|
CATH LASER GUIDE 2.0x7FR TURBO
|
Facility
|
IP
|
$12,500.00
|
|
| Hospital Charge Code |
270646807
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$1,875.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,875.00
|
|
|
CATH LAUNCHER 7FR EBU 3.5
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270645940
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$54.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
CATH LAUNCHER 7FR EBU 3.5
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270645940
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Medicare Advantage |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.38
|
| Rate for Payer: Cigna Commercial |
$112.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
CATH LAUNCHER IMA 6FR 55cm
|
Facility
|
OP
|
$245.00
|
|
| Hospital Charge Code |
270645686C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$122.50 |
| Rate for Payer: Aetna Commercial |
$73.50
|
| 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) NJ Health |
$49.00
|
| 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 |
$59.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
|
|
CATH LAUNCHER IMA 6FR 55cm
|
Facility
|
IP
|
$245.00
|
|
| Hospital Charge Code |
270645686
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$59.29 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$49.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
|
|
CATH LAUNCHER IMA 6FR 55cm
|
Facility
|
OP
|
$245.00
|
|
| Hospital Charge Code |
270645686
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$122.50 |
| Rate for Payer: Aetna Commercial |
$73.50
|
| 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) NJ Health |
$49.00
|
| 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 |
$59.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
|
|
CATH LAUNCHER IMA 6FR 55cm
|
Facility
|
IP
|
$245.00
|
|
| Hospital Charge Code |
270645686C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$59.29 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$49.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
|
|
CATH LAUNCHER PK1 6FR 47cm
|
Facility
|
IP
|
$245.00
|
|
| Hospital Charge Code |
270645462C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$59.29 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$49.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
|
|
CATH LAUNCHER PK1 6FR 47cm
|
Facility
|
OP
|
$245.00
|
|
| Hospital Charge Code |
270645462C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$122.50 |
| Rate for Payer: Aetna Commercial |
$73.50
|
| 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) NJ Health |
$49.00
|
| 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 |
$59.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
|
|
CATH LAUNCHER PK1 7FR 47cm
|
Facility
|
OP
|
$245.00
|
|
| Hospital Charge Code |
270645473C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$122.50 |
| Rate for Payer: Aetna Commercial |
$73.50
|
| 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) NJ Health |
$49.00
|
| 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 |
$59.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
|
|
CATH LAUNCHER PK1 7FR 47cm
|
Facility
|
IP
|
$245.00
|
|
| Hospital Charge Code |
270645473C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$59.29 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$49.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
|
|
CATH LAUNCHER RDC 6FR 55cm
|
Facility
|
OP
|
$245.00
|
|
| Hospital Charge Code |
270645468C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$122.50 |
| Rate for Payer: Aetna Commercial |
$73.50
|
| 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) NJ Health |
$49.00
|
| 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 |
$59.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
|
|
CATH LAUNCHER RDC 6FR 55cm
|
Facility
|
IP
|
$245.00
|
|
| Hospital Charge Code |
270645468C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$59.29 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$49.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
|
|
CATH LAUNCHER RDC 7FR 55cm
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270645469C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$54.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
CATH LAUNCHER RDC 7FR 55cm
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270645469C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Medicare Advantage |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.38
|
| Rate for Payer: Cigna Commercial |
$112.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
CATH LIFEPORT DT 8.4FR LPS7513
|
Facility
|
IP
|
$1,165.65
|
|
| Hospital Charge Code |
270636940
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$174.85 |
| Max. Negotiated Rate |
$282.09 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$233.13
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$282.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$174.85
|
|
|
CATH LIFEPORT DT 8.4FR LPS7513
|
Facility
|
OP
|
$1,165.65
|
|
| Hospital Charge Code |
270636940
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$174.85 |
| Max. Negotiated Rate |
$582.83 |
| Rate for Payer: Aetna Commercial |
$349.69
|
| Rate for Payer: Aetna Medicare Advantage |
$349.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$297.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$297.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$233.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$297.24
|
| Rate for Payer: Cigna Commercial |
$582.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$282.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$174.85
|
|
|
CATH LIFEPORT DUAL LPS-7255
|
Facility
|
OP
|
$2,872.00
|
|
| Hospital Charge Code |
270626552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.80 |
| Max. Negotiated Rate |
$1,436.00 |
| Rate for Payer: Aetna Commercial |
$861.60
|
| Rate for Payer: Aetna Medicare Advantage |
$861.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$732.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$732.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$574.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$732.36
|
| Rate for Payer: Cigna Commercial |
$1,436.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$695.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$430.80
|
|
|
CATH LIFEPORT DUAL LPS-7255
|
Facility
|
IP
|
$2,872.00
|
|
| Hospital Charge Code |
270626552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.80 |
| Max. Negotiated Rate |
$695.02 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$574.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$695.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$430.80
|
|
|
CATH LNCHR 7FR EBU 3.5 LA7EU35
|
Facility
|
OP
|
$245.00
|
|
| Hospital Charge Code |
270645940C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$122.50 |
| Rate for Payer: Aetna Commercial |
$73.50
|
| 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) NJ Health |
$49.00
|
| 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 |
$59.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
|
|
CATH LNCHR 7FR EBU 3.5 LA7EU35
|
Facility
|
IP
|
$245.00
|
|
| Hospital Charge Code |
270645940C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$59.29 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$49.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
|
|
CATH LNCHR 7FR EBU 3 LA7EBU30
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270645939C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$59.29 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$49.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
|
|
CATH LNCHR 7FR EBU 3 LA7EBU30
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270645939C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$122.50 |
| Rate for Payer: Aetna Commercial |
$73.50
|
| 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) NJ Health |
$49.00
|
| 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 |
$59.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
|
|
CATH LNCHR 7FR EBU4.0 LA7EBU40
|
Facility
|
OP
|
$245.00
|
|
| Hospital Charge Code |
270645942C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$122.50 |
| Rate for Payer: Aetna Commercial |
$73.50
|
| 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) NJ Health |
$49.00
|
| 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 |
$59.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
|
|
CATH LNCHR 7FR EBU4.0 LA7EBU40
|
Facility
|
IP
|
$245.00
|
|
| Hospital Charge Code |
270645942C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$59.29 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$49.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
|