|
DILATOR VESSEL 10FR .038 20cm
|
Facility
|
OP
|
$36.70
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270624076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$18.35 |
| Rate for Payer: Aetna Commercial |
$11.01
|
| Rate for Payer: Aetna Medicare Advantage |
$11.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.36
|
| Rate for Payer: Cigna Commercial |
$18.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.50
|
|
|
DILATOR VESSEL 10FR .038 20cm
|
Facility
|
IP
|
$36.70
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270624076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$8.88 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.50
|
|
|
DILATOR VESSEL 12FR .038 20cm
|
Facility
|
OP
|
$36.70
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270624077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$18.35 |
| Rate for Payer: Aetna Commercial |
$11.01
|
| Rate for Payer: Aetna Medicare Advantage |
$11.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.36
|
| Rate for Payer: Cigna Commercial |
$18.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.50
|
|
|
DILATOR VESSEL 12FR .038 20cm
|
Facility
|
IP
|
$36.70
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270624077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$8.88 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.50
|
|
|
DILATOR VESSEL 14F .038 20CM
|
Facility
|
OP
|
$36.70
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270601491S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$18.35 |
| Rate for Payer: Aetna Commercial |
$11.01
|
| Rate for Payer: Aetna Medicare Advantage |
$11.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.36
|
| Rate for Payer: Cigna Commercial |
$18.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.50
|
|
|
DILATOR VESSEL 14F .038 20CM
|
Facility
|
IP
|
$36.70
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270601491S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$8.88 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.50
|
|
|
DILATOR VESSEL 14FR .038 20cm
|
Facility
|
OP
|
$36.70
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270601491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$18.35 |
| Rate for Payer: Aetna Commercial |
$11.01
|
| Rate for Payer: Aetna Medicare Advantage |
$11.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.36
|
| Rate for Payer: Cigna Commercial |
$18.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.50
|
|
|
DILATOR VESSEL 14FR .038 20cm
|
Facility
|
IP
|
$36.70
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270601491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$8.88 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.50
|
|
|
DILATOR VESSEL -4F .035 15c
|
Facility
|
IP
|
$62.45
|
|
| Hospital Charge Code |
270705305
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$9.37 |
| Max. Negotiated Rate |
$9.37 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.37
|
|
|
DILATOR VESSEL -4F .035 15c
|
Facility
|
OP
|
$62.45
|
|
| Hospital Charge Code |
270705305
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$8.12 |
| Max. Negotiated Rate |
$31.23 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: Aetna Medicare Advantage |
$18.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15.92
|
| Rate for Payer: Cigna Commercial |
$31.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.12
|
| Rate for Payer: Oxford Commercial |
$31.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$31.23
|
|
|
DILATOR VESSEL 4FR- 3339-31
|
Facility
|
IP
|
$260.00
|
|
| Hospital Charge Code |
270677538
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.00
|
|
|
DILATOR VESSEL 4FR- 3339-31
|
Facility
|
OP
|
$260.00
|
|
| Hospital Charge Code |
270677538
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna Commercial |
$78.00
|
| Rate for Payer: Aetna Medicare Advantage |
$78.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$66.30
|
| Rate for Payer: Cigna Commercial |
$130.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.80
|
| Rate for Payer: Oxford Commercial |
$130.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$130.00
|
|
|
DILATOR VESSEL 5FR .038 20cm
|
Facility
|
IP
|
$39.80
|
|
| Hospital Charge Code |
270624075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$5.97 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.97
|
|
|
DILATOR VESSEL 5FR .038 20cm
|
Facility
|
OP
|
$39.80
|
|
| Hospital Charge Code |
270624075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$19.90 |
| Rate for Payer: Aetna Commercial |
$11.94
|
| Rate for Payer: Aetna Medicare Advantage |
$11.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.15
|
| Rate for Payer: Cigna Commercial |
$19.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.17
|
| Rate for Payer: Oxford Commercial |
$19.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.97
|
| Rate for Payer: UnitedHealthcare Commercial |
$19.90
|
|
|
DILATOR VESSEL 5 FR 20 CM
|
Facility
|
IP
|
$42.45
|
|
| Hospital Charge Code |
270682392
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$6.37 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.37
|
|
|
DILATOR VESSEL 5 FR 20 CM
|
Facility
|
OP
|
$42.45
|
|
| Hospital Charge Code |
270682392
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$5.52 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$12.73
|
| Rate for Payer: Aetna Medicare Advantage |
$12.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.82
|
| Rate for Payer: Cigna Commercial |
$21.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.52
|
| Rate for Payer: Oxford Commercial |
$21.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$21.23
|
|
|
DILATOR VESSEL 5FR 20CM
|
Facility
|
OP
|
$50.00
|
|
| Hospital Charge Code |
270331443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Aetna Commercial |
$15.00
|
| Rate for Payer: Aetna Medicare Advantage |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.75
|
| Rate for Payer: Cigna Commercial |
$25.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
|
|
DILATOR VESSEL 5FR 20CM
|
Facility
|
IP
|
$50.00
|
|
| Hospital Charge Code |
270331443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$12.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
|
|
DILATOR VESSEL 5FR.22CM
|
Facility
|
IP
|
$52.00
|
|
| Hospital Charge Code |
270331242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$12.58 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.58
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.80
|
|
|
DILATOR VESSEL 5FR.22CM
|
Facility
|
OP
|
$52.00
|
|
| Hospital Charge Code |
270331242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Aetna Commercial |
$15.60
|
| Rate for Payer: Aetna Medicare Advantage |
$15.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.26
|
| Rate for Payer: Cigna Commercial |
$26.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.58
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.80
|
|
|
DILATOR VESSEL -6F .038 15c
|
Facility
|
OP
|
$42.45
|
|
| Hospital Charge Code |
270705306
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$5.52 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$12.73
|
| Rate for Payer: Aetna Medicare Advantage |
$12.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.82
|
| Rate for Payer: Cigna Commercial |
$21.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.52
|
| Rate for Payer: Oxford Commercial |
$21.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$21.23
|
|
|
DILATOR VESSEL -6F .038 15c
|
Facility
|
IP
|
$42.45
|
|
| Hospital Charge Code |
270705306
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$6.37 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.37
|
|
|
DILATOR VESSEL 6FR .038 20cm
|
Facility
|
IP
|
$36.70
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270624073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$8.88 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.50
|
|
|
DILATOR VESSEL 6FR .038 20cm
|
Facility
|
OP
|
$36.70
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270624073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$18.35 |
| Rate for Payer: Aetna Commercial |
$11.01
|
| Rate for Payer: Aetna Medicare Advantage |
$11.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.36
|
| Rate for Payer: Cigna Commercial |
$18.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.50
|
|
|
DILATOR VESSEL 7FR .038 20cm
|
Facility
|
IP
|
$36.70
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270605470
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$8.88 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.50
|
|