|
HEAD ZIM HUM 16 4065-50
|
Facility
|
IP
|
$3,084.85
|
|
| Hospital Charge Code |
270620706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.73 |
| Max. Negotiated Rate |
$746.53 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$616.97
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$746.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$462.73
|
|
|
HEAD ZIM HUM 16 4065-50
|
Facility
|
OP
|
$3,084.85
|
|
| Hospital Charge Code |
270620706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.73 |
| Max. Negotiated Rate |
$1,542.42 |
| Rate for Payer: Aetna Commercial |
$925.46
|
| Rate for Payer: Aetna Medicare Advantage |
$925.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$786.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$786.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$616.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$786.64
|
| Rate for Payer: Cigna Commercial |
$1,542.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$746.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$462.73
|
|
|
HEAD ZIM HUM 21 4065-51
|
Facility
|
IP
|
$4,769.65
|
|
| Hospital Charge Code |
270613411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$715.45 |
| Max. Negotiated Rate |
$1,154.26 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$953.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,154.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$715.45
|
|
|
HEAD ZIM HUM 21 4065-51
|
Facility
|
OP
|
$4,769.65
|
|
| Hospital Charge Code |
270613411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$715.45 |
| Max. Negotiated Rate |
$2,384.82 |
| Rate for Payer: Aetna Commercial |
$1,430.89
|
| Rate for Payer: Aetna Medicare Advantage |
$1,430.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,216.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,216.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$953.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,216.26
|
| Rate for Payer: Cigna Commercial |
$2,384.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,154.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$715.45
|
|
|
HEAD ZIM HUM 21 46 43004621
|
Facility
|
OP
|
$5,486.45
|
|
| Hospital Charge Code |
270629065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$822.97 |
| Max. Negotiated Rate |
$2,743.22 |
| Rate for Payer: Aetna Commercial |
$1,645.93
|
| Rate for Payer: Aetna Medicare Advantage |
$1,645.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,399.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,399.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,097.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,399.04
|
| Rate for Payer: Cigna Commercial |
$2,743.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,327.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$822.97
|
|
|
HEAD ZIM HUM 21 46 43004621
|
Facility
|
IP
|
$5,486.45
|
|
| Hospital Charge Code |
270629065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$822.97 |
| Max. Negotiated Rate |
$1,327.72 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,097.29
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,327.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$822.97
|
|
|
HEALDESS COMPRES SCREW 2.5 14M
|
Facility
|
OP
|
$1,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270690412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.25 |
| Max. Negotiated Rate |
$737.50 |
| Rate for Payer: Aetna Commercial |
$442.50
|
| Rate for Payer: Aetna Medicare Advantage |
$442.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$376.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$376.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$295.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$376.12
|
| Rate for Payer: Cigna Commercial |
$737.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$356.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$221.25
|
|
|
HEALDESS COMPRES SCREW 2.5 14M
|
Facility
|
IP
|
$1,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270690412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.25 |
| Max. Negotiated Rate |
$356.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$295.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$356.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$221.25
|
|
|
HEALICOIL KNOTLESS ANCHOR
|
Facility
|
OP
|
$3,375.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270690827
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.25 |
| 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) NJ Health |
$675.00
|
| 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 |
$816.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$506.25
|
|
|
HEALICOIL KNOTLESS ANCHOR
|
Facility
|
IP
|
$3,375.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270690827
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.25 |
| Max. Negotiated Rate |
$816.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$675.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$816.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$506.25
|
|
|
HEALICOIL RG SA 4.75 W/2 UB-BL
|
Facility
|
IP
|
$1,872.00
|
|
| Hospital Charge Code |
270682438
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$280.80 |
| Max. Negotiated Rate |
$280.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$280.80
|
|
|
HEALICOIL RG SA 4.75 W/2 UB-BL
|
Facility
|
OP
|
$1,872.00
|
|
| Hospital Charge Code |
270682438
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.36 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Aetna Commercial |
$561.60
|
| Rate for Payer: Aetna Medicare Advantage |
$561.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$477.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$477.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$477.36
|
| Rate for Payer: Cigna Commercial |
$936.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$243.36
|
| Rate for Payer: Oxford Commercial |
$936.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$280.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$936.00
|
|
|
HEALICOIL RSB 4.75 MM SUTUR UL
|
Facility
|
OP
|
$3,875.00
|
|
| Hospital Charge Code |
270682922
