|
GLIDECATH N/TAPER 4F 100 32172
|
Facility
|
IP
|
$253.25
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270630470S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.99 |
| Max. Negotiated Rate |
$61.29 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$50.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$61.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.99
|
|
|
GLIDECATH N/TAPER 4F 100 32172
|
Facility
|
OP
|
$307.60
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270630470N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.14 |
| Max. Negotiated Rate |
$153.80 |
| Rate for Payer: Aetna Commercial |
$92.28
|
| Rate for Payer: Aetna Medicare Advantage |
$92.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$78.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$78.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$61.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$78.44
|
| Rate for Payer: Cigna Commercial |
$153.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$74.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.14
|
|
|
GLIDECATH N/TAPER 4F 100 32172
|
Facility
|
IP
|
$253.25
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270630470
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.99 |
| Max. Negotiated Rate |
$61.29 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$50.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$61.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.99
|
|
|
GLIDECATH N/TAPER 4F 100 32172
|
Facility
|
OP
|
$253.25
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270630470S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.99 |
| Max. Negotiated Rate |
$126.62 |
| Rate for Payer: Aetna Commercial |
$75.97
|
| Rate for Payer: Aetna Medicare Advantage |
$75.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$50.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.58
|
| Rate for Payer: Cigna Commercial |
$126.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$61.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.99
|
|
|
GLIDECATH N/TAPER 4F 100 32172
|
Facility
|
OP
|
$253.25
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270630470
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.99 |
| Max. Negotiated Rate |
$126.62 |
| Rate for Payer: Aetna Commercial |
$75.97
|
| Rate for Payer: Aetna Medicare Advantage |
$75.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$50.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.58
|
| Rate for Payer: Cigna Commercial |
$126.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$61.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.99
|
|
|
GLIDECATH N/TAPER 4F 100 32172
|
Facility
|
IP
|
$307.60
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270630470N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.14 |
| Max. Negotiated Rate |
$74.44 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$61.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$74.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.14
|
|
|
GLIDECATH NTAPER 4F 100c 32173
|
Facility
|
IP
|
$1,775.00
|
|
| Hospital Charge Code |
270623515
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.25 |
| Max. Negotiated Rate |
$429.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$355.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$429.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$266.25
|
|
|
GLIDECATH NTAPER 4F 100c 32173
|
Facility
|
OP
|
$1,775.00
|
|
| Hospital Charge Code |
270623515
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.25 |
| Max. Negotiated Rate |
$887.50 |
| Rate for Payer: Aetna Commercial |
$532.50
|
| Rate for Payer: Aetna Medicare Advantage |
$532.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$452.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$452.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$355.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$452.62
|
| Rate for Payer: Cigna Commercial |
$887.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$429.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$266.25
|
|
|
GLIDECATH NTAPER 4F 100c 32173
|
Facility
|
OP
|
$288.55
|
|
| Hospital Charge Code |
270623515V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$43.28 |
| Max. Negotiated Rate |
$144.28 |
| Rate for Payer: Aetna Commercial |
$86.56
|
| Rate for Payer: Aetna Medicare Advantage |
$86.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$73.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$73.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$57.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$73.58
|
| Rate for Payer: Cigna Commercial |
$144.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$69.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$43.28
|
|
|
GLIDECATH NTAPER 4F 100c 32173
|
Facility
|
OP
|
$253.25
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270623515S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.99 |
| Max. Negotiated Rate |
$126.62 |
| Rate for Payer: Aetna Commercial |
$75.97
|
| Rate for Payer: Aetna Medicare Advantage |
$75.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$50.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.58
|
| Rate for Payer: Cigna Commercial |
$126.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$61.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.99
|
|
|
GLIDECATH NTAPER 4F 100c 32173
|
Facility
|
IP
|
$273.65
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270623515N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.05 |
| Max. Negotiated Rate |
$66.22 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$54.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$66.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.05
|
|
|
GLIDECATH NTAPER 4F 100c 32173
|
Facility
|
IP
|
$253.25
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270623515S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.99 |
| Max. Negotiated Rate |
