|
DEVICE BONE BIOPSY SZ 2 F07A
|
Facility
|
OP
|
$650.00
|
|
| Hospital Charge Code |
270637759
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.50 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna Commercial |
$195.00
|
| Rate for Payer: Aetna Medicare Advantage |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$165.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$165.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$165.75
|
| Rate for Payer: Cigna Commercial |
$325.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$84.50
|
| Rate for Payer: Oxford Commercial |
$325.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$97.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$325.00
|
|
|
DEVICE BONE FILLER SZ #3 F04B
|
Facility
|
OP
|
$545.65
|
|
| Hospital Charge Code |
270631260
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.93 |
| Max. Negotiated Rate |
$272.82 |
| Rate for Payer: Aetna Commercial |
$163.69
|
| Rate for Payer: Aetna Medicare Advantage |
$163.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$139.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$139.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$139.14
|
| Rate for Payer: Cigna Commercial |
$272.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$70.93
|
| Rate for Payer: Oxford Commercial |
$272.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$81.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$272.82
|
|
|
DEVICE BONE FILLER SZ #3 F04B
|
Facility
|
IP
|
$545.65
|
|
| Hospital Charge Code |
270631260
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.85 |
| Max. Negotiated Rate |
$81.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$81.85
|
|
|
DEVICE BREZR RX INFLATION 6666
|
Facility
|
IP
|
$372.00
|
|
| Hospital Charge Code |
270630323
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.80 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$55.80
|
|
|
DEVICE BREZR RX INFLATION 6666
|
Facility
|
OP
|
$372.00
|
|
| Hospital Charge Code |
270630323
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.36 |
| Max. Negotiated Rate |
$186.00 |
| Rate for Payer: Aetna Commercial |
$111.60
|
| Rate for Payer: Aetna Medicare Advantage |
$111.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$94.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$94.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$94.86
|
| Rate for Payer: Cigna Commercial |
$186.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$48.36
|
| Rate for Payer: Oxford Commercial |
$186.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$55.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$186.00
|
|
|
DEVICE CAPIO SLIM SUT CAPT SNG
|
Facility
|
IP
|
$2,802.45
|
|
| Hospital Charge Code |
270616239
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$420.37 |
| Max. Negotiated Rate |
$678.19 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$560.49
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$678.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.37
|
|
|
DEVICE CAPIO SLIM SUT CAPT SNG
|
Facility
|
OP
|
$2,802.45
|
|
| Hospital Charge Code |
270616239
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$420.37 |
| Max. Negotiated Rate |
$1,401.22 |
| Rate for Payer: Aetna Commercial |
$840.74
|
| Rate for Payer: Aetna Medicare Advantage |
$840.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$714.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$714.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$560.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$714.62
|
| Rate for Payer: Cigna Commercial |
$1,401.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$678.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.37
|
|
|
DEVICE CAPIO SLIM SUT CAPTURG
|
Facility
|
OP
|
$2,480.00
|
|
| Hospital Charge Code |
270676958
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$322.40 |
| Max. Negotiated Rate |
$1,240.00 |
| Rate for Payer: Aetna Commercial |
$744.00
|
| Rate for Payer: Aetna Medicare Advantage |
$744.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$632.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$632.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$632.40
|
| Rate for Payer: Cigna Commercial |
$1,240.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$322.40
|
| Rate for Payer: Oxford Commercial |
$1,240.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$372.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,240.00
|
|
|
DEVICE CAPIO SLIM SUT CAPTURG
|
Facility
|
IP
|
$2,480.00
|
|
| Hospital Charge Code |
270676958
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$372.00 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$372.00
|
|
|
DEVICECAPTIVATOR EMR STD
|
Facility
|
OP
|
$1,490.00
|
|
| Hospital Charge Code |
270677012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$193.70 |
| Max. Negotiated Rate |
$745.00 |
| Rate for Payer: Aetna Commercial |
$447.00
|
| Rate for Payer: Aetna Medicare Advantage |
$447.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$379.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$379.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$379.95
|
| Rate for Payer: Cigna Commercial |
$745.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$193.70
|
| Rate for Payer: Oxford Commercial |
$745.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$223.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$745.00
|
|
|
DEVICECAPTIVATOR EMR STD
|
Facility
|
IP
|
$1,490.00
|
|
| Hospital Charge Code |
270677012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$223.50 |
| Max. Negotiated Rate |
$223.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$223.50
|
|
|
DEVICE CELLECT RETENTION
|
Facility
|
IP
|
$3,127.00
|
|
| Hospital Charge Code |
270657933
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$469.05 |
| Max. Negotiated Rate |
$756.73 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$625.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$756.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$469.05
|
|
|
DEVICE CELLECT RETENTION
|
Facility
|
OP
|
$3,127.00
|
|
| Hospital Charge Code |
270657933
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$469.05 |
| Max. Negotiated Rate |
$1,563.50 |
| Rate for Payer: Aetna Commercial |
