|
LEAD TENDRIL SDX 58CM
|
Facility
|
OP
|
$4,040.00
|
|
| Hospital Charge Code |
270669324
|
|
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 58CM
|
Facility
|
IP
|
$4,040.00
|
|
| Hospital Charge Code |
270669324
|
|
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 STS 58CM
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
270669000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$600.00
|
| Rate for Payer: Aetna Medicare Advantage |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$510.00
|
| Rate for Payer: Cigna Commercial |
$1,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$484.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
LEAD TENDRIL STS 58CM
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
270669000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$484.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$484.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
LEAD TILDA R60
|
Facility
|
IP
|
$2,125.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
270657602
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$318.75 |
| Max. Negotiated Rate |
$514.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$425.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$514.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$318.75
|
|
|
LEAD TILDA R60
|
Facility
|
OP
|
$2,125.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
270657602
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$318.75 |
| Max. Negotiated Rate |
$1,062.50 |
| Rate for Payer: Aetna Commercial |
$637.50
|
| Rate for Payer: Aetna Medicare Advantage |
$637.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$541.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$541.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$425.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$541.88
|
| Rate for Payer: Cigna Commercial |
$1,062.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$514.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$318.75
|
|
|
LEAD TRIAL LEAD 60 CM
|
Facility
|
IP
|
$6,475.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
270683667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$971.25 |
| Max. Negotiated Rate |
$1,566.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,295.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,566.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$971.25
|
|
|
LEAD TRIAL LEAD 60 CM
|
Facility
|
OP
|
$6,475.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
270683667S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$971.25 |
| Max. Negotiated Rate |
$3,237.50 |
| Rate for Payer: Aetna Commercial |
$1,942.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,942.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,651.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,651.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,295.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,651.12
|
| Rate for Payer: Cigna Commercial |
$3,237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,566.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$971.25
|
|
|
LEAD TRIAL LEAD 60 CM
|
Facility
|
IP
|
$6,475.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
270683667S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$971.25 |
| Max. Negotiated Rate |
$1,566.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,295.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,566.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$971.25
|
|
|
LEAD TRIAL LEAD 60 CM
|
Facility
|
OP
|
$6,475.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
270683667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$971.25 |
| Max. Negotiated Rate |
$3,237.50 |
| Rate for Payer: Aetna Commercial |
$1,942.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,942.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,651.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,651.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,295.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,651.12
|
| Rate for Payer: Cigna Commercial |
$3,237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,566.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$971.25
|
|
|
LEAD UMRI PR/LPA1200M/46
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
270683491
|
|
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 UMRI PR/LPA1200M/46
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
270683491
|
|
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 URINE
|
Facility
|
IP
|
$257.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
38479439
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.55 |
| Max. Negotiated Rate |
$38.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.55
|
|
|
LEAD URINE
|
Facility
|
OP
|
$257.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
38479439
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$39.24
|
| Rate for Payer: Aetna Medicare Advantage |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$44.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$16.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$44.37
|
| Rate for Payer: Cigna Commercial |
$12.11
|
| Rate for Payer: Cigna Medicare Advantage |
$6.05
|
| Rate for Payer: Clover Medicare Advantage |
$11.50
|
| Rate for Payer: EmblemHealth Commercial |
$36.33
|
| Rate for Payer: Humana Medicare Advantage |
$12.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.41
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.11
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$12.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.11
|
|
|
LEAD, URINE
|
Facility
|
OP
|
$257.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
38472449
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$39.24
|
| Rate for Payer: Aetna Medicare Advantage |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$44.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$16.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$44.37
|
| Rate for Payer: Cigna Commercial |
$12.11
|
| Rate for Payer: Cigna Medicare Advantage |
$6.05
|
| Rate for Payer: Clover Medicare Advantage |
$11.50
|
| Rate for Payer: EmblemHealth Commercial |
$36.33
|
| Rate for Payer: Humana Medicare Advantage |
$12.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.41
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.11
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$12.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.11
|
|
|
LEAD, URINE
|
Facility
|
IP
|
$257.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
38472449
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.55 |
| Max. Negotiated Rate |
$38.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.55
|
|
|
LEAD, URINE I
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
3030558A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$16.78
|
| Rate for Payer: Aetna Medicare Advantage |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.98
|
| Rate for Payer: Cigna Commercial |
$5.18
|
| Rate for Payer: Cigna Medicare Advantage |
$2.59
|
| Rate for Payer: Clover Medicare Advantage |
$4.92
|
| Rate for Payer: EmblemHealth Commercial |
$15.54
|
| Rate for Payer: Humana Medicare Advantage |
$5.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.91
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.18
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$5.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.18
|
|
|
LEAD, URINE I
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
3030558A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.05 |
| Max. Negotiated Rate |
$16.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.05
|
|
|
LEAD, URINE II
|
Facility
|
IP
|
$111.25
|
|
|
Service Code
|
HCPCS 83665
|
| Hospital Charge Code |
3030558B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.69 |
| Max. Negotiated Rate |
$16.69 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.69
|
|
|
LEAD, URINE II
|
Facility
|
OP
|
$111.25
|
|
|
Service Code
|
HCPCS 83665
|
| Hospital Charge Code |
3030558B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.46 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$33.38
|
| Rate for Payer: Aetna Medicare Advantage |
$33.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$28.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$28.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$28.37
|
| Rate for Payer: Cigna Commercial |
$55.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.46
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
LEAD URINE RANDOM
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
3032060A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$39.24
|
| Rate for Payer: Aetna Medicare Advantage |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$44.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$16.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$44.37
|
| Rate for Payer: Cigna Commercial |
$12.11
|
| Rate for Payer: Cigna Medicare Advantage |
$6.05
|
| Rate for Payer: Clover Medicare Advantage |
$11.50
|
| Rate for Payer: EmblemHealth Commercial |
$36.33
|
| Rate for Payer: Humana Medicare Advantage |
$12.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$26.13
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.11
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$12.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.11
|
|
|
LEAD URINE RANDOM
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
3032060A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.15 |
| Max. Negotiated Rate |
$30.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.15
|
|
|
LEAD US MA
|
Facility
|
IP
|
$5,130.00
|
|
| Hospital Charge Code |
270657304
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$769.50 |
| Max. Negotiated Rate |
$1,241.46 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,026.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,241.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$769.50
|
|
|
LEAD US MA
|
Facility
|
OP
|
$5,130.00
|
|
| Hospital Charge Code |
270657304
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$769.50 |
| Max. Negotiated Rate |
$2,565.00 |
| Rate for Payer: Aetna Commercial |
$1,539.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,539.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,308.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,308.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,026.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,308.15
|
| Rate for Payer: Cigna Commercial |
$2,565.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,241.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$769.50
|
|
|
LEAD US MA 58
|
Facility
|
IP
|
$5,130.00
|
|
| Hospital Charge Code |
270657306
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$769.50 |
| Max. Negotiated Rate |
$1,241.46 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,026.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,241.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$769.50
|
|