$61.29 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$50.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$61.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.99
|
|
|
GLIDECATH NTAPER 4F 100c 32173
|
Facility
|
IP
|
$288.55
|
|
| Hospital Charge Code |
270623515V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$43.28 |
| Max. Negotiated Rate |
$69.83 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$57.71
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$69.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$43.28
|
|
|
GLIDECATH NTAPER 4F 100c 32173
|
Facility
|
OP
|
$273.65
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270623515N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.05 |
| Max. Negotiated Rate |
$136.82 |
| Rate for Payer: Aetna Commercial |
$82.09
|
| Rate for Payer: Aetna Medicare Advantage |
$82.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$69.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$69.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$54.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$69.78
|
| Rate for Payer: Cigna Commercial |
$136.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$66.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.05
|
|
|
GLIDECATH N/TAPER 4FR 100x038
|
Facility
|
OP
|
$1,775.00
|
|
| Hospital Charge Code |
270705313
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$230.75 |
| Max. Negotiated Rate |
$887.50 |
| Rate for Payer: Aetna Commercial |
$532.50
|
| Rate for Payer: Aetna Medicare Advantage |
$532.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$452.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$452.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$452.62
|
| Rate for Payer: Cigna Commercial |
$887.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$230.75
|
| Rate for Payer: Oxford Commercial |
$887.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$266.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$887.50
|
|
|
GLIDECATH N/TAPER 4FR 100x038
|
Facility
|
IP
|
$1,775.00
|
|
| Hospital Charge Code |
270705313
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$266.25 |
| Max. Negotiated Rate |
$266.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$266.25
|
|
|
GLIDECATH N/TAPER 4FR 150x038
|
Facility
|
IP
|
$1,775.00
|
|
| Hospital Charge Code |
270705314
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$266.25 |
| Max. Negotiated Rate |
$266.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$266.25
|
|
|
GLIDECATH N/TAPER 4FR 150x038
|
Facility
|
OP
|
$1,775.00
|
|
| Hospital Charge Code |
270705314
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$230.75 |
| Max. Negotiated Rate |
$887.50 |
| Rate for Payer: Aetna Commercial |
$532.50
|
| Rate for Payer: Aetna Medicare Advantage |
$532.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$452.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$452.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$452.62
|
| Rate for Payer: Cigna Commercial |
$887.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$230.75
|
| Rate for Payer: Oxford Commercial |
$887.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$266.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$887.50
|
|
|
GLIDECATH SIM3 5FR 100CM
|
Facility
|
IP
|
$74.30
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270681564S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.14 |
| Max. Negotiated Rate |
$17.98 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.14
|
|
|
GLIDECATH SIM3 5FR 100CM
|
Facility
|
OP
|
$74.30
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270681564S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.14 |
| Max. Negotiated Rate |
$37.15 |
| Rate for Payer: Aetna Commercial |
$22.29
|
| Rate for Payer: Aetna Medicare Advantage |
$22.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.95
|
| Rate for Payer: Cigna Commercial |
$37.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.14
|
|
|
GLIDECATH STR 150CM 4FR D-BRD
|
Facility
|
IP
|
$1,080.00
|
|
| Hospital Charge Code |
270665134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.00
|
|
|
GLIDECATH STR 150CM 4FR D-BRD
|
Facility
|
OP
|
$1,080.00
|
|
| Hospital Charge Code |
270665134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna Commercial |
$324.00
|
| Rate for Payer: Aetna Medicare Advantage |
$324.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$275.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$275.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$275.40
|
| Rate for Payer: Cigna Commercial |
$540.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$140.40
|
| Rate for Payer: Oxford Commercial |
$540.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$540.00
|
|
|
GLIDECATH STRAIGHT 4FR 65cm
|
Facility
|
OP
|
$357.50
|
|
|
Service Code
|
HCPCS C2629
|
| Hospital Charge Code |
270645472C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.62 |
| Max. Negotiated Rate |
$178.75 |
| Rate for Payer: Aetna Commercial |
$107.25
|
| Rate for Payer: Aetna Medicare Advantage |
$107.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$91.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$91.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$71.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$91.16
|
| Rate for Payer: Cigna Commercial |
$178.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$86.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.62
|
|
|
GLIDECATH STRAIGHT 4FR 65cm
|
Facility
|
IP
|
$357.50
|
|
|
Service Code
|
HCPCS C2629
|
| Hospital Charge Code |
270645472C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.62 |
| Max. Negotiated Rate |
$86.52 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$71.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$86.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.62
|
|
|
GLIDECATH TORCON NB SIM1 5F 10
|
Facility
|
IP
|
$74.30
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270681566S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.14 |
| Max. Negotiated Rate |
$17.98 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.14
|
|
