|
SAFEGUARD 24CM
|
Facility
|
OP
|
$295.00
|
|
| Hospital Charge Code |
270657684
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$147.50 |
| Rate for Payer: Aetna Commercial |
$112.10
|
| Rate for Payer: Aetna Medicare Advantage |
$88.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$75.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$75.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$75.22
|
| Rate for Payer: Cigna Commercial |
$147.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$76.70
|
| Rate for Payer: Oxford Commercial |
$59.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$44.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$59.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.38
|
|
|
SAFEGUARD PRESSURE ASSIST DEV
|
Facility
|
IP
|
$245.00
|
|
| Hospital Charge Code |
270669756N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$36.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
|
|
SAFEGUARD PRESSURE ASSIST DEV
|
Facility
|
IP
|
$245.00
|
|
| Hospital Charge Code |
270669756
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$36.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
|
|
SAFEGUARD PRESSURE ASSIST DEV
|
Facility
|
OP
|
$245.00
|
|
| Hospital Charge Code |
270669756
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.96 |
| Max. Negotiated Rate |
$122.50 |
| Rate for Payer: Aetna Commercial |
$93.10
|
| Rate for Payer: Aetna Medicare Advantage |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$62.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$62.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$62.48
|
| Rate for Payer: Cigna Commercial |
$122.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$63.70
|
| Rate for Payer: Oxford Commercial |
$49.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$49.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.96
|
|
|
SAFEGUARD PRESSURE ASSIST DEV
|
Facility
|
OP
|
$245.00
|
|
| Hospital Charge Code |
270669756N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.96 |
| Max. Negotiated Rate |
$122.50 |
| Rate for Payer: Aetna Commercial |
$93.10
|
| Rate for Payer: Aetna Medicare Advantage |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$62.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$62.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$62.48
|
| Rate for Payer: Cigna Commercial |
$122.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$63.70
|
| Rate for Payer: Oxford Commercial |
$49.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$49.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.96
|
|
|
SAFESHEATH II 6FR W/SIDEPORT
|
Facility
|
OP
|
$250.00
|
|
| Hospital Charge Code |
270678659
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna Commercial |
$95.00
|
| Rate for Payer: Aetna Medicare Advantage |
$75.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$63.75
|
| Rate for Payer: Cigna Commercial |
$125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$65.00
|
| Rate for Payer: Oxford Commercial |
$50.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$50.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.10
|
|
|
SAFESHEATH II 6FR W/SIDEPORT
|
Facility
|
IP
|
$250.00
|
|
| Hospital Charge Code |
270678659
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.50
|
|
|
SAFESHEATH II 6FR W/SIDEPORT
|
Facility
|
OP
|
$250.00
|
|
| Hospital Charge Code |
270678659S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna Commercial |
$95.00
|
| Rate for Payer: Aetna Medicare Advantage |
$75.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$63.75
|
| Rate for Payer: Cigna Commercial |
$125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$65.00
|
| Rate for Payer: Oxford Commercial |
$50.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$50.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.10
|
|
|
SAFESHEATH II 6FR W/SIDEPORT
|
Facility
|
IP
|
$250.00
|
|
| Hospital Charge Code |
270678659S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.50
|
|
|
SAFESHEATH II 7FR W/SIDEPORT
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270675044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$60.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$50.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$60.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.50
|
|
|
SAFESHEATH II 7FR W/SIDEPORT
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270675044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna Commercial |
$95.00
|
| Rate for Payer: Aetna Medicare Advantage |
$75.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$50.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$63.75
|
| Rate for Payer: Cigna Commercial |
$125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$60.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.10
|
|
|
SAFETOUCH SYST W/O FILTER
|
Facility
|
IP
|
$36.92
|
|
| Hospital Charge Code |
270649497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.54 |
| Max. Negotiated Rate |
$5.54 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.54
|
|
|
SAFETOUCH SYST W/O FILTER
|
Facility
|
OP
|
$36.92
|
|
| Hospital Charge Code |
270649497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$18.46 |
| Rate for Payer: Aetna Commercial |
$14.03
|
| Rate for Payer: Aetna Medicare Advantage |
$11.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.41
|
| Rate for Payer: Cigna Commercial |
