|
CATH TURBO BOOSTER 7FR 110cm
|
Facility
|
IP
|
$2,625.00
|
|
| Hospital Charge Code |
270639522
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$393.75 |
| Max. Negotiated Rate |
$635.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$525.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$635.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$393.75
|
|
|
CATH TURBO BOOSTER 7FR 110cm
|
Facility
|
OP
|
$2,625.00
|
|
| Hospital Charge Code |
270639522
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$393.75 |
| Max. Negotiated Rate |
$1,312.50 |
| Rate for Payer: Aetna Commercial |
$787.50
|
| Rate for Payer: Aetna Medicare Advantage |
$787.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$669.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$669.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$525.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$669.38
|
| Rate for Payer: Cigna Commercial |
$1,312.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$635.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$393.75
|
|
|
CATH TURBO ELITE OTW 2.0
|
Facility
|
OP
|
$12,500.00
|
|
| Hospital Charge Code |
270638468C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$6,250.00 |
| Rate for Payer: Aetna Commercial |
$3,750.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,187.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,187.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,187.50
|
| Rate for Payer: Cigna Commercial |
$6,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,025.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,875.00
|
|
|
CATH TURBO ELITE OTW 2.0
|
Facility
|
IP
|
$12,500.00
|
|
| Hospital Charge Code |
270638468C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$3,025.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,025.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,875.00
|
|
|
CATH TURBO ELIT OTW 1 4 414151
|
Facility
|
OP
|
$12,500.00
|
|
| Hospital Charge Code |
270638466V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$6,250.00 |
| Rate for Payer: Aetna Commercial |
$3,750.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,187.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,187.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,187.50
|
| Rate for Payer: Cigna Commercial |
$6,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,025.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,875.00
|
|
|
CATH TURBO ELIT OTW 1 4 414151
|
Facility
|
IP
|
$12,500.00
|
|
| Hospital Charge Code |
270638466V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$3,025.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,025.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,875.00
|
|
|
CATH TURBO ELIT OTW 1 7 417152
|
Facility
|
OP
|
$12,500.00
|
|
| Hospital Charge Code |
270638467V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$6,250.00 |
| Rate for Payer: Aetna Commercial |
$3,750.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,187.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,187.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,187.50
|
| Rate for Payer: Cigna Commercial |
$6,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,025.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,875.00
|
|
|
CATH TURBO ELIT OTW 1 7 417152
|
Facility
|
IP
|
$12,500.00
|
|
| Hospital Charge Code |
270638467V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$3,025.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,025.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,875.00
|
|
|
CATH TURBO ELIT OTW 2 0 420006
|
Facility
|
OP
|
$12,500.00
|
|
| Hospital Charge Code |
270638468V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$6,250.00 |
| Rate for Payer: Aetna Commercial |
$3,750.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,187.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,187.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,187.50
|
| Rate for Payer: Cigna Commercial |
$6,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,025.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,875.00
|
|
|
CATH TURBO ELIT OTW 2 0 420006
|
Facility
|
IP
|
$12,500.00
|
|
| Hospital Charge Code |
270638468V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$3,025.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,025.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,875.00
|
|
|
CATH TURBO ELIT OTW 2 3 423001
|
Facility
|
OP
|
$12,500.00
|
|
| Hospital Charge Code |
270638469V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$6,250.00 |
| Rate for Payer: Aetna Commercial |
$3,750.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,187.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,187.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,187.50
|
| Rate for Payer: Cigna Commercial |
$6,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,025.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,875.00
|
|
|
CATH TURBO ELIT OTW 2 3 423001
|
Facility
|
OP
|
$9,040.00
|
|
|
Service Code
|
HCPCS C1885
|
| Hospital Charge Code |
270638469
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,175.20 |
| Max. Negotiated Rate |
$4,520.00 |
| Rate for Payer: Aetna Commercial |
$2,712.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,712.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,305.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,305.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,305.20
|
| Rate for Payer: Cigna Commercial |
$4,520.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,175.20
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,356.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
CATH TURBO ELIT OTW 2 3 423001
|
Facility
|
IP
|
$9,040.00
|
|
|
Service Code
|
HCPCS C1885
|
| Hospital Charge Code |
