|
LEAD SELUTE PICOTIP 4064
|
Facility
|
OP
|
$3,840.00
|
|
| Hospital Charge Code |
270627634
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$576.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,152.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,152.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$979.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$979.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$768.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$979.20
|
| Rate for Payer: Cigna Commercial |
$1,920.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$929.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$576.00
|
|
|
LEAD SELUTE PICOTIP 4064
|
Facility
|
IP
|
$3,840.00
|
|
| Hospital Charge Code |
270627634
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$576.00 |
| Max. Negotiated Rate |
$929.28 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$768.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$929.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$576.00
|
|
|
LEADSET 5-LEAD W/CLIP
|
Facility
|
IP
|
$138.70
|
|
| Hospital Charge Code |
270682371
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.80
|
|
|
LEADSET 5-LEAD W/CLIP
|
Facility
|
OP
|
$138.70
|
|
| Hospital Charge Code |
270682371
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$69.35 |
| Rate for Payer: Aetna Commercial |
$41.61
|
| Rate for Payer: Aetna Medicare Advantage |
$41.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$35.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$35.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$35.37
|
| Rate for Payer: Cigna Commercial |
$69.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.03
|
| Rate for Payer: Oxford Commercial |
$69.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$69.35
|
|
|
LEAD SJM PACEMAKER 1346T/58
|
Facility
|
IP
|
$3,447.25
|
|
| Hospital Charge Code |
270621362
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$517.09 |
| Max. Negotiated Rate |
$834.23 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$689.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$834.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$517.09
|
|
|
LEAD SJM PACEMAKER 1346T/58
|
Facility
|
OP
|
$3,447.25
|
|
| Hospital Charge Code |
270621362
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$517.09 |
| Max. Negotiated Rate |
$1,723.62 |
| Rate for Payer: Aetna Commercial |
$1,034.17
|
| Rate for Payer: Aetna Medicare Advantage |
$1,034.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$879.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$879.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$689.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$879.05
|
| Rate for Payer: Cigna Commercial |
$1,723.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$834.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$517.09
|
|
|
LEAD SJM PACEMAKER 1346T/58
|
Facility
|
IP
|
$3,475.00
|
|
| Hospital Charge Code |
270621362C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$521.25 |
| Max. Negotiated Rate |
$840.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$695.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$840.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$521.25
|
|
|
LEAD SJM PACEMAKER 1346T/58
|
Facility
|
OP
|
$3,475.00
|
|
| Hospital Charge Code |
270621362C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$521.25 |
| Max. Negotiated Rate |
$1,737.50 |
| Rate for Payer: Aetna Commercial |
$1,042.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,042.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$886.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$886.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$695.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$886.12
|
| Rate for Payer: Cigna Commercial |
$1,737.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$840.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$521.25
|
|
|
LEAD SLZR PCEMKR 430-07
|
Facility
|
OP
|
$3,376.85
|
|
| Hospital Charge Code |
270605851
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$506.53 |
| Max. Negotiated Rate |
$1,688.42 |
| Rate for Payer: Aetna Commercial |
$1,013.05
|
| Rate for Payer: Aetna Medicare Advantage |
$1,013.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$861.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$861.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$675.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$861.10
|
| Rate for Payer: Cigna Commercial |
$1,688.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$817.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$506.53
|
|
|
LEAD SLZR PCEMKR 430-07
|
Facility
|
IP
|
$3,376.85
|
|
| Hospital Charge Code |
270605851
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$506.53 |
| Max. Negotiated Rate |
$817.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$675.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$817.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$506.53
|
|
|
LEAD SLZR PCEMKR 430-07-58
|
Facility
|
IP
|
$3,127.25
|
|
| Hospital Charge Code |
270606423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$469.09 |
| Max. Negotiated Rate |
$756.79 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$625.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$756.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$469.09
|
|
|
LEAD SLZR PCEMKR 430-07-58
|
Facility
|
OP
|
$3,127.25
|
|
| Hospital Charge Code |
270606423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$469.09 |
| Max. Negotiated Rate |
$1,563.62 |
| Rate for Payer: Aetna Commercial |
$938.17
|
| Rate for Payer: Aetna Medicare Advantage |
$938.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$797.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$797.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$625.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$797.45
|
| Rate for Payer: Cigna Commercial |
$1,563.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$756.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$469.09
|
|
|
LEAD SLZR PCEMKR ZY52PJUSBV
|
Facility
|
OP
|
$3,268.85
|
|
| Hospital Charge Code |
270605852
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$490.33 |
| Max. Negotiated Rate |
$1,634.42 |
| Rate for Payer: Aetna Commercial |
$980.65
|
| Rate for Payer: Aetna Medicare Advantage |
