|
VALVE CHEST DRAIN PNEWMOSTAT
|
Facility
|
OP
|
$164.00
|
|
| Hospital Charge Code |
270664233
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Aetna Commercial |
$49.20
|
| Rate for Payer: Aetna Medicare Advantage |
$49.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$41.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$41.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$41.82
|
| Rate for Payer: Cigna Commercial |
$82.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.32
|
| Rate for Payer: Oxford Commercial |
$82.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$82.00
|
|
|
VALVE CHEST DRAIN PNEWMOSTAT
|
Facility
|
IP
|
$164.00
|
|
| Hospital Charge Code |
270664233
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$24.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.60
|
|
|
VALVE CODM CERTAS PL INLINE SM
|
Facility
|
IP
|
$30,120.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270698460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,518.00 |
| Max. Negotiated Rate |
$7,289.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,024.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,289.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,518.00
|
|
|
VALVE CODM CERTAS PL INLINE SM
|
Facility
|
OP
|
$30,120.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270698460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,518.00 |
| Max. Negotiated Rate |
$15,060.00 |
| Rate for Payer: Aetna Commercial |
$9,036.00
|
| Rate for Payer: Aetna Medicare Advantage |
$9,036.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,680.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,680.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,024.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,680.60
|
| Rate for Payer: Cigna Commercial |
$15,060.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,289.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,518.00
|
|
|
VALVE CONT LOWLOWPRE CSF SHUNT
|
Facility
|
IP
|
$5,635.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
270698772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.25 |
| Max. Negotiated Rate |
$1,363.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,127.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,363.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$845.25
|
|
|
VALVE CONT LOWLOWPRE CSF SHUNT
|
Facility
|
OP
|
$5,635.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
270698772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.25 |
| Max. Negotiated Rate |
$2,817.50 |
| Rate for Payer: Aetna Commercial |
$1,690.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,690.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,436.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,436.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,127.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,436.92
|
| Rate for Payer: Cigna Commercial |
$2,817.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,363.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$845.25
|
|
|
VALVE COPILOT BLEEDBACK MAP300
|
Facility
|
OP
|
$108.15
|
|
| Hospital Charge Code |
270660277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.06 |
| Max. Negotiated Rate |
$54.08 |
| Rate for Payer: Aetna Commercial |
$32.45
|
| Rate for Payer: Aetna Medicare Advantage |
$32.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$27.58
|
| Rate for Payer: Cigna Commercial |
$54.08
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.06
|
| Rate for Payer: Oxford Commercial |
$54.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.22
|
| Rate for Payer: UnitedHealthcare Commercial |
$54.08
|
|
|
VALVE COPILOT BLEEDBACK MAP300
|
Facility
|
IP
|
$108.15
|
|
| Hospital Charge Code |
270660277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.22 |
| Max. Negotiated Rate |
$16.22 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.22
|
|
|
VALVE DELTA 1.0MM
|
Facility
|
OP
|
$2,822.45
|
|
| Hospital Charge Code |
270603369
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$423.37 |
| Max. Negotiated Rate |
$1,411.22 |
| Rate for Payer: Aetna Commercial |
$846.74
|
| Rate for Payer: Aetna Medicare Advantage |
$846.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$719.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$719.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$564.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$719.72
|
| Rate for Payer: Cigna Commercial |
$1,411.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$683.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$423.37
|
|
|
VALVE DELTA 1.0MM
|
Facility
|
IP
|
$2,822.45
|
|
| Hospital Charge Code |
270603369
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$423.37 |
| Max. Negotiated Rate |
$683.03 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$564.49
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$683.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$423.37
|
|
|
VALVE DELTA 1.5MM
|
Facility
|
OP
|
$16,262.45
|
|
| Hospital Charge Code |
270603368
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,114.12 |
| Max. Negotiated Rate |
$8,131.23 |
| Rate for Payer: Aetna Commercial |
$4,878.73
|
| Rate for Payer: Aetna Medicare Advantage |
$4,878.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,146.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,146.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,146.92
|
| Rate for Payer: Cigna Commercial |
$8,131.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,114.12
|
| Rate for Payer: Oxford Commercial |
$8,131.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,439.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,131.23
|
|
|
VALVE DELTA 1.5MM
|
Facility
|
IP
|
$16,262.45
|
|
| Hospital Charge Code |
270603368
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,439.37 |
| Max. Negotiated Rate |
$2,439.37 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,439.37
|
|
|
VALVE DELTA 2.0MM
|
Facility
|
IP
|
$2,822.45
|
|
| Hospital Charge Code |
270603370
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$423.37 |
| Max. Negotiated Rate |
$423.37 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$423.37
|
|
|
VALVE DELTA 2.0MM
|
Facility
|
OP
|
$2,822.45
|
|
| Hospital Charge Code |
270603370