$938.10
|
| Rate for Payer: Aetna Medicare Advantage |
$938.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$797.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$797.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$625.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$797.38
|
| Rate for Payer: Cigna Commercial |
$1,563.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$756.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$469.05
|
|
|
DEVICE CLIP QIK FIX HX200U135A
|
Facility
|
OP
|
$281.65
|
|
| Hospital Charge Code |
270627692
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.61 |
| Max. Negotiated Rate |
$140.82 |
| Rate for Payer: Aetna Commercial |
$84.50
|
| Rate for Payer: Aetna Medicare Advantage |
$84.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$71.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$71.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$71.82
|
| Rate for Payer: Cigna Commercial |
$140.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.61
|
| Rate for Payer: Oxford Commercial |
$140.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$140.82
|
|
|
DEVICE CLIP QIK FIX HX200U135A
|
Facility
|
IP
|
$281.65
|
|
| Hospital Charge Code |
270627692
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.25 |
| Max. Negotiated Rate |
$42.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.25
|
|
|
DEVICE ENSEAL 5mm x 35cm
|
Facility
|
OP
|
$2,125.00
|
|
| Hospital Charge Code |
270639785
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$276.25 |
| Max. Negotiated Rate |
$1,062.50 |
| Rate for Payer: Aetna Commercial |
$637.50
|
| Rate for Payer: Aetna Medicare Advantage |
$637.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$541.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$541.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$541.88
|
| Rate for Payer: Cigna Commercial |
$1,062.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$276.25
|
| Rate for Payer: Oxford Commercial |
$1,062.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$318.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,062.50
|
|
|
DEVICE ENSEAL 5mm x 35cm
|
Facility
|
IP
|
$2,125.00
|
|
| Hospital Charge Code |
270639785
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$318.75 |
| Max. Negotiated Rate |
$318.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$318.75
|
|
|
DEVICE EXPRESS FILTRATION P
|
Facility
|
OP
|
$5,725.00
|
|
|
Service Code
|
HCPCS C1783
|
| Hospital Charge Code |
270659750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$858.75 |
| Max. Negotiated Rate |
$2,862.50 |
| Rate for Payer: Aetna Commercial |
$1,717.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,717.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,459.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,459.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,145.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,459.88
|
| Rate for Payer: Cigna Commercial |
$2,862.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,385.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$858.75
|
|
|
DEVICE EXPRESS FILTRATION P
|
Facility
|
IP
|
$5,725.00
|
|
|
Service Code
|
HCPCS C1783
|
| Hospital Charge Code |
270659750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$858.75 |
| Max. Negotiated Rate |
$1,385.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,145.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,385.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$858.75
|
|
|
DEVICE FIXATION 15 FAST OPTIFI
|
Facility
|
IP
|
$2,375.00
|
|
| Hospital Charge Code |
270685694
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$356.25 |
| Max. Negotiated Rate |
$356.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$356.25
|
|
|
DEVICE FIXATION 15 FAST OPTIFI
|
Facility
|
OP
|
$2,375.00
|
|
| Hospital Charge Code |
270685694
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$308.75 |
| Max. Negotiated Rate |
$1,187.50 |
| Rate for Payer: Aetna Commercial |
$712.50
|
| Rate for Payer: Aetna Medicare Advantage |
$712.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$605.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$605.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$605.62
|
| Rate for Payer: Cigna Commercial |
$1,187.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$308.75
|
| Rate for Payer: Oxford Commercial |
$1,187.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$356.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,187.50
|
|
|
DEVICE FLIPCUTTER 9.0MM
|
Facility
|
IP
|
$3,375.00
|
|
| Hospital Charge Code |
270675323
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$506.25 |
| Max. Negotiated Rate |
$506.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$506.25
|
|
|
DEVICE FLIPCUTTER 9.0MM
|
Facility
|
OP
|
$3,375.00
|
|
| Hospital Charge Code |
270675323
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$438.75 |
| Max. Negotiated Rate |
$1,687.50 |
| Rate for Payer: Aetna Commercial |
$1,012.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,012.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$860.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$860.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$860.62
|
| Rate for Payer: Cigna Commercial |
$1,687.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$438.75
|
| Rate for Payer: Oxford Commercial |
$1,687.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$506.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,687.50
|
|
|
DEVICE FORCE TRIVERSE
|
Facility
|
IP
|
$169.25
|
|
| Hospital Charge Code |
270668208
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.39 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.39
|
|
|
DEVICE FORCE TRIVERSE
|
Facility
|
OP
|
$169.25
|
|
| Hospital Charge Code |
270668208
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$84.62 |
| Rate for Payer: Aetna Commercial |
$50.77
|
| Rate for Payer: Aetna Medicare Advantage |
$50.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.16
|
| Rate for Payer: Cigna Commercial |
$84.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.00
|
| Rate for Payer: Oxford Commercial |
$84.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.39
|
| Rate for Payer: UnitedHealthcare Commercial |
$84.62
|
|