Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

THROMBECTOMY SET AVX ULTRA

Facility

OP

$3,625.00

Hospital Charge Code	270657876
Hospital Revenue Code	278
Min. Negotiated Rate	$87.36
Max. Negotiated Rate	$1,812.50
Rate for Payer: Aetna Commercial	$1,377.50
Rate for Payer: Aetna Medicare Advantage	$1,087.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$924.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$924.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$924.38
Rate for Payer: Cigna Commercial	$1,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$877.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$797.50
Rate for Payer: Qualcare PPO/HMO/WC	$543.75
Rate for Payer: UnitedHealthcare Community & State	$87.36
Rate for Payer: Wellpoint Medicaid Managed Care	$96.06

THROMBECTOMY SET AVX ULTRA

Facility

IP

$3,625.00

Hospital Charge Code	270657876
Hospital Revenue Code	278
Min. Negotiated Rate	$543.75
Max. Negotiated Rate	$877.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$877.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$797.50
Rate for Payer: Qualcare PPO/HMO/WC	$543.75

THROMBECTOMY SET AVX ULTRA

Facility

IP

$3,625.00

Hospital Charge Code	2709006400
Hospital Revenue Code	272
Min. Negotiated Rate	$543.75
Max. Negotiated Rate	$543.75
Rate for Payer: Qualcare PPO/HMO/WC	$543.75

THROMBECTOMY SET AVX ULTRA

Facility

OP

$3,625.00

Hospital Charge Code	2709006400
Hospital Revenue Code	272
Min. Negotiated Rate	$87.36
Max. Negotiated Rate	$1,812.50
Rate for Payer: Aetna Commercial	$1,377.50
Rate for Payer: Aetna Medicare Advantage	$1,087.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$924.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$924.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$924.38
Rate for Payer: Cigna Commercial	$1,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,087.50
Rate for Payer: Oxford Commercial	$725.00
Rate for Payer: Qualcare PPO/HMO/WC	$543.75
Rate for Payer: UnitedHealthcare Commercial	$725.00
Rate for Payer: UnitedHealthcare Community & State	$87.36
Rate for Payer: Wellpoint Medicaid Managed Care	$96.06

THROMBECTOMY SET SOLENT OMNI U

Facility

IP

$8,450.00

Service Code	HCPCS C1757
Hospital Charge Code	270648590
Hospital Revenue Code	278
Min. Negotiated Rate	$1,267.50
Max. Negotiated Rate	$2,044.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,690.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,044.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,859.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,267.50

THROMBECTOMY SET SOLENT OMNI U

Facility

IP

$9,600.00

Service Code	HCPCS C1757
Hospital Charge Code	270648590N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,440.00
Max. Negotiated Rate	$2,323.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,920.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,323.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,112.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,440.00

THROMBECTOMY SET SOLENT OMNI U

Facility

OP

$9,600.00

Service Code	HCPCS C1757
Hospital Charge Code	270648590N
Hospital Revenue Code	278
Min. Negotiated Rate	$231.36
Max. Negotiated Rate	$4,800.00
Rate for Payer: Aetna Commercial	$3,648.00
Rate for Payer: Aetna Medicare Advantage	$2,880.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,448.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,448.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,920.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,448.00
Rate for Payer: Cigna Commercial	$4,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,323.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,112.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,440.00
Rate for Payer: UnitedHealthcare Community & State	$231.36
Rate for Payer: Wellpoint Medicaid Managed Care	$254.40

THROMBECTOMY SET SOLENT OMNI U

Facility

IP

$8,450.00

Service Code	HCPCS C1757
Hospital Charge Code	270648590S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,267.50
Max. Negotiated Rate	$2,044.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,690.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,044.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,859.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,267.50

