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All Charges

Charge

Type

Setting

Price

CATH VCF HIGH FLOW 4FR .035X65

Facility

IP

$550.00

Service Code	HCPCS C1887
Hospital Charge Code	270662848N
Hospital Revenue Code	278
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$133.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

CATH VCF HIGH FLOW 4FR .035X65

Facility

OP

$550.00

Service Code	HCPCS C1887
Hospital Charge Code	270662848N
Hospital Revenue Code	278
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$209.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Community & State	$13.26
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

CATH VCF HIGH FLOW 4FR .035X65

Facility

IP

$550.00

Service Code	HCPCS C1887
Hospital Charge Code	270662848
Hospital Revenue Code	278
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$133.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

CATH VCF HIGH FLOW 4FR .035X65

Facility

OP

$550.00

Service Code	HCPCS C1887
Hospital Charge Code	270662848
Hospital Revenue Code	278
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$209.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Community & State	$13.26
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

CATH VCF HIGH FLOW 4FR .035X65

Facility

IP

$550.00

Service Code	HCPCS C1887
Hospital Charge Code	270662848S
Hospital Revenue Code	278
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$133.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

CATH VCF HIGH FLOW 4FR .035X65

Facility

OP

$550.00

Service Code	HCPCS C1887
Hospital Charge Code	270662848S
Hospital Revenue Code	278
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$209.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Community & State	$13.26
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

CATH VENOUS MRI POR

Facility

IP

$1,149.00

Hospital Charge Code	270606031
Hospital Revenue Code	272
Min. Negotiated Rate	$172.35
Max. Negotiated Rate	$172.35
Rate for Payer: Qualcare PPO/HMO/WC	$172.35

CATH VENOUS MRI POR

Facility

OP

$1,149.00

Hospital Charge Code	270606031
Hospital Revenue Code	272
Min. Negotiated Rate	$27.69
Max. Negotiated Rate	$574.50
Rate for Payer: Aetna Commercial	$436.62
Rate for Payer: Aetna Medicare Advantage	$344.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.00
Rate for Payer: Cigna Commercial	$574.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$344.70
Rate for Payer: Oxford Commercial	$229.80
Rate for Payer: Qualcare PPO/HMO/WC	$172.35
Rate for Payer: UnitedHealthcare Commercial	$229.80
Rate for Payer: UnitedHealthcare Community & State	$27.69
Rate for Payer: Wellpoint Medicaid Managed Care	$30.45

CATH VENT DRAIN 3.14MMX35CM

Facility

OP

$945.00

Service Code	HCPCS C1729
Hospital Charge Code	270695273
Hospital Revenue Code	278
Min. Negotiated Rate	$22.77
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna Commercial	$359.10
Rate for Payer: Aetna Medicare Advantage	$283.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$240.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$240.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$189.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$240.97
Rate for Payer: Cigna Commercial	$472.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$228.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$207.90
Rate for Payer: Qualcare PPO/HMO/WC	$141.75
Rate for Payer: UnitedHealthcare Community & State	$22.77
Rate for Payer: Wellpoint Medicaid Managed Care	$25.04

CATH VENT DRAIN 3.14MMX35CM

Facility

IP

$945.00

Service Code	HCPCS C1729
Hospital Charge Code	270695273
Hospital Revenue Code	278
Min. Negotiated Rate	$141.75
Max. Negotiated Rate	$228.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$189.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$228.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$207.90
Rate for Payer: Qualcare PPO/HMO/WC	$141.75

CATH VENTRICULAR RT ANGLE 9cm

Facility

OP

$810.00

Hospital Charge Code	270647030
Hospital Revenue Code	272
Min. Negotiated Rate	$19.52
Max. Negotiated Rate	$405.00
Rate for Payer: Aetna Commercial	$307.80
Rate for Payer: Aetna Medicare Advantage	$243.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$206.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$206.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$206.55
Rate for Payer: Cigna Commercial	$405.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.00
Rate for Payer: Oxford Commercial	$162.00
Rate for Payer: Qualcare PPO/HMO/WC	$121.50
Rate for Payer: UnitedHealthcare Commercial	$162.00
Rate for Payer: UnitedHealthcare Community & State	$19.52
Rate for Payer: Wellpoint Medicaid Managed Care	$21.46

CATH VENTRICULAR RT ANGLE 9cm

Facility

IP

$810.00

Hospital Charge Code	270647030
Hospital Revenue Code	272
Min. Negotiated Rate	$121.50
Max. Negotiated Rate	$121.50
Rate for Payer: Qualcare PPO/HMO/WC	$121.50

