|
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
|
|
|
LEAD TENDRIL 58cm
|
Facility
|
IP
|
$4,040.00
|
|
| Hospital Charge Code |
270CH0119
|
|
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 58cm
|
Facility
|
OP
|
$4,040.00
|
|
| Hospital Charge Code |
270CH0119
|
|
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 SDX 46
|
Facility
|
OP
|
$4,040.00
|
|
| Hospital Charge Code |
2709007232
|
|
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 SDX 46
|
Facility
|
IP
|
$4,040.00
|
|
| Hospital Charge Code |
2709007232
|
|
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 SDX 46
|
Facility
|
OP
|
$4,040.00
|
|
| Hospital Charge Code |
270CH0115
|
|
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 SDX 46
|
Facility
|
IP
|
$4,040.00
|
|
| Hospital Charge Code |
270646415
|
|
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 SDX 46
|
Facility
|
OP
|
$4,040.00
|
|
| Hospital Charge Code |
270646415
|
|
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 SDX 46
|
Facility
|
IP
|
$4,040.00
|
|
| Hospital Charge Code |
270CH0115
|
|
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 SDX 46CM 1688TC
|
Facility
|
IP
|
$4,040.00
|
|
| Hospital Charge Code |
270646415C
|
|
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 SDX 46CM 1688TC
|
Facility
|
OP
|
$4,040.00
|
|
| Hospital Charge Code |
270646415C
|
|
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 SDX 52
|
Facility
|
OP
|
$4,040.00
|
|
| Hospital Charge Code |
2709007231
|
|
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 SDX 52
|
Facility
|
IP
|
$4,040.00
|
|
| Hospital Charge Code |
2709007231
|
|
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 SDX 52
|
Facility
|
IP
|
$4,040.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
270655924
|
|
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 SDX 52
|
Facility
|
IP
|
$4,040.00
|
|
| Hospital Charge Code |
270CH0114
|
|
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 SDX 52
|
Facility
|
OP
|
$4,040.00
|
|
| Hospital Charge Code |
270CH0114
|
|
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 SDX 52
|
Facility
|
OP
|
$4,040.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
270655924
|
|
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 SDX 52CM
|
Facility
|
IP
|
$3,000.00
|
|
| Hospital Charge Code |
270639704
|
|
Hospital Revenue Code
|
278
|
| 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 TENDRIL SDX 52CM
|
Facility
|
OP
|
$3,000.00
|
|
| Hospital Charge Code |
270639704
|
|
Hospital Revenue Code
|
278
|
| 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 TENDRIL SDX52cm 1688TC/52
|
Facility
|
OP
|
$4,040.00
|
|
| Hospital Charge Code |
270655924C
|
|
Hospital Revenue Code
|
278
|
| 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 SDX52cm 1688TC/52
|
Facility
|
IP
|
$4,040.00
|
|
| Hospital Charge Code |
270655924C
|
|
Hospital Revenue Code
|
278
|
| 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 SDX 58
|
Facility
|
IP
|
$4,040.00
|
|
| Hospital Charge Code |
2709007234
|
|
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 SDX 58
|
Facility
|
OP
|
$4,040.00
|
|
| Hospital Charge Code |
2709007234
|
|
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 SDX 58
|
Facility
|
OP
|
$4,040.00
|
|
| Hospital Charge Code |
270CH0116
|
|
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 SDX 58
|
Facility
|
IP
|
$4,040.00
|
|
| Hospital Charge Code |
270CH0116
|
|
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
|
|