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$503.75 |
| Max. Negotiated Rate |
$1,937.50 |
| Rate for Payer: Aetna Commercial |
$1,162.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,162.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$988.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$988.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$988.12
|
| Rate for Payer: Cigna Commercial |
$1,937.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$503.75
|
| Rate for Payer: Oxford Commercial |
$1,937.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$581.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,937.50
|
|
|
HEALICOIL RSB 4.75 MM SUTUR UL
|
Facility
|
IP
|
$3,875.00
|
|
| Hospital Charge Code |
270682922
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$581.25 |
| Max. Negotiated Rate |
$581.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$581.25
|
|
|
HEALIX ADVANCE ANCHOR W/
|
Facility
|
IP
|
$2,230.00
|
|
| Hospital Charge Code |
270657377
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$334.50 |
| Max. Negotiated Rate |
$539.66 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$446.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$539.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$334.50
|
|
|
HEALIX ADVANCE ANCHOR W/
|
Facility
|
OP
|
$2,230.00
|
|
| Hospital Charge Code |
270657377
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$334.50 |
| Max. Negotiated Rate |
$1,115.00 |
| Rate for Payer: Aetna Commercial |
$669.00
|
| Rate for Payer: Aetna Medicare Advantage |
$669.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$568.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$568.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$446.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$568.65
|
| Rate for Payer: Cigna Commercial |
$1,115.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$539.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$334.50
|
|
|
HEALIX ADVANCE KNOTLESS BR ANC
|
Facility
|
OP
|
$2,525.00
|
|
| Hospital Charge Code |
270663292
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$378.75 |
| Max. Negotiated Rate |
$1,262.50 |
| Rate for Payer: Aetna Commercial |
$757.50
|
| Rate for Payer: Aetna Medicare Advantage |
$757.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$643.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$643.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$505.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$643.88
|
| Rate for Payer: Cigna Commercial |
$1,262.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$611.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$378.75
|
|
|
HEALIX ADVANCE KNOTLESS BR ANC
|
Facility
|
IP
|
$2,525.00
|
|
| Hospital Charge Code |
270663292
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$378.75 |
| Max. Negotiated Rate |
$611.05 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$505.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$611.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$378.75
|
|
|
HEALON 4CC VIAL
|
Facility
|
IP
|
$597.00
|
|
| Hospital Charge Code |
270331801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.55 |
| Max. Negotiated Rate |
$89.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.55
|
|
|
HEALON 4CC VIAL
|
Facility
|
OP
|
$597.00
|
|
| Hospital Charge Code |
270331801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.61 |
| Max. Negotiated Rate |
$298.50 |
| Rate for Payer: Aetna Commercial |
$179.10
|
| Rate for Payer: Aetna Medicare Advantage |
$179.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$152.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$152.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$152.24
|
| Rate for Payer: Cigna Commercial |
$298.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$77.61
|
| Rate for Payer: Oxford Commercial |
$298.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$298.50
|
|
|
HEALON 5 0.6ML SYRINGE
|
Facility
|
OP
|
$414.00
|
|
| Hospital Charge Code |
60635577
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.82 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna Commercial |
$124.20
|
| Rate for Payer: Aetna Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$105.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$105.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$105.57
|
| Rate for Payer: Cigna Commercial |
$207.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$53.82
|
| Rate for Payer: Oxford Commercial |
$207.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$207.00
|
|
|
HEALON 5 0.6ML SYRINGE
|
Facility
|
IP
|
$414.00
|
|
| Hospital Charge Code |
60635577
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$62.10 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.10
|
|
|
HEALON .85
|
Facility
|
IP
|
$929.00
|
|
| Hospital Charge Code |
270332572
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.35 |
| Max. Negotiated Rate |
$139.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$139.35
|
|
|
HEALON .85
|
Facility
|
OP
|
$929.00
|
|
| Hospital Charge Code |
270332572
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.77 |
| Max. Negotiated Rate |
$464.50 |
| Rate for Payer: Aetna Commercial |
$278.70
|
| Rate for Payer: Aetna Medicare Advantage |
$278.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$236.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$236.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$236.90
|
| Rate for Payer: Cigna Commercial |
$464.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$120.77
|
| Rate for Payer: Oxford Commercial |
$464.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$139.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$464.50
|
|
|
HEALON ACD+GEL REF:HDPRP15
|
Facility
|
OP
|
$575.00
|
|
| Hospital Charge Code |
270703451
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.25 |
| Max. Negotiated Rate |
$287.50 |
| Rate for Payer: Aetna Commercial |
$172.50
|
| Rate for Payer: Aetna Medicare Advantage |
$172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$146.62
|
| Rate for Payer: Cigna Commercial |
$287.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
|