CATH VENTRICULAR STANDARD 23cm

Facility

OP

$800.00

Hospital Charge Code	270647221
Hospital Revenue Code	272
Min. Negotiated Rate	$19.28
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna Commercial	$304.00
Rate for Payer: Aetna Medicare Advantage	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.00
Rate for Payer: Cigna Commercial	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.00
Rate for Payer: Oxford Commercial	$160.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00
Rate for Payer: UnitedHealthcare Commercial	$160.00
Rate for Payer: UnitedHealthcare Community & State	$19.28
Rate for Payer: Wellpoint Medicaid Managed Care	$21.20

CATH VENTRICULAR STANDARD 23cm

Facility

IP

$800.00

Hospital Charge Code	270647221
Hospital Revenue Code	272
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$120.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00

CATH VERIPATH 6FR H/STICK 50cm

Facility

IP

$575.00

Hospital Charge Code	270653090
Hospital Revenue Code	278
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$139.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$126.50
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

CATH VERIPATH 6FR H/STICK 50cm

Facility

OP

$575.00

Hospital Charge Code	270653090
Hospital Revenue Code	278
Min. Negotiated Rate	$13.86
Max. Negotiated Rate	$287.50
Rate for Payer: Aetna Commercial	$218.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$126.50
Rate for Payer: Qualcare PPO/HMO/WC	$86.25
Rate for Payer: UnitedHealthcare Community & State	$13.86
Rate for Payer: Wellpoint Medicaid Managed Care	$15.24

CATH VERIPATH 6FR M/PURP 50cm

Facility

IP

$575.00

Hospital Charge Code	270653060
Hospital Revenue Code	278
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$139.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$126.50
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

CATH VERIPATH 6FR M/PURP 50cm

Facility

OP

$575.00

Hospital Charge Code	270653060
Hospital Revenue Code	278
Min. Negotiated Rate	$13.86
Max. Negotiated Rate	$287.50
Rate for Payer: Aetna Commercial	$218.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$126.50
Rate for Payer: Qualcare PPO/HMO/WC	$86.25
Rate for Payer: UnitedHealthcare Community & State	$13.86
Rate for Payer: Wellpoint Medicaid Managed Care	$15.24

CATH VERIPATH 6FR RDC1 50cm

Facility

IP

$575.00

Hospital Charge Code	270653072
Hospital Revenue Code	278
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$139.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$126.50
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

CATH VERIPATH 6FR RDC1 50cm

Facility

OP

$575.00

Hospital Charge Code	270653072
Hospital Revenue Code	278
Min. Negotiated Rate	$13.86
Max. Negotiated Rate	$287.50
Rate for Payer: Aetna Commercial	$218.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$126.50
Rate for Payer: Qualcare PPO/HMO/WC	$86.25
Rate for Payer: UnitedHealthcare Community & State	$13.86
Rate for Payer: Wellpoint Medicaid Managed Care	$15.24

CATH VERIPATH 6FR RDC 50cm

Facility

IP

$575.00

Hospital Charge Code	270653078
Hospital Revenue Code	278
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$139.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$126.50
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

CATH VERIPATH 6FR RDC 50cm

Facility

OP

$575.00

Hospital Charge Code	270653078
Hospital Revenue Code	278
Min. Negotiated Rate	$13.86
Max. Negotiated Rate	$287.50
Rate for Payer: Aetna Commercial	$218.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$126.50
Rate for Payer: Qualcare PPO/HMO/WC	$86.25
Rate for Payer: UnitedHealthcare Community & State	$13.86
Rate for Payer: Wellpoint Medicaid Managed Care	$15.24

CATH VERIPATH 7FR H/STICK 50cm

Facility

OP

$575.00

Hospital Charge Code	270653091
Hospital Revenue Code	278
Min. Negotiated Rate	$13.86
Max. Negotiated Rate	$287.50
Rate for Payer: Aetna Commercial	$218.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$126.50
Rate for Payer: Qualcare PPO/HMO/WC	$86.25
Rate for Payer: UnitedHealthcare Community & State	$13.86
Rate for Payer: Wellpoint Medicaid Managed Care	$15.24

CATH VERIPATH 7FR H/STICK 50cm

Facility

IP

$575.00

Hospital Charge Code	270653091
Hospital Revenue Code	278
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$139.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$126.50
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

CATH VERIPATH 7FR LIMA 50cm

Facility

IP

$575.00

Hospital Charge Code	270653086
Hospital Revenue Code	278
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$139.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$126.50
Rate for Payer: Qualcare PPO/HMO/WC	$86.25