|
SEAMGUARD GIA 60 ASG003
|
Facility
|
OP
|
$1,078.80
|
|
| Hospital Charge Code |
270623269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.82 |
| Max. Negotiated Rate |
$539.40 |
| Rate for Payer: Aetna Commercial |
$323.64
|
| Rate for Payer: Aetna Medicare Advantage |
$323.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$275.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$275.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$215.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$275.09
|
| Rate for Payer: Cigna Commercial |
$539.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$261.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$161.82
|
|
|
SEAMGUARD GIA 60 ASG003
|
Facility
|
IP
|
$862.45
|
|
| Hospital Charge Code |
270632269
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$129.37 |
| Max. Negotiated Rate |
$129.37 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$129.37
|
|
|
SEAMGUARD GORTEX
|
Facility
|
IP
|
$1,073.65
|
|
| Hospital Charge Code |
270605794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.05 |
| Max. Negotiated Rate |
$259.82 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$214.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$259.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$161.05
|
|
|
SEAMGUARD GORTEX
|
Facility
|
OP
|
$1,073.65
|
|
| Hospital Charge Code |
270605794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.05 |
| Max. Negotiated Rate |
$536.83 |
| Rate for Payer: Aetna Commercial |
$322.10
|
| Rate for Payer: Aetna Medicare Advantage |
$322.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$273.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$273.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$214.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$273.78
|
| Rate for Payer: Cigna Commercial |
$536.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$259.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$161.05
|
|
|
SEAMGUARD STAPLE LINE 6.5
|
Facility
|
OP
|
$1,450.00
|
|
| Hospital Charge Code |
270658079
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$217.50 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Aetna Commercial |
$435.00
|
| Rate for Payer: Aetna Medicare Advantage |
$435.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$369.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$369.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$290.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$369.75
|
| Rate for Payer: Cigna Commercial |
$725.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$350.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$217.50
|
|
|
SEAMGUARD STAPLE LINE 6.5
|
Facility
|
IP
|
$1,450.00
|
|
| Hospital Charge Code |
270658079
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$217.50 |
| Max. Negotiated Rate |
$350.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$290.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$350.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$217.50
|
|
|
SEATH DRYSEAL 18FR
|
Facility
|
IP
|
$1,475.00
|
|
| Hospital Charge Code |
270644341
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.25 |
| Max. Negotiated Rate |
$356.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$295.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$356.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$221.25
|
|
|
SEATH DRYSEAL 18FR
|
Facility
|
OP
|
$1,475.00
|
|
| Hospital Charge Code |
270644341
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.25 |
| Max. Negotiated Rate |
$737.50 |
| Rate for Payer: Aetna Commercial |
$442.50
|
| Rate for Payer: Aetna Medicare Advantage |
$442.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$376.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$376.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$295.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$376.12
|
| Rate for Payer: Cigna Commercial |
$737.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$356.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$221.25
|
|
|
SEATH PINNACLE R/O II INTROD
|
Facility
|
OP
|
$29.70
|
|
| Hospital Charge Code |
270658239
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$14.85 |
| Rate for Payer: Aetna Commercial |
$8.91
|
| Rate for Payer: Aetna Medicare Advantage |
$8.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.57
|
| Rate for Payer: Cigna Commercial |
$14.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.46
|
|
|
SEATH PINNACLE R/O II INTROD
|
Facility
|
IP
|
$29.70
|
|
| Hospital Charge Code |
270658239
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$7.19 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.46
|
|
|
SEATH PINNACLE R/O II INTRODUC
|
Facility
|
OP
|
$31.90
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
270654359
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$15.95 |
| Rate for Payer: Aetna Commercial |
$9.57
|
| Rate for Payer: Aetna Medicare Advantage |
$9.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.13
|
| Rate for Payer: Cigna Commercial |
$15.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.79
|
|
|
SEATH PINNACLE R/O II INTRODUC
|
Facility
|
OP
|
$31.90
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
270654359N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$15.95 |
| Rate for Payer: Aetna Commercial |
$9.57
|
| Rate for Payer: Aetna Medicare Advantage |
$9.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.13
|
| Rate for Payer: Cigna Commercial |
$15.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.79
|
|
|
SEATH PINNACLE R/O II INTRODUC
|
Facility
|
IP
|
$31.90