THROMBECTOMY SET SOLENT OMNI U

Facility

OP

$8,450.00

Service Code	HCPCS C1757
Hospital Charge Code	270648590
Hospital Revenue Code	278
Min. Negotiated Rate	$203.65
Max. Negotiated Rate	$4,225.00
Rate for Payer: Aetna Commercial	$3,211.00
Rate for Payer: Aetna Medicare Advantage	$2,535.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,154.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,154.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,690.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,154.75
Rate for Payer: Cigna Commercial	$4,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,044.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,859.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,267.50
Rate for Payer: UnitedHealthcare Community & State	$203.65
Rate for Payer: Wellpoint Medicaid Managed Care	$223.93

THROMBECTOMY SET SOLENT OMNI U

Facility

OP

$8,450.00

Service Code	HCPCS C1757
Hospital Charge Code	270648590S
Hospital Revenue Code	278
Min. Negotiated Rate	$203.65
Max. Negotiated Rate	$4,225.00
Rate for Payer: Aetna Commercial	$3,211.00
Rate for Payer: Aetna Medicare Advantage	$2,535.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,154.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,154.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,690.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,154.75
Rate for Payer: Cigna Commercial	$4,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,044.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,859.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,267.50
Rate for Payer: UnitedHealthcare Community & State	$203.65
Rate for Payer: Wellpoint Medicaid Managed Care	$223.93

THROMBECTOMY SET SOLENT PROXI

Facility

IP

$9,100.00

Service Code	HCPCS C1757
Hospital Charge Code	270657885
Hospital Revenue Code	278
Min. Negotiated Rate	$1,365.00
Max. Negotiated Rate	$2,202.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,820.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,202.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,002.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,365.00

THROMBECTOMY SET SOLENT PROXI

Facility

OP

$9,100.00

Service Code	HCPCS C1757
Hospital Charge Code	270657885
Hospital Revenue Code	278
Min. Negotiated Rate	$219.31
Max. Negotiated Rate	$4,550.00
Rate for Payer: Aetna Commercial	$3,458.00
Rate for Payer: Aetna Medicare Advantage	$2,730.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,320.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,320.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,820.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,320.50
Rate for Payer: Cigna Commercial	$4,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,202.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,002.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,365.00
Rate for Payer: UnitedHealthcare Community & State	$219.31
Rate for Payer: Wellpoint Medicaid Managed Care	$241.15

THROMBECTOMY SET SO OMNI ULTRA

Facility

IP

$9,600.00

Hospital Charge Code	2709007191
Hospital Revenue Code	272
Min. Negotiated Rate	$1,440.00
Max. Negotiated Rate	$1,440.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,440.00

THROMBECTOMY SET SO OMNI ULTRA

Facility

OP

$9,600.00

Hospital Charge Code	2709007191
Hospital Revenue Code	272
Min. Negotiated Rate	$231.36
Max. Negotiated Rate	$4,800.00
Rate for Payer: Aetna Commercial	$3,648.00
Rate for Payer: Aetna Medicare Advantage	$2,880.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,448.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,448.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,448.00
Rate for Payer: Cigna Commercial	$4,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,880.00
Rate for Payer: Oxford Commercial	$1,920.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,440.00
Rate for Payer: UnitedHealthcare Commercial	$1,920.00
Rate for Payer: UnitedHealthcare Community & State	$231.36
Rate for Payer: Wellpoint Medicaid Managed Care	$254.40

THROMBECTOMY SET SO PROX ULTRA

Facility

OP

$9,100.00

Hospital Charge Code	2709007190
Hospital Revenue Code	272
Min. Negotiated Rate	$219.31
Max. Negotiated Rate	$4,550.00
Rate for Payer: Aetna Commercial	$3,458.00
Rate for Payer: Aetna Medicare Advantage	$2,730.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,320.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,320.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,320.50
Rate for Payer: Cigna Commercial	$4,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,730.00
Rate for Payer: Oxford Commercial	$1,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,365.00
Rate for Payer: UnitedHealthcare Commercial	$1,820.00
Rate for Payer: UnitedHealthcare Community & State	$219.31
Rate for Payer: Wellpoint Medicaid Managed Care	$241.15

