|
FLEXTIP RF PROBE, 28CM
|
Facility
|
OP
|
$2,975.00
|
|
| Hospital Charge Code |
270702073
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.49 |
| Max. Negotiated Rate |
$1,487.50 |
| Rate for Payer: Aetna Commercial |
$1,130.50
|
| Rate for Payer: Aetna Medicare Advantage |
$892.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$758.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$758.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$758.62
|
| Rate for Payer: Cigna Commercial |
$1,487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$773.50
|
| Rate for Payer: Oxford Commercial |
$595.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$446.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$595.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$94.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$84.49
|
|
|
FLEXTUBE GSP HMEF
|
Facility
|
IP
|
$12.67
|
|
| Hospital Charge Code |
270689023
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.90
|
|
|
FLEXTUBE GSP HMEF
|
Facility
|
OP
|
$12.67
|
|
| Hospital Charge Code |
270689023
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$6.33 |
| Rate for Payer: Aetna Commercial |
$4.81
|
| Rate for Payer: Aetna Medicare Advantage |
$3.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.23
|
| Rate for Payer: Cigna Commercial |
$6.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.29
|
| Rate for Payer: Oxford Commercial |
$2.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.53
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.36
|
|
|
FLEXWIRE .86 DBL TIP NITI
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692912
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.25 |
| Max. Negotiated Rate |
$168.19 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$139.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$168.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$104.25
|
|
|
FLEXWIRE .86 DBL TIP NITI
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692912
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.74 |
| Max. Negotiated Rate |
$347.50 |
| Rate for Payer: Aetna Commercial |
$264.10
|
| Rate for Payer: Aetna Medicare Advantage |
$208.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$177.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$177.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$139.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$177.22
|
| Rate for Payer: Cigna Commercial |
$347.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$168.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$104.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.74
|
|
|
FLIPCUTTER 10MM
|
Facility
|
IP
|
$1,625.00
|
|
| Hospital Charge Code |
270666962
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$243.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.75
|
|
|
FLIPCUTTER 10MM
|
Facility
|
OP
|
$1,625.00
|
|
| Hospital Charge Code |
270666962
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$812.50 |
| Rate for Payer: Aetna Commercial |
$617.50
|
| Rate for Payer: Aetna Medicare Advantage |
$487.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$414.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$414.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$414.38
|
| Rate for Payer: Cigna Commercial |
$812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$422.50
|
| Rate for Payer: Oxford Commercial |
$325.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$325.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$51.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$46.15
|
|
|
FLIPCUTTER 11MM
|
Facility
|
IP
|
$1,625.00
|
|
| Hospital Charge Code |
270664581
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$243.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.75
|
|
|
FLIPCUTTER 11MM
|
Facility
|
IP
|
$3,375.00
|
|
| Hospital Charge Code |
270682557
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$506.25 |
| Max. Negotiated Rate |
$506.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$506.25
|
|
|
FLIPCUTTER 11MM
|
Facility
|
OP
|
$3,375.00
|
|
| Hospital Charge Code |
270682557
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.85 |
| Max. Negotiated Rate |
$1,687.50 |
| Rate for Payer: Aetna Commercial |
$1,282.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,012.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$860.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$860.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$860.62
|
| Rate for Payer: Cigna Commercial |
$1,687.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$877.50
|
| Rate for Payer: Oxford Commercial |
$675.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$506.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$675.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$106.65
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$95.85
|
|
|
FLIPCUTTER 11MM
|
Facility
|
OP
|
$1,625.00
|
|
| Hospital Charge Code |
270664581
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$812.50 |
| Rate for Payer: Aetna Commercial |
$617.50
|
| Rate for Payer: Aetna Medicare Advantage |
$487.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$414.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$414.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$414.38
|
| Rate for Payer: Cigna Commercial |
$812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$422.50
|
| Rate for Payer: Oxford Commercial |
$325.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$325.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$51.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$46.15
|
|
|
FLIPCUTTER 6.5MM
|
Facility
|
OP
|
$1,625.00
|
|
| Hospital Charge Code |
270677965
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$812.50 |
| Rate for Payer: Aetna Commercial |
$617.50
|
| Rate for Payer: Aetna Medicare Advantage |
$487.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$414.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$414.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$414.38
|
| Rate for Payer: Cigna Commercial |
$812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$422.50
|
| Rate for Payer: Oxford Commercial |