270638469
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,356.00 |
| Max. Negotiated Rate |
$1,356.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,356.00
|
|
|
CATH TURBO ELIT OTW 2 3 423001
|
Facility
|
IP
|
$12,500.00
|
|
| Hospital Charge Code |
270638469V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$3,025.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,025.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,875.00
|
|
|
CATH TURBO ELTE OTW 0 9 410152
|
Facility
|
OP
|
$12,500.00
|
|
| Hospital Charge Code |
270638465V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$6,250.00 |
| Rate for Payer: Aetna Commercial |
$3,750.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,187.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,187.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,187.50
|
| Rate for Payer: Cigna Commercial |
$6,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,025.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,875.00
|
|
|
CATH TURBO ELTE OTW 0 9 410152
|
Facility
|
IP
|
$12,500.00
|
|
| Hospital Charge Code |
270638465V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$3,025.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,025.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,875.00
|
|
|
CATH TURBO ELTE OTW 0 9 410152
|
Facility
|
IP
|
$12,500.00
|
|
| Hospital Charge Code |
270638465C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$3,025.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,025.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,875.00
|
|
|
CATH TURBO ELTE OTW 0 9 410152
|
Facility
|
OP
|
$12,500.00
|
|
| Hospital Charge Code |
270638465C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$6,250.00 |
| Rate for Payer: Aetna Commercial |
$3,750.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,187.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,187.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,187.50
|
| Rate for Payer: Cigna Commercial |
$6,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,025.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,875.00
|
|
|
CATH TURBOHAWK 6CM TIP
|
Facility
|
OP
|
$16,975.00
|
|
|
Service Code
|
HCPCS C1885
|
| Hospital Charge Code |
270644411C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,546.25 |
| Max. Negotiated Rate |
$8,487.50 |
| Rate for Payer: Aetna Commercial |
$5,092.50
|
| Rate for Payer: Aetna Medicare Advantage |
$5,092.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,328.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,328.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,328.62
|
| Rate for Payer: Cigna Commercial |
$8,487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,107.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,546.25
|
|
|
CATH TURBOHAWK 6CM TIP
|
Facility
|
IP
|
$16,975.00
|
|
|
Service Code
|
HCPCS C1885
|
| Hospital Charge Code |
270644411C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,546.25 |
| Max. Negotiated Rate |
$4,107.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,107.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,546.25
|
|
|
CATH TURBOHAWK 6F 133x3.9x20cm
|
Facility
|
IP
|
$16,975.00
|
|
|
Service Code
|
HCPCS C1885
|
| Hospital Charge Code |
270645549C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,546.25 |
| Max. Negotiated Rate |
$4,107.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,107.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,546.25
|
|
|
CATH TURBOHAWK 6F 133x3.9x20cm
|
Facility
|
OP
|
$16,000.00
|
|
|
Service Code
|
HCPCS C1885
|
| Hospital Charge Code |
270645549N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,400.00 |
| Max. Negotiated Rate |
$8,000.00 |
| Rate for Payer: Aetna Commercial |
$4,800.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,080.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,080.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,080.00
|
| Rate for Payer: Cigna Commercial |
$8,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,872.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,400.00
|
|
|
CATH TURBOHAWK 6F 133x3.9x20cm
|
Facility
|
OP
|
$16,975.00
|
|
|
Service Code
|
HCPCS C1885
|
| Hospital Charge Code |
270645549C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,546.25 |
| Max. Negotiated Rate |
$8,487.50 |
| Rate for Payer: Aetna Commercial |
$5,092.50
|
| Rate for Payer: Aetna Medicare Advantage |
$5,092.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,328.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,328.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,328.62
|
| Rate for Payer: Cigna Commercial |
$8,487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,107.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,546.25
|
|
|
CATH TURBOHAWK 6F 133x3.9x20cm
|
Facility
|
OP
|
$16,975.00
|
|
|
Service Code
|
HCPCS C1885
|
| Hospital Charge Code |
270645549
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,546.25 |
| Max. Negotiated Rate |
$8,487.50 |
| Rate for Payer: Aetna Commercial |
$5,092.50
|
| Rate for Payer: Aetna Medicare Advantage |
$5,092.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,328.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,328.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,328.62
|
| Rate for Payer: Cigna Commercial |
$8,487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,107.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,546.25
|
|
|
CATH TURBOHAWK 6F 133x3.9x20cm
|
Facility
|
IP
|
$16,975.00
|
|
|
Service Code
|
HCPCS C1885
|
| Hospital Charge Code |
270645549
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,546.25 |
| Max. Negotiated Rate |
$4,107.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,107.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,546.25
|
|