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$366.92 |
| Max. Negotiated Rate |
$1,411.22 |
| Rate for Payer: Aetna Commercial |
$846.74
|
| Rate for Payer: Aetna Medicare Advantage |
$846.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$719.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$719.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$719.72
|
| Rate for Payer: Cigna Commercial |
$1,411.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$366.92
|
| Rate for Payer: Oxford Commercial |
$1,411.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$423.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,411.22
|
|
|
VALVE DELTA REGCSFSHUNTLVL 1.5
|
Facility
|
OP
|
$9,240.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
270698771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,386.00 |
| Max. Negotiated Rate |
$4,620.00 |
| Rate for Payer: Aetna Commercial |
$2,772.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,772.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,356.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,356.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,848.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,356.20
|
| Rate for Payer: Cigna Commercial |
$4,620.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,236.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,386.00
|
|
|
VALVE DELTA REGCSFSHUNTLVL 1.5
|
Facility
|
IP
|
$9,240.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
270698771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,386.00 |
| Max. Negotiated Rate |
$2,236.08 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,848.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,236.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,386.00
|
|
|
VALVE DOUBLE Y LG BORE MAP220
|
Facility
|
IP
|
$110.00
|
|
| Hospital Charge Code |
270638000C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.50
|
|
|
VALVE DOUBLE Y LG BORE MAP220
|
Facility
|
OP
|
$110.00
|
|
| Hospital Charge Code |
270638000C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Aetna Commercial |
$33.00
|
| Rate for Payer: Aetna Medicare Advantage |
$33.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$28.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$28.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$28.05
|
| Rate for Payer: Cigna Commercial |
$55.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.30
|
| Rate for Payer: Oxford Commercial |
$55.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$55.00
|
|
|
VALVE FP-STRATA 2 REGULAR
|
Facility
|
IP
|
$29,939.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
270657921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,490.85 |
| Max. Negotiated Rate |
$7,245.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,987.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,245.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,490.85
|
|
|
VALVE FP-STRATA 2 REGULAR
|
Facility
|
OP
|
$29,939.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
270657921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,490.85 |
| Max. Negotiated Rate |
$14,969.50 |
| Rate for Payer: Aetna Commercial |
$8,981.70
|
| Rate for Payer: Aetna Medicare Advantage |
$8,981.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,634.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,634.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,987.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,634.44
|
| Rate for Payer: Cigna Commercial |
$14,969.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,245.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,490.85
|
|
|
VALVE FP-STRATA 2 SMALL
|
Facility
|
OP
|
$29,939.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
270694974
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,490.85 |
| Max. Negotiated Rate |
$14,969.50 |
| Rate for Payer: Aetna Commercial |
$8,981.70
|
| Rate for Payer: Aetna Medicare Advantage |
$8,981.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,634.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,634.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,987.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,634.44
|
| Rate for Payer: Cigna Commercial |
$14,969.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,245.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,490.85
|
|
|
VALVE FP-STRATA 2 SMALL
|
Facility
|
IP
|
$29,939.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
270694974
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,490.85 |
| Max. Negotiated Rate |
$7,245.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,987.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,245.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,490.85
|
|
|
VALVE FP-STRATA NSC REGULAR
|
Facility
|
IP
|
$27,435.10
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
270695659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,115.27 |
| Max. Negotiated Rate |
$6,639.29 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,487.02
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,639.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,115.27
|
|
|
VALVE FP-STRATA NSC REGULAR
|
Facility
|
OP
|
$27,435.10
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
270695659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,115.27 |
| Max. Negotiated Rate |
$13,717.55 |
| Rate for Payer: Aetna Commercial |
$8,230.53
|
| Rate for Payer: Aetna Medicare Advantage |
$8,230.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,995.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,995.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,487.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,995.95
|
| Rate for Payer: Cigna Commercial |
$13,717.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,639.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,115.27
|
|
|
VALVE FP-STRATA NSC SMALL
|
Facility
|
IP
|
$27,271.40
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
270695660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,090.71 |
| Max. Negotiated Rate |
$6,599.68 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,454.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,599.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,090.71
|
|