$325.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$325.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$51.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$46.15
|
|
|
FLIPCUTTER 6.5MM
|
Facility
|
IP
|
$1,625.00
|
|
| Hospital Charge Code |
270677965
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$243.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.75
|
|
|
FLIPCUTTER 7.5MM
|
Facility
|
IP
|
$2,325.00
|
|
| Hospital Charge Code |
270664773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$348.75 |
| Max. Negotiated Rate |
$348.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$348.75
|
|
|
FLIPCUTTER 7.5MM
|
Facility
|
OP
|
$2,325.00
|
|
| Hospital Charge Code |
270664773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.03 |
| Max. Negotiated Rate |
$1,162.50 |
| Rate for Payer: Aetna Commercial |
$883.50
|
| Rate for Payer: Aetna Medicare Advantage |
$697.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$592.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$592.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$592.88
|
| Rate for Payer: Cigna Commercial |
$1,162.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$604.50
|
| Rate for Payer: Oxford Commercial |
$465.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$348.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$465.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$73.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$66.03
|
|
|
FLIPCUTTER 8.5MM
|
Facility
|
OP
|
$1,625.00
|
|
| Hospital Charge Code |
270666959
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$812.50 |
| Rate for Payer: Aetna Commercial |
$617.50
|
| Rate for Payer: Aetna Medicare Advantage |
$487.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$414.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$414.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$414.38
|
| Rate for Payer: Cigna Commercial |
$812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$422.50
|
| Rate for Payer: Oxford Commercial |
$325.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$325.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$51.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$46.15
|
|
|
FLIPCUTTER 8.5MM
|
Facility
|
IP
|
$1,625.00
|
|
| Hospital Charge Code |
270666959
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$243.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.75
|
|
|
FLIPCUTTER 8MM
|
Facility
|
IP
|
$2,325.00
|
|
| Hospital Charge Code |
270663952
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$348.75 |
| Max. Negotiated Rate |
$348.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$348.75
|
|
|
FLIPCUTTER 8MM
|
Facility
|
OP
|
$2,325.00
|
|
| Hospital Charge Code |
270663952
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.03 |
| Max. Negotiated Rate |
$1,162.50 |
| Rate for Payer: Aetna Commercial |
$883.50
|
| Rate for Payer: Aetna Medicare Advantage |
$697.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$592.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$592.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$592.88
|
| Rate for Payer: Cigna Commercial |
$1,162.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$604.50
|
| Rate for Payer: Oxford Commercial |
$465.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$348.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$465.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$73.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$66.03
|
|
|
FLIPCUTTER 9.5MM
|
Facility
|
OP
|
$1,625.00
|
|
| Hospital Charge Code |
270666960
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$812.50 |
| Rate for Payer: Aetna Commercial |
$617.50
|
| Rate for Payer: Aetna Medicare Advantage |
$487.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$414.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$414.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$414.38
|
| Rate for Payer: Cigna Commercial |
$812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$422.50
|
| Rate for Payer: Oxford Commercial |
$325.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$325.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$51.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$46.15
|
|
|
FLIPCUTTER 9.5MM
|
Facility
|
IP
|
$1,625.00
|
|
| Hospital Charge Code |
270666960
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$243.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.75
|
|
|
FLIPCUTTER 9MM
|
Facility
|
OP
|
$1,625.00
|
|
| Hospital Charge Code |
270669596
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$812.50 |
| Rate for Payer: Aetna Commercial |
$617.50
|
| Rate for Payer: Aetna Medicare Advantage |
$487.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$414.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$414.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$414.38
|
| Rate for Payer: Cigna Commercial |
$812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$422.50
|
| Rate for Payer: Oxford Commercial |
$325.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$325.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$51.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$46.15
|
|
|
FLIPCUTTER 9MM
|
Facility
|
IP
|
$1,625.00
|
|
| Hospital Charge Code |
270669596
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$243.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.75
|
|
|
FLIPCUTTER II 10.5MM
|
Facility
|
IP
|
$1,625.00
|
|
| Hospital Charge Code |
270659654
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$243.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.75
|
|
|
FLIPCUTTER II 10.5MM
|
Facility
|
OP
|
$1,625.00
|
|
| Hospital Charge Code |
270659654
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$812.50 |
| Rate for Payer: Aetna Commercial |
$617.50
|
| Rate for Payer: Aetna Medicare Advantage |
$487.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$414.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$414.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$414.38
|
| Rate for Payer: Cigna Commercial |
$812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$422.50
|
| Rate for Payer: Oxford Commercial |
$325.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$325.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$51.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$46.15
|
|