|
SYRINGE CONTROL 10cc W/LUERLOK
|
Facility
|
OP
|
$3.95
|
|
| Hospital Charge Code |
270621577
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna Commercial |
$1.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.01
|
| Rate for Payer: Cigna Commercial |
$1.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.03
|
| Rate for Payer: Oxford Commercial |
$0.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.59
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.79
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.11
|
|
|
SYRINGE CONTROL 10cc W/LUERLOK
|
Facility
|
IP
|
$3.95
|
|
| Hospital Charge Code |
270621577
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.59
|
|
|
SYRINGE CONTROL 12ML CCS600
|
Facility
|
OP
|
$26.45
|
|
| Hospital Charge Code |
270624016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$13.22 |
| Rate for Payer: Aetna Commercial |
$10.05
|
| Rate for Payer: Aetna Medicare Advantage |
$7.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6.74
|
| Rate for Payer: Cigna Commercial |
$13.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.88
|
| Rate for Payer: Oxford Commercial |
$5.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.97
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.29
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.75
|
|
|
SYRINGE CONTROL 12ML CCS600
|
Facility
|
IP
|
$26.45
|
|
| Hospital Charge Code |
270624016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$3.97 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.97
|
|
|
SYRINGE DIGIFLATOR INFLATIO
|
Facility
|
OP
|
$158.00
|
|
| Hospital Charge Code |
270650911
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$79.00 |
| Rate for Payer: Aetna Commercial |
$60.04
|
| Rate for Payer: Aetna Medicare Advantage |
$47.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$40.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$40.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$40.29
|
| Rate for Payer: Cigna Commercial |
$79.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$41.08
|
| Rate for Payer: Oxford Commercial |
$31.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$31.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.49
|
|
|
SYRINGE DIGIFLATOR INFLATIO
|
Facility
|
IP
|
$158.00
|
|
| Hospital Charge Code |
270650911
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.70 |
| Max. Negotiated Rate |
$23.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.70
|
|
|
SYRINGE EMBOSPHERE 2ML S420GH
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
270658213
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.19 |
| Max. Negotiated Rate |
$126.50 |
| Rate for Payer: Aetna Commercial |
$96.14
|
| Rate for Payer: Aetna Medicare Advantage |
$75.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$50.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.52
|
| Rate for Payer: Cigna Commercial |
$126.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$61.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.95
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.19
|
|
|
SYRINGE EMBOSPHERE 2ML S420GH
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
270658213S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.95 |
| Max. Negotiated Rate |
$61.23 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$50.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$61.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.95
|
|
|
SYRINGE EMBOSPHERE 2ML S420GH
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
270658213S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.19 |
| Max. Negotiated Rate |
$126.50 |
| Rate for Payer: Aetna Commercial |
$96.14
|
| Rate for Payer: Aetna Medicare Advantage |
$75.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$50.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.52
|
| Rate for Payer: Cigna Commercial |
$126.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$61.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.95
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.19
|
|
|
SYRINGE EMBOSPHERE 2ML S420GH
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
270658213
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.95 |
| Max. Negotiated Rate |
$61.23 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$50.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$61.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.95
|
|
|
SYRINGE EMBOSPHERE 2ML S420GHC
|
Facility
|
OP
|
$1,215.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
270687184
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.51 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Aetna Commercial |
$461.70
|
| Rate for Payer: Aetna Medicare Advantage |
$364.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$309.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$309.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$243.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$309.82
|
| Rate for Payer: Cigna Commercial |
$607.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$294.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$182.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$38.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$34.51
|
|
|
SYRINGE EMBOSPHERE 2ML S420GHC
|
Facility
|
IP
|
$1,215.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
270687184
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$182.25 |
| Max. Negotiated Rate |
$294.03 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$243.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$294.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$182.25
|
|
|
SYRINGE EMBOSPHERE 2ML S620GH
|
Facility
|
OP
|
$253.00
|
|
| Hospital Charge Code |
270631462N
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.19 |
| Max. Negotiated Rate |
$126.50 |
| Rate for Payer: Aetna Commercial |
$96.14
|
| Rate for Payer: Aetna Medicare Advantage |
$75.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.52
|
| Rate for Payer: Cigna Commercial |
$126.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$65.78
|
| Rate for Payer: Oxford Commercial |
$50.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$50.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.19
|
|
|
SYRINGE EMBOSPHERE 2ML S620GH
|
Facility
|
OP
|
$1,215.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
270631462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.51 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Aetna Commercial |
$461.70
|
| Rate for Payer: Aetna Medicare Advantage |
