS 607070106
|
Facility
|
IP
|
$151.19
|
|
| Hospital Charge Code |
270639240
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.68 |
| Max. Negotiated Rate |
$22.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.68
|
|
|
CUFF 45 CM
|
Facility
|
IP
|
$30,590.00
|
|
|
Service Code
|
HCPCS C1815
|
| Hospital Charge Code |
270683058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,588.50 |
| Max. Negotiated Rate |
$7,402.78 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,118.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,402.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,588.50
|
|
|
CUFF 45 CM
|
Facility
|
OP
|
$30,590.00
|
|
|
Service Code
|
HCPCS C1815
|
| Hospital Charge Code |
270683058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,588.50 |
| Max. Negotiated Rate |
$15,295.00 |
| Rate for Payer: Aetna Commercial |
$9,177.00
|
| Rate for Payer: Aetna Medicare Advantage |
$9,177.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,800.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,800.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,118.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,800.45
|
| Rate for Payer: Cigna Commercial |
$15,295.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,402.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,588.50
|
|
|
CUFF ADULT FINGER 060000004301
|
Facility
|
OP
|
$73.60
|
|
| Hospital Charge Code |
270631128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.57 |
| Max. Negotiated Rate |
$36.80 |
| Rate for Payer: Aetna Commercial |
$22.08
|
| Rate for Payer: Aetna Medicare Advantage |
$22.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.77
|
| Rate for Payer: Cigna Commercial |
$36.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.57
|
| Rate for Payer: Oxford Commercial |
$36.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.04
|
| Rate for Payer: UnitedHealthcare Commercial |
$36.80
|
|
|
CUFF ADULT FINGER 060000004301
|
Facility
|
IP
|
$73.60
|
|
| Hospital Charge Code |
270631128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.04 |
| Max. Negotiated Rate |
$11.04 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.04
|
|
|
CUFF AORC EXT 16x5.5 YRECX1655
|
Facility
|
IP
|
$10,044.00
|
|
| Hospital Charge Code |
270629977
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,506.60 |
| Max. Negotiated Rate |
$1,506.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,506.60
|
|
|
CUFF AORC EXT 16x5.5 YRECX1655
|
Facility
|
OP
|
$10,044.00
|
|
| Hospital Charge Code |
270629977
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,305.72 |
| Max. Negotiated Rate |
$5,022.00 |
| Rate for Payer: Aetna Commercial |
$3,013.20
|
| Rate for Payer: Aetna Medicare Advantage |
$3,013.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,561.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,561.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,561.22
|
| Rate for Payer: Cigna Commercial |
$5,022.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,305.72
|
| Rate for Payer: Oxford Commercial |
$5,022.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,506.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,022.00
|
|
|
CUFF AORTIC EXTENSON YRECX1555
|
Facility
|
OP
|
$10,044.00
|
|
| Hospital Charge Code |
270631400
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,305.72 |
| Max. Negotiated Rate |
$5,022.00 |
| Rate for Payer: Aetna Commercial |
$3,013.20
|
| Rate for Payer: Aetna Medicare Advantage |
$3,013.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,561.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,561.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,561.22
|
| Rate for Payer: Cigna Commercial |
$5,022.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,305.72
|
| Rate for Payer: Oxford Commercial |
$5,022.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,506.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,022.00
|
|
|
CUFF AORTIC EXTENSON YRECX1555
|
Facility
|
IP
|
$10,044.00
|
|
| Hospital Charge Code |
270631400
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,506.60 |
| Max. Negotiated Rate |
$1,506.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,506.60
|
|
|
CUFF AT DUAL PORT 18 607070103
|
Facility
|
OP
|
$117.10
|
|
| Hospital Charge Code |
270630625
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.22 |
| Max. Negotiated Rate |
$58.55 |
| Rate for Payer: Aetna Commercial |
$35.13
|
| Rate for Payer: Aetna Medicare Advantage |
$35.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$29.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$29.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$29.86
|
| Rate for Payer: Cigna Commercial |
$58.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.22
|
| Rate for Payer: Oxford Commercial |
$58.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$58.55
|
|
|
CUFF AT DUAL PORT 18 607070103
|
Facility
|
IP
|
$117.10
|
|
| Hospital Charge Code |
270630625
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.57 |
| Max. Negotiated Rate |
$17.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.57
|
|
|
CUFF ATS DUAL PORT 18 IN
|
Facility
|
IP
|
$112.29
|
|
| Hospital Charge Code |
270620629
