|
KIT 5F COAXIAL MINI .018X.40CM
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
270659910
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$12.50 |
| Rate for Payer: Aetna Commercial |
$7.50
|
| Rate for Payer: Aetna Medicare Advantage |
$7.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6.38
|
| Rate for Payer: Cigna Commercial |
$12.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.25
|
| Rate for Payer: Oxford Commercial |
$12.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$12.50
|
|
|
KIT 5F COAXIAL MINI .018X.40CM
|
Facility
|
IP
|
$25.00
|
|
| Hospital Charge Code |
270659910
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.75
|
|
|
KIT 5FR MCRPNCTRE 0.018x40CM
|
Facility
|
OP
|
$1,750.00
|
|
| Hospital Charge Code |
270650009C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.50 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna Commercial |
$525.00
|
| Rate for Payer: Aetna Medicare Advantage |
$525.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$446.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$446.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$446.25
|
| Rate for Payer: Cigna Commercial |
$875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$227.50
|
| Rate for Payer: Oxford Commercial |
$875.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$262.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$875.00
|
|
|
KIT 5FR MCRPNCTRE 0.018x40CM
|
Facility
|
IP
|
$1,750.00
|
|
| Hospital Charge Code |
270650009C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$262.50
|
|
|
KIT ABLATION ENDOMETRIAL HANDP
|
Facility
|
IP
|
$18,300.00
|
|
| Hospital Charge Code |
270655612
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,745.00 |
| Max. Negotiated Rate |
$4,428.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,660.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,428.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,745.00
|
|
|
KIT ABLATION ENDOMETRIAL HANDP
|
Facility
|
OP
|
$18,300.00
|
|
| Hospital Charge Code |
270655612
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,745.00 |
| Max. Negotiated Rate |
$9,150.00 |
| Rate for Payer: Aetna Commercial |
$5,490.00
|
| Rate for Payer: Aetna Medicare Advantage |
$5,490.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,666.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,666.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,660.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,666.50
|
| Rate for Payer: Cigna Commercial |
$9,150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,428.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,745.00
|
|
|
KIT ACCES 800 W/INHIZ 72006601
|
Facility
|
IP
|
$2,625.00
|
|
| Hospital Charge Code |
270641449
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$393.75 |
| Max. Negotiated Rate |
$393.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$393.75
|
|
|
KIT ACCES 800 W/INHIZ 72006601
|
Facility
|
OP
|
$2,625.00
|
|
| Hospital Charge Code |
270641449
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$341.25 |
| Max. Negotiated Rate |
$1,312.50 |
| Rate for Payer: Aetna Commercial |
$787.50
|
| Rate for Payer: Aetna Medicare Advantage |
$787.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$669.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$669.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$669.38
|
| Rate for Payer: Cigna Commercial |
$1,312.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$341.25
|
| Rate for Payer: Oxford Commercial |
$1,312.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$393.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,312.50
|
|
|
KIT ACCESS 9CM LARGE BORE
|
Facility
|
OP
|
$76.00
|
|
| Hospital Charge Code |
270689931S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Aetna Commercial |
$22.80
|
| Rate for Payer: Aetna Medicare Advantage |
$22.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.38
|
| Rate for Payer: Cigna Commercial |
$38.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.88
|
| Rate for Payer: Oxford Commercial |
$38.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$38.00
|
|
|
KIT ACCESS 9CM LARGE BORE
|
Facility
|
IP
|
$76.00
|
|
| Hospital Charge Code |
270689931S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.40
|
|
|
KIT ACCESS HIP
|
Facility
|
OP
|
$1,000.00
|
|
| Hospital Charge Code |
270687980
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$300.00
|
| Rate for Payer: Aetna Medicare Advantage |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$255.00
|
| Rate for Payer: Cigna Commercial |
$500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$130.00
|
| Rate for Payer: Oxford Commercial |
$500.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$500.00
|
|
|
KIT ACCESS HIP
|
Facility
|
IP
|
$1,000.00
|
|
| Hospital Charge Code |
270687980
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
|
|
KIT ACCESS MULTI-LEAD TRIALING
|
Facility
|
OP
|
$1,000.00
|
|
| Hospital Charge Code |
270645617
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$300.00
|
| Rate for Payer: Aetna Medicare Advantage |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$255.00
|
| Rate for Payer: Cigna Commercial |
$500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$130.00
|
| Rate for Payer: Oxford Commercial |
$500.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$500.00
|
|
|
KIT ACCESS MULTI-LEAD TRIALING
|
Facility
|
IP
|
$1,000.00
|
|
| Hospital Charge Code |
270645617
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
|
|
KIT ACCESSORY
|
Facility
|
IP
|
$750.00
|
|
| Hospital Charge Code |
270648829
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
KIT ACCESSORY
|
Facility
|
OP
|
$750.00
|
|
| Hospital Charge Code |
270648829
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| Rate for Payer: Aetna Medicare Advantage |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$97.50
|
| Rate for Payer: Oxford Commercial |
$375.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$375.00
|
|
|
KIT ACCESSORY 355531
|
Facility
|
OP
|
$1,500.00
|
|
| Hospital Charge Code |
270647431
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$450.00
|
| 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 |
$195.00
|
| Rate for Payer: Oxford Commercial |
$750.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$750.00
|
|
|
KIT ACCESSORY 355531
|
Facility
|
IP
|
$1,500.00
|
|
| Hospital Charge Code |
270647431
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
|
|
KIT ACCESSORY DISPOSABLE 3 AM
|
Facility
|
OP
|
$1,000.00
|
|
| Hospital Charge Code |
270664259
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$300.00
|
| Rate for Payer: Aetna Medicare Advantage |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$255.00
|
| Rate for Payer: Cigna Commercial |
$500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$130.00
|
| Rate for Payer: Oxford Commercial |
$500.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$500.00
|
|
|
KIT ACCESSORY DISPOSABLE 3 AM
|
Facility
|
IP
|
$1,000.00
|
|
| Hospital Charge Code |
270664259
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
|
|
KIT ACCESSRY PACEMAKERS 355031
|
Facility
|
OP
|
$1,500.00
|
|
| Hospital Charge Code |
270639469
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$450.00
|
| 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 |
$195.00
|
| Rate for Payer: Oxford Commercial |
$750.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$750.00
|
|
|
KIT ACCESSRY PACEMAKERS 355031
|
Facility
|
IP
|
$1,500.00
|
|
| Hospital Charge Code |
270639469
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
|
|
KIT ACHILLIES SPEEDBRIDGE
|
Facility
|
IP
|
$9,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270683376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,496.25 |
| Max. Negotiated Rate |
$2,413.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,995.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,413.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,496.25
|
|
|
KIT ACHILLIES SPEEDBRIDGE
|
Facility
|
OP
|
$9,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270683376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,496.25 |
| Max. Negotiated Rate |
$4,987.50 |
| Rate for Payer: Aetna Commercial |
$2,992.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,992.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,543.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,543.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,995.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,543.62
|
| Rate for Payer: Cigna Commercial |
$4,987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,413.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,496.25
|
|
|
KIT ACL CROSSPIN DISP 909820
|
Facility
|
IP
|
$2,301.50
|
|
| Hospital Charge Code |
270630823
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$345.23 |
| Max. Negotiated Rate |
$345.23 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$345.23
|
|