$364.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$309.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$309.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$243.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$309.82
|
| Rate for Payer: Cigna Commercial |
$607.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$294.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$182.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$38.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$34.51
|
|
|
SYRINGE EMBOSPHERE 2ML S620GH
|
Facility
|
OP
|
$1,215.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
270631462S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.51 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Aetna Commercial |
$461.70
|
| Rate for Payer: Aetna Medicare Advantage |
$364.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$309.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$309.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$243.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$309.82
|
| Rate for Payer: Cigna Commercial |
$607.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$294.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$182.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$38.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$34.51
|
|
|
SYRINGE EMBOSPHERE 2ML S620GH
|
Facility
|
IP
|
$1,215.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
270631462S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$182.25 |
| Max. Negotiated Rate |
$294.03 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$243.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$294.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$182.25
|
|
|
SYRINGE EMBOSPHERE 2ML S620GH
|
Facility
|
IP
|
$253.00
|
|
| Hospital Charge Code |
270631462N
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.95 |
| Max. Negotiated Rate |
$37.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.95
|
|
|
SYRINGE EMBOSPHERE 2ML S620GH
|
Facility
|
IP
|
$1,215.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
270631462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$182.25 |
| Max. Negotiated Rate |
$294.03 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$243.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$294.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$182.25
|
|
|
SYRINGE EMBOSPRE 2ML GR S820GH
|
Facility
|
OP
|
$6,200.00
|
|
| Hospital Charge Code |
270631481
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$176.08 |
| Max. Negotiated Rate |
$3,100.00 |
| Rate for Payer: Aetna Commercial |
$2,356.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,860.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,581.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,581.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,581.00
|
| Rate for Payer: Cigna Commercial |
$3,100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,612.00
|
| Rate for Payer: Oxford Commercial |
$1,240.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$930.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,240.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$195.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$176.08
|
|
|
SYRINGE EMBOSPRE 2ML GR S820GH
|
Facility
|
IP
|
$6,200.00
|
|
| Hospital Charge Code |
270631481
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$930.00 |
| Max. Negotiated Rate |
$930.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$930.00
|
|
|
SYRINGE EMBOSPRE 2ML GR S820GH
|
Facility
|
IP
|
$1,215.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
270631481S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$182.25 |
| Max. Negotiated Rate |
$294.03 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$243.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$294.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$182.25
|
|
|
SYRINGE EMBOSPRE 2ML GR S820GH
|
Facility
|
IP
|
$992.00
|
|
| Hospital Charge Code |
270631481N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.80 |
| Max. Negotiated Rate |
$148.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$148.80
|
|
|
SYRINGE EMBOSPRE 2ML GR S820GH
|
Facility
|
OP
|
$1,215.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
270631481S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.51 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Aetna Commercial |
$461.70
|
| Rate for Payer: Aetna Medicare Advantage |
$364.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$309.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$309.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$243.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$309.82
|
| Rate for Payer: Cigna Commercial |
$607.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$294.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$182.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$38.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$34.51
|
|
|
SYRINGE EMBOSPRE 2ML GR S820GH
|
Facility
|
OP
|
$992.00
|
|
| Hospital Charge Code |
270631481N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.17 |
| Max. Negotiated Rate |
$496.00 |
| Rate for Payer: Aetna Commercial |
$376.96
|
| Rate for Payer: Aetna Medicare Advantage |
$297.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$252.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$252.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$252.96
|
| Rate for Payer: Cigna Commercial |
$496.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$257.92
|
| Rate for Payer: Oxford Commercial |
$198.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$148.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$198.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$31.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.17
|
|
|
SYRINGE EPI PULSATOR PLASTIC
|
Facility
|
OP
|
$731.05
|
|
| Hospital Charge Code |
270665061
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.76 |
| Max. Negotiated Rate |
$365.52 |
| Rate for Payer: Aetna Commercial |
$277.80
|
| Rate for Payer: Aetna Medicare Advantage |
$219.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$186.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$186.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$186.42
|
| Rate for Payer: Cigna Commercial |
$365.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$190.07
|
| Rate for Payer: Oxford Commercial |
$146.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$109.66
|
| Rate for Payer: UnitedHealthcare Commercial |
$146.21
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20.76
|
|
