|
LEAD PISCES QD COMP 33c 388733
|
Facility
|
OP
|
$6,646.45
|
|
| Hospital Charge Code |
270631618
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$996.97 |
| Max. Negotiated Rate |
$3,323.22 |
| Rate for Payer: Aetna Commercial |
$1,993.93
|
| Rate for Payer: Aetna Medicare Advantage |
$1,993.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,694.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,694.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,329.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,694.84
|
| Rate for Payer: Cigna Commercial |
$3,323.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,608.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$996.97
|
|
|
LEAD PISCES QUAD 45cm 3487A45
|
Facility
|
OP
|
$6,646.45
|
|
| Hospital Charge Code |
270632002
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$996.97 |
| Max. Negotiated Rate |
$3,323.22 |
| Rate for Payer: Aetna Commercial |
$1,993.93
|
| Rate for Payer: Aetna Medicare Advantage |
$1,993.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,694.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,694.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,329.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,694.84
|
| Rate for Payer: Cigna Commercial |
$3,323.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,608.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$996.97
|
|
|
LEAD PISCES QUAD 45cm 3487A45
|
Facility
|
IP
|
$6,646.45
|
|
| Hospital Charge Code |
270632002
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$996.97 |
| Max. Negotiated Rate |
$1,608.44 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,329.29
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,608.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$996.97
|
|
|
LEADPLUS U_US
|
Facility
|
IP
|
$2,850.00
|
|
| Hospital Charge Code |
270665501
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$427.50 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$427.50
|
|
|
LEADPLUS U_US
|
Facility
|
OP
|
$2,850.00
|
|
| Hospital Charge Code |
270665501
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$370.50 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Aetna Commercial |
$855.00
|
| Rate for Payer: Aetna Medicare Advantage |
$855.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$726.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$726.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$726.75
|
| Rate for Payer: Cigna Commercial |
$1,425.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$370.50
|
| Rate for Payer: Oxford Commercial |
$1,425.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$427.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,425.00
|
|
|
LEAD PMAKER RA CAPE FIX 407645
|
Facility
|
IP
|
$3,224.00
|
|
| Hospital Charge Code |
270634241C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$483.60 |
| Max. Negotiated Rate |
$780.21 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$644.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$780.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$483.60
|
|
|
LEAD PMAKER RA CAPE FIX 407645
|
Facility
|
OP
|
$3,224.00
|
|
| Hospital Charge Code |
270634241
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$483.60 |
| Max. Negotiated Rate |
$1,612.00 |
| Rate for Payer: Aetna Commercial |
$967.20
|
| Rate for Payer: Aetna Medicare Advantage |
$967.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$822.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$822.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$644.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$822.12
|
| Rate for Payer: Cigna Commercial |
$1,612.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$780.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$483.60
|
|
|
LEAD PMAKER RA CAPE FIX 407645
|
Facility
|
OP
|
$3,224.00
|
|
| Hospital Charge Code |
270634241C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$483.60 |
| Max. Negotiated Rate |
$1,612.00 |
| Rate for Payer: Aetna Commercial |
$967.20
|
| Rate for Payer: Aetna Medicare Advantage |
$967.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$822.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$822.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$644.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$822.12
|
| Rate for Payer: Cigna Commercial |
$1,612.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$780.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$483.60
|
|
|
LEAD PMAKER RA CAPE FIX 407645
|
Facility
|
IP
|
$3,224.00
|
|
| Hospital Charge Code |
270634241
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$483.60 |
| Max. Negotiated Rate |
$780.21 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$644.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$780.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$483.60
|
|
|
LEAD PM CAPSURE ATRIAL 559453C
|
Facility
|
IP
|
$3,875.00
|
|
| Hospital Charge Code |
270642021C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$581.25 |
| Max. Negotiated Rate |
$937.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$775.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$937.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$581.25
|
|
|
LEAD PM CAPSURE ATRIAL 559453C
|
Facility
|
OP
|
$3,875.00
|
|
| Hospital Charge Code |
270642021C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$581.25 |
| 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) NJ Health |
$775.00
|
| 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 |
$937.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$581.25
|
|
|
LEAD PM CAPSUREFX NOVUS 507645
|
Facility
|
OP
|
$2,795.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
270623756
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$419.25 |
| Max. Negotiated Rate |
$1,397.50 |
| Rate for Payer: Aetna Commercial |
$838.50
|
| Rate for Payer: Aetna Medicare Advantage |
$838.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$712.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$712.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$559.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$712.73
|
| Rate for Payer: Cigna Commercial |
$1,397.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$676.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$419.25
|
|
|
LEAD PM CAPSUREFX NOVUS 507645
|
Facility
|
IP
|