THROMBECTOMY SET SO PROX ULTRA

Facility

IP

$9,100.00

Hospital Charge Code	2709007190
Hospital Revenue Code	272
Min. Negotiated Rate	$1,365.00
Max. Negotiated Rate	$1,365.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,365.00

THROMBECTOMY SET SPIROFLEX

Facility

IP

$2,070.00

Service Code	HCPCS C1757
Hospital Charge Code	270645707N
Hospital Revenue Code	278
Min. Negotiated Rate	$310.50
Max. Negotiated Rate	$500.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$414.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$500.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$455.40
Rate for Payer: Qualcare PPO/HMO/WC	$310.50

THROMBECTOMY SET SPIROFLEX

Facility

IP

$10,750.00

Service Code	HCPCS C1757
Hospital Charge Code	270645707S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,365.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

THROMBECTOMY SET SPIROFLEX

Facility

OP

$10,750.00

Service Code	HCPCS C1757
Hospital Charge Code	270645707S
Hospital Revenue Code	278
Min. Negotiated Rate	$259.07
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$4,085.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,365.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50
Rate for Payer: UnitedHealthcare Community & State	$259.07
Rate for Payer: Wellpoint Medicaid Managed Care	$284.88

THROMBECTOMY SET SPIROFLEX

Facility

OP

$2,070.00

Service Code	HCPCS C1757
Hospital Charge Code	270645707N
Hospital Revenue Code	278
Min. Negotiated Rate	$49.89
Max. Negotiated Rate	$1,035.00
Rate for Payer: Aetna Commercial	$786.60
Rate for Payer: Aetna Medicare Advantage	$621.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$527.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$527.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$414.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$527.85
Rate for Payer: Cigna Commercial	$1,035.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$500.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$455.40
Rate for Payer: Qualcare PPO/HMO/WC	$310.50
Rate for Payer: UnitedHealthcare Community & State	$49.89
Rate for Payer: Wellpoint Medicaid Managed Care	$54.85

THROMBECTOMY SET SPIROFLEX UL

Facility

IP

$10,750.00

Service Code	HCPCS C1757
Hospital Charge Code	270645707
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,365.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

THROMBECTOMY SET SPIROFLEX UL

Facility

OP

$10,750.00

Service Code	HCPCS C1757
Hospital Charge Code	270645707
Hospital Revenue Code	278
Min. Negotiated Rate	$259.07
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$4,085.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,365.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50
Rate for Payer: UnitedHealthcare Community & State	$259.07
Rate for Payer: Wellpoint Medicaid Managed Care	$284.88

THROMBECTOMY SET SPIROFLEX ULT

Facility

OP

$10,350.00

Hospital Charge Code	2709006399
Hospital Revenue Code	272
Min. Negotiated Rate	$249.44
Max. Negotiated Rate	$5,175.00
Rate for Payer: Aetna Commercial	$3,933.00
Rate for Payer: Aetna Medicare Advantage	$3,105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,639.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,639.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,639.25
Rate for Payer: Cigna Commercial	$5,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,105.00
Rate for Payer: Oxford Commercial	$2,070.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,552.50
Rate for Payer: UnitedHealthcare Commercial	$2,070.00
Rate for Payer: UnitedHealthcare Community & State	$249.44
Rate for Payer: Wellpoint Medicaid Managed Care	$274.27

THROMBECTOMY SET SPIROFLEX ULT

Facility

IP

$10,350.00

Hospital Charge Code	2709006399
Hospital Revenue Code	272
Min. Negotiated Rate	$1,552.50
Max. Negotiated Rate	$1,552.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,552.50

THROMBIN (BOVINE) 5000 U VIAL

Facility

IP

$577.00

Service Code	NDC 60793021505
Hospital Charge Code	606390276
Hospital Revenue Code	250
Min. Negotiated Rate	$86.55
Max. Negotiated Rate	$86.55
Rate for Payer: Qualcare PPO/HMO/WC	$86.55