$18.46
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.60
|
| Rate for Payer: Oxford Commercial |
$7.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.54
|
| Rate for Payer: UnitedHealthcare Commercial |
$7.38
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.05
|
|
|
SAFETY SEAL MIDAS REX
|
Facility
|
OP
|
$335.00
|
|
| Hospital Charge Code |
270335562
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$167.50 |
| Rate for Payer: Aetna Commercial |
$127.30
|
| Rate for Payer: Aetna Medicare Advantage |
$100.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$85.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$85.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$85.42
|
| Rate for Payer: Cigna Commercial |
$167.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$87.10
|
| Rate for Payer: Oxford Commercial |
$67.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$67.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.51
|
|
|
SAFETY SEAL MIDAS REX
|
Facility
|
IP
|
$335.00
|
|
| Hospital Charge Code |
270335562
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.25 |
| Max. Negotiated Rate |
$50.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.25
|
|
|
SAFEVIEW ENDOSCOP TISS REL SYS
|
Facility
|
OP
|
$7,475.00
|
|
| Hospital Charge Code |
270694890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$212.29 |
| Max. Negotiated Rate |
$3,737.50 |
| Rate for Payer: Aetna Commercial |
$2,840.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,242.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,906.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,906.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,906.12
|
| Rate for Payer: Cigna Commercial |
$3,737.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,943.50
|
| Rate for Payer: Oxford Commercial |
$1,495.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,121.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,495.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$236.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$212.29
|
|
|
SAFEVIEW ENDOSCOP TISS REL SYS
|
Facility
|
IP
|
$7,475.00
|
|
| Hospital Charge Code |
270694890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,121.25 |
| Max. Negotiated Rate |
$1,121.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,121.25
|
|
|
SAGITAL SAW THICK LONG
|
Facility
|
OP
|
$695.00
|
|
| Hospital Charge Code |
270332571
|
|
Hospital Revenue Code
|
272
|
| 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) PPO |
$177.22
|
| Rate for Payer: Cigna Commercial |
$347.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$180.70
|
| Rate for Payer: Oxford Commercial |
$139.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$104.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$139.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.74
|
|
|
SAGITAL SAW THICK LONG
|
Facility
|
IP
|
$695.00
|
|
| Hospital Charge Code |
270332571
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.25 |
| Max. Negotiated Rate |
$104.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$104.25
|
|
|
SAGITTAL BLADE 18.0 X 1.19 X90
|
Facility
|
IP
|
$300.00
|
|
| Hospital Charge Code |
270687901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
|
|
SAGITTAL BLADE 18.0 X 1.19 X90
|
Facility
|
OP
|
$300.00
|
|
| Hospital Charge Code |
270687901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$114.00
|
| Rate for Payer: Aetna Medicare Advantage |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$76.50
|
| Rate for Payer: Cigna Commercial |
$150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$78.00
|
| Rate for Payer: Oxford Commercial |
$60.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$60.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.52
|
|
|
SAGITTAL BLADE 25.0 X 1.27 X 9
|
Facility
|
IP
|
$300.00
|
|
| Hospital Charge Code |
270650287
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
|
|
SAGITTAL BLADE 25.0 X 1.27 X 9
|
Facility
|
OP
|
$300.00
|
|
| Hospital Charge Code |
270650287
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$114.00
|
| Rate for Payer: Aetna Medicare Advantage |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$76.50
|
| Rate for Payer: Cigna Commercial |
$150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$78.00
|
| Rate for Payer: Oxford Commercial |
$60.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$60.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.52
|
|
|
SAGITTAL BLADE 25MMX95MMX1.2MM
|
Facility
|
OP
|
$265.00
|
|
| Hospital Charge Code |
270660097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$132.50 |
| Rate for Payer: Aetna Commercial |
$100.70
|
| Rate for Payer: Aetna Medicare Advantage |
$79.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$67.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$67.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$67.58
|
| Rate for Payer: Cigna Commercial |
$132.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$68.90
|
| Rate for Payer: Oxford Commercial |
$53.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$53.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.53
|
|
|
SAGITTAL BLADE 25MMX95MMX1.2MM
|
Facility
|
IP
|
$265.00
|
|
| Hospital Charge Code |
270660097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.75 |
| Max. Negotiated Rate |
$39.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.75
|
|