$980.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$833.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$833.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$653.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$833.56
|
| Rate for Payer: Cigna Commercial |
$1,634.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$791.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$490.33
|
|
|
LEAD SLZR PCEMKR ZY52PJUSBV
|
Facility
|
IP
|
$3,268.85
|
|
| Hospital Charge Code |
270605852
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$490.33 |
| Max. Negotiated Rate |
$791.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$653.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$791.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$490.33
|
|
|
LEAD STEROID ELUTNG 1346T/52CM
|
Facility
|
IP
|
$3,447.25
|
|
| Hospital Charge Code |
270633048
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$517.09 |
| Max. Negotiated Rate |
$834.23 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$689.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$834.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$517.09
|
|
|
LEAD STEROID ELUTNG 1346T/52CM
|
Facility
|
OP
|
$3,447.25
|
|
| Hospital Charge Code |
270633048
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$517.09 |
| Max. Negotiated Rate |
$1,723.62 |
| Rate for Payer: Aetna Commercial |
$1,034.17
|
| Rate for Payer: Aetna Medicare Advantage |
$1,034.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$879.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$879.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$689.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$879.05
|
| Rate for Payer: Cigna Commercial |
$1,723.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$834.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$517.09
|
|
|
LEAD TENDRIL 46cm
|
Facility
|
IP
|
$4,040.00
|
|
| Hospital Charge Code |
2709007246
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$606.00 |
| Max. Negotiated Rate |
$606.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$606.00
|
|
|
LEAD TENDRIL 46cm
|
Facility
|
OP
|
$4,040.00
|
|
| Hospital Charge Code |
2709007246
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$525.20 |
| Max. Negotiated Rate |
$2,020.00 |
| Rate for Payer: Aetna Commercial |
$1,212.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,212.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,030.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,030.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$2,020.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$525.20
|
| Rate for Payer: Oxford Commercial |
$2,020.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$606.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,020.00
|
|
|
LEAD TENDRIL 46cm
|
Facility
|
IP
|
$4,040.00
|
|
| Hospital Charge Code |
270CH0117
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$606.00 |
| Max. Negotiated Rate |
$977.68 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$808.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$977.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$606.00
|
|
|
LEAD TENDRIL 46cm
|
Facility
|
OP
|
$4,040.00
|
|
| Hospital Charge Code |
270CH0117
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$606.00 |
| Max. Negotiated Rate |
$2,020.00 |
| Rate for Payer: Aetna Commercial |
$1,212.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,212.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,030.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,030.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$808.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$2,020.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$977.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$606.00
|
|
|
LEAD TENDRIL 52cm
|
Facility
|
OP
|
$4,040.00
|
|
| Hospital Charge Code |
2709007247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$525.20 |
| Max. Negotiated Rate |
$2,020.00 |
| Rate for Payer: Aetna Commercial |
$1,212.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,212.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,030.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,030.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$2,020.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$525.20
|
| Rate for Payer: Oxford Commercial |
$2,020.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$606.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,020.00
|
|
|
LEAD TENDRIL 52cm
|
Facility
|
IP
|
$4,040.00
|
|
| Hospital Charge Code |
2709007247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$606.00 |
| Max. Negotiated Rate |
$606.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$606.00
|
|
|
LEAD TENDRIL 52cm
|
Facility
|
IP
|
$4,040.00
|
|
| Hospital Charge Code |
270CH0118
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$606.00 |
| Max. Negotiated Rate |
$977.68 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$808.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$977.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$606.00
|
|
|
LEAD TENDRIL 52cm
|
Facility
|
OP
|
$4,040.00
|
|
| Hospital Charge Code |
270CH0118
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$606.00 |
| Max. Negotiated Rate |
$2,020.00 |
| Rate for Payer: Aetna Commercial |
$1,212.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,212.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,030.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,030.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$808.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$2,020.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$977.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$606.00
|
|
|
LEAD TENDRIL 58cm
|
Facility
|
OP
|
$4,040.00
|
|
| Hospital Charge Code |
2709007248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$525.20 |
| Max. Negotiated Rate |
$2,020.00 |
| Rate for Payer: Aetna Commercial |
$1,212.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,212.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,030.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,030.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$2,020.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$525.20
|
| Rate for Payer: Oxford Commercial |
$2,020.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$606.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,020.00
|
|