$2,795.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
270623756
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$419.25 |
| Max. Negotiated Rate |
$676.39 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$559.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$676.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$419.25
|
|
|
LEAD PM CAPSUREFX NOVUS 507645
|
Facility
|
OP
|
$3,844.00
|
|
| Hospital Charge Code |
270623756C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$576.60 |
| Max. Negotiated Rate |
$1,922.00 |
| Rate for Payer: Aetna Commercial |
$1,153.20
|
| Rate for Payer: Aetna Medicare Advantage |
$1,153.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$980.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$980.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$768.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$980.22
|
| Rate for Payer: Cigna Commercial |
$1,922.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$930.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$576.60
|
|
|
LEAD PM CAPSUREFX NOVUS 507645
|
Facility
|
IP
|
$3,844.00
|
|
| Hospital Charge Code |
270623756C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$576.60 |
| Max. Negotiated Rate |
$930.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$768.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$930.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$576.60
|
|
|
LEAD QUAD COMPACT 33cml 389133
|
Facility
|
IP
|
$8,200.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
270633682
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,230.00 |
| Max. Negotiated Rate |
$1,984.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,640.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,984.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,230.00
|
|
|
LEAD QUAD COMPACT 33cml 389133
|
Facility
|
OP
|
$8,200.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
270633682
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,230.00 |
| Max. Negotiated Rate |
$4,100.00 |
| Rate for Payer: Aetna Commercial |
$2,460.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,460.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,091.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,091.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,640.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,091.00
|
| Rate for Payer: Cigna Commercial |
$4,100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,984.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,230.00
|
|
|
LEAD QUI ENDOCARD 59CM 4035
|
Facility
|
OP
|
$3,427.25
|
|
| Hospital Charge Code |
270617495
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$514.09 |
| Max. Negotiated Rate |
$1,713.62 |
| Rate for Payer: Aetna Commercial |
$1,028.17
|
| Rate for Payer: Aetna Medicare Advantage |
$1,028.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$873.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$873.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$685.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$873.95
|
| Rate for Payer: Cigna Commercial |
$1,713.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$829.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$514.09
|
|
|
LEAD QUI ENDOCARD 59CM 4035
|
Facility
|
IP
|
$3,427.25
|
|
| Hospital Charge Code |
270617495
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$514.09 |
| Max. Negotiated Rate |
$829.39 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$685.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$829.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$514.09
|
|
|
LEAD QUI PCEMKR V 4034
|
Facility
|
OP
|
$3,427.25
|
|
| Hospital Charge Code |
270617228
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$514.09 |
| Max. Negotiated Rate |
$1,713.62 |
| Rate for Payer: Aetna Commercial |
$1,028.17
|
| Rate for Payer: Aetna Medicare Advantage |
$1,028.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$873.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$873.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$685.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$873.95
|
| Rate for Payer: Cigna Commercial |
$1,713.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$829.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$514.09
|
|
|
LEAD QUI PCEMKR V 4034
|
Facility
|
IP
|
$3,427.25
|
|
| Hospital Charge Code |
270617228
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$514.09 |
| Max. Negotiated Rate |
$829.39 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$685.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$829.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$514.09
|
|
|
LEAD RV DEXTRUS
|
Facility
|
OP
|
$3,000.00
|
|
| Hospital Charge Code |
270649287C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$900.00
|
| Rate for Payer: Aetna Medicare Advantage |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$726.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$450.00
|
|
|
LEAD RV DEXTRUS
|
Facility
|
IP
|
$3,000.00
|
|
| Hospital Charge Code |
270649287C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$726.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$600.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$726.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$450.00
|
|
|
LEAD SCREWIN TENDRIL 1488/46CM
|
Facility
|
OP
|
$3,720.00
|
|
| Hospital Charge Code |
270633047
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$558.00 |
| Max. Negotiated Rate |
$1,860.00 |
| Rate for Payer: Aetna Commercial |
$1,116.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,116.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$948.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$948.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$744.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$948.60
|
| Rate for Payer: Cigna Commercial |
$1,860.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$900.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$558.00
|
|
|
LEAD SCREWIN TENDRIL 1488/46CM
|
Facility
|
IP
|
$3,720.00
|
|
| Hospital Charge Code |
270633047
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$558.00 |
| Max. Negotiated Rate |
$900.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$744.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$900.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$558.00
|
|