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.84 |
| Max. Negotiated Rate |
$16.84 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.84
|
|
|
CUFF ATS DUAL PORT 18 IN
|
Facility
|
OP
|
$112.29
|
|
| Hospital Charge Code |
270620629
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$56.15 |
| Rate for Payer: Aetna Commercial |
$33.69
|
| Rate for Payer: Aetna Medicare Advantage |
$33.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$28.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$28.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$28.63
|
| Rate for Payer: Cigna Commercial |
$56.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.60
|
| Rate for Payer: Oxford Commercial |
$56.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.84
|
| Rate for Payer: UnitedHealthcare Commercial |
$56.15
|
|
|
CUFF ATS DUAL PORT 30
|
Facility
|
OP
|
$136.50
|
|
| Hospital Charge Code |
270664097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.75 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Aetna Commercial |
$40.95
|
| Rate for Payer: Aetna Medicare Advantage |
$40.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.81
|
| Rate for Payer: Cigna Commercial |
$68.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17.75
|
| Rate for Payer: Oxford Commercial |
$68.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.48
|
| Rate for Payer: UnitedHealthcare Commercial |
$68.25
|
|
|
CUFF ATS DUAL PORT 30
|
Facility
|
IP
|
$136.50
|
|
| Hospital Charge Code |
270664097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.48 |
| Max. Negotiated Rate |
$20.48 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.48
|
|
|
CUFF BP DISP NEP-NATAL 1 TUBE
|
Facility
|
IP
|
$197.45
|
|
| Hospital Charge Code |
270664141
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.62 |
| Max. Negotiated Rate |
$29.62 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.62
|
|
|
CUFF BP DISP NEP-NATAL 1 TUBE
|
Facility
|
OP
|
$197.45
|
|
| Hospital Charge Code |
270664141
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.67 |
| Max. Negotiated Rate |
$98.72 |
| Rate for Payer: Aetna Commercial |
$59.23
|
| Rate for Payer: Aetna Medicare Advantage |
$59.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$50.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$50.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$50.35
|
| Rate for Payer: Cigna Commercial |
$98.72
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$25.67
|
| Rate for Payer: Oxford Commercial |
$98.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.62
|
| Rate for Payer: UnitedHealthcare Commercial |
$98.72
|
|
|
CUFF COMPLETE V-LOK ADULT
|
Facility
|
OP
|
$137.00
|
|
| Hospital Charge Code |
270331861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.81 |
| Max. Negotiated Rate |
$68.50 |
| Rate for Payer: Aetna Commercial |
$41.10
|
| Rate for Payer: Aetna Medicare Advantage |
$41.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.94
|
| Rate for Payer: Cigna Commercial |
$68.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17.81
|
| Rate for Payer: Oxford Commercial |
$68.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$68.50
|
|
|
CUFF COMPLETE V-LOK ADULT
|
Facility
|
IP
|
$137.00
|
|
| Hospital Charge Code |
270331861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.55 |
| Max. Negotiated Rate |
$20.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.55
|
|
|
CUFF CRYO MED KNEE 11-A
|
Facility
|
IP
|
$616.00
|
|
| Hospital Charge Code |
270611846
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$92.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$92.40
|
|
|
CUFF CRYO MED KNEE 11-A
|
Facility
|
OP
|
$616.00
|
|
| Hospital Charge Code |
270611846
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.08 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Aetna Commercial |
$184.80
|
| Rate for Payer: Aetna Medicare Advantage |
$184.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$157.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$157.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$157.08
|
| Rate for Payer: Cigna Commercial |
$308.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$80.08
|
| Rate for Payer: Oxford Commercial |
$308.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$92.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$308.00
|
|
|
CUFF DISP DUAL PORT 42 SINGLE
|
Facility
|
IP
|
$154.65
|
|
| Hospital Charge Code |
270648579
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$23.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.20
|
|
|
CUFF DISP DUAL PORT 42 SINGLE
|
Facility
|
OP
|
$154.65
|
|
| Hospital Charge Code |
270648579
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.10 |
| Max. Negotiated Rate |
$77.33 |
| Rate for Payer: Aetna Commercial |
$46.40
|
| Rate for Payer: Aetna Medicare Advantage |
$46.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$39.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$39.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$39.44
|
| Rate for Payer: Cigna Commercial |
$77.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.10
|
| Rate for Payer: Oxford Commercial |
$77.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$77.33
|
|