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
270654359S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$7.72 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.79
|
|
|
SEATH PINNACLE R/O II INTRODUC
|
Facility
|
IP
|
$31.90
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
270654359
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$7.72 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.79
|
|
|
SEATH PINNACLE R/O II INTRODUC
|
Facility
|
IP
|
$31.90
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
270654359N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$7.72 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.79
|
|
|
SEATH PINNACLE R/O II INTRODUC
|
Facility
|
OP
|
$31.90
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
270654359S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$15.95 |
| Rate for Payer: Aetna Commercial |
$9.57
|
| Rate for Payer: Aetna Medicare Advantage |
$9.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.13
|
| Rate for Payer: Cigna Commercial |
$15.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.79
|
|
|
SEAT TOILET RAISED SPECIAL NVC
|
Facility
|
OP
|
$203.25
|
|
| Hospital Charge Code |
270624860
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.42 |
| Max. Negotiated Rate |
$101.62 |
| Rate for Payer: Aetna Commercial |
$60.98
|
| Rate for Payer: Aetna Medicare Advantage |
$60.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$51.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$51.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$51.83
|
| Rate for Payer: Cigna Commercial |
$101.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$26.42
|
| Rate for Payer: Oxford Commercial |
$101.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.49
|
| Rate for Payer: UnitedHealthcare Commercial |
$101.62
|
|
|
SEAT TOILET RAISED SPECIAL NVC
|
Facility
|
IP
|
$203.25
|
|
| Hospital Charge Code |
270624860
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.49 |
| Max. Negotiated Rate |
$30.49 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.49
|
|
|
SEC ANT LUM CAGE H18 10DEG
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270703855
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,750.00 |
| Max. Negotiated Rate |
$6,050.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,050.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,750.00
|
|
|
SEC ANT LUM CAGE H18 10DEG
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270703855
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,750.00 |
| Max. Negotiated Rate |
$12,500.00 |
| Rate for Payer: Aetna Commercial |
$7,500.00
|
| Rate for Payer: Aetna Medicare Advantage |
$7,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,375.00
|
| Rate for Payer: Cigna Commercial |
$12,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,050.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,750.00
|
|
|
SEC FT MX 127DEG STEM 10X35
|
Facility
|
OP
|
$11,937.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270691174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,790.67 |
| Max. Negotiated Rate |
$5,968.90 |
| Rate for Payer: Aetna Commercial |
$3,581.34
|
| Rate for Payer: Aetna Medicare Advantage |
$3,581.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,044.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,044.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,387.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,044.14
|
| Rate for Payer: Cigna Commercial |
$5,968.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,888.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,790.67
|
|
|
SEC FT MX 127DEG STEM 10X35
|
Facility
|
IP
|
$11,937.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270691174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,790.67 |
| Max. Negotiated Rate |
$2,888.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,387.56
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,888.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,790.67
|
|
|
SECFTMX127DEGSTEMSZ9NK35MMCTPR
|
Facility
|
OP
|
$11,937.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270691183
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,790.67 |
| Max. Negotiated Rate |
$5,968.90 |
| Rate for Payer: Aetna Commercial |
$3,581.34
|
| Rate for Payer: Aetna Medicare Advantage |
$3,581.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,044.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,044.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,387.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,044.14
|
| Rate for Payer: Cigna Commercial |
$5,968.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,888.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,790.67
|
|
|
SECFTMX127DEGSTEMSZ9NK35MMCTPR
|
Facility
|
IP
|
$11,937.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270691183
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,790.67 |
| Max. Negotiated Rate |
$2,888.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,387.56
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,888.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,790.67
|
|
|
SEC LUM ANT CAGE MED H16 10DEG
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
2703855
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,750.00 |
| Max. Negotiated Rate |
$12,500.00 |
| Rate for Payer: Aetna Commercial |
$7,500.00
|
| Rate for Payer: Aetna Medicare Advantage |
$7,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,375.00
|
| Rate for Payer: Cigna Commercial |
$12,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,050.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,750.00
|
|
