|
ANGIOMAT ILLUMENA CONTRAST SYR
|
Facility
|
IP
|
$32.29
|
|
| Hospital Charge Code |
270667071S
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$4.84 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.84
|
|
|
ANGIOMAT ILLUMENA CONTRAST SYR
|
Facility
|
OP
|
$32.29
|
|
| Hospital Charge Code |
270667071S
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$16.14 |
| Rate for Payer: Aetna Commercial |
$9.69
|
| Rate for Payer: Aetna Medicare Advantage |
$9.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.23
|
| Rate for Payer: Cigna Commercial |
$16.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.20
|
| Rate for Payer: Oxford Commercial |
$16.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.84
|
| Rate for Payer: UnitedHealthcare Commercial |
$16.14
|
|
|
ANGIOMAT ILLUMENA CONTRAST SYR
|
Facility
|
IP
|
$25.00
|
|
| Hospital Charge Code |
270667072
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.75
|
|
|
ANGIOMAT ILLUMENA CONTRAST SYR
|
Facility
|
IP
|
$25.00
|
|
| Hospital Charge Code |
270667071N
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.75
|
|
|
ANGIOMAT ILLUMENA CONTRAST SYR
|
Facility
|
OP
|
$32.29
|
|
| Hospital Charge Code |
270667071
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$16.14 |
| Rate for Payer: Aetna Commercial |
$9.69
|
| Rate for Payer: Aetna Medicare Advantage |
$9.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.23
|
| Rate for Payer: Cigna Commercial |
$16.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.20
|
| Rate for Payer: Oxford Commercial |
$16.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.84
|
| Rate for Payer: UnitedHealthcare Commercial |
$16.14
|
|
|
ANGIOMAT ILLUMENA CONTRAST SYR
|
Facility
|
IP
|
$32.29
|
|
| Hospital Charge Code |
270667071
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$4.84 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.84
|
|
|
ANGIO PELVIC
|
Facility
|
OP
|
$6,122.00
|
|
| Hospital Charge Code |
2009075
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$795.86 |
| Max. Negotiated Rate |
$3,061.00 |
| Rate for Payer: Aetna Commercial |
$1,836.60
|
| Rate for Payer: Aetna Medicare Advantage |
$1,836.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,561.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,561.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,561.11
|
| Rate for Payer: Cigna Commercial |
$3,061.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$795.86
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$918.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
ANGIO PELVIC
|
Facility
|
IP
|
$6,122.00
|
|
| Hospital Charge Code |
2009075
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$918.30 |
| Max. Negotiated Rate |
$918.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$918.30
|
|
|
ANGIOPLASTY WITH STENT
|
Facility
|
OP
|
$15,539.00
|
|
|
Service Code
|
HCPCS 31635
|
| Hospital Charge Code |
1600000519
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$4,661.70 |
| Rate for Payer: Aetna Commercial |
$4,661.70
|
| Rate for Payer: Aetna Medicare Advantage |
$4,661.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,962.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,962.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,962.45
|
| Rate for Payer: Cigna Commercial |
$4,238.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,020.07
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,330.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,687.00
|
|
|
ANGIOPLASTY WITH STENT
|
Facility
|
IP
|
$15,539.00
|
|
|
Service Code
|
HCPCS 31635
|
| Hospital Charge Code |
1600000519
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,330.85 |
| Max. Negotiated Rate |
$2,330.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,330.85
|
|
|
ANGIO SEAL HEMOSTATS 8F 610097
|
Facility
|
IP
|
$1,116.00
|
|
| Hospital Charge Code |
270623508
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$167.40 |
| Max. Negotiated Rate |
$270.07 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$223.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$270.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$167.40
|
|
|
ANGIO SEAL HEMOSTATS 8F 610097
|
Facility
|
OP
|
$1,116.00
|
|
| Hospital Charge Code |
270623508
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$167.40 |
| Max. Negotiated Rate |
$558.00 |
| Rate for Payer: Aetna Commercial |
$334.80
|
| Rate for Payer: Aetna Medicare Advantage |
$334.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$284.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$284.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$223.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$284.58
|
| Rate for Payer: Cigna Commercial |
$558.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$270.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$167.40
|
|
|
ANGIO SEAL KITS 6FR 610119
|
Facility
|
OP
|
$1,205.00
|
|
| Hospital Charge Code |
2707500021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.65 |
| Max. Negotiated Rate |
$602.50 |
| Rate for Payer: Aetna Commercial |
$361.50
|
| Rate for Payer: Aetna Medicare Advantage |
$361.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$307.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$307.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$307.27
|
| Rate for Payer: Cigna Commercial |
$602.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$156.65
|
| Rate for Payer: Oxford Commercial |
$602.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$180.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$602.50
|
|
|
ANGIO SEAL KITS 6FR 610119
|
Facility
|
IP
|
$1,205.00
|
|
| Hospital Charge Code |
2707500021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.75 |
| Max. Negotiated Rate |
$180.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$180.75
|
|
|
ANGIO SEAL STS 6FR 610119
|
Facility
|
IP
|
$1,450.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
270632654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$217.50 |
| Max. Negotiated Rate |
$350.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$290.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$350.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$217.50
|
|
|
ANGIO SEAL STS 6FR 610119
|
Facility
|
OP
|
$1,450.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
270632654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$217.50 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Aetna Commercial |
$435.00
|
| Rate for Payer: Aetna Medicare Advantage |
$435.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$369.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$369.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$290.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$369.75
|
| Rate for Payer: Cigna Commercial |
$725.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$350.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$217.50
|
|
|
ANGIOSEAL VIP 6FR
|
Facility
|
IP
|
$12,000.00
|
|
| Hospital Charge Code |
270637740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$2,904.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,904.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,800.00
|
|
|
ANGIOSEAL VIP 6FR
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
270637740N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.15 |
| Max. Negotiated Rate |
$58.32 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$48.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$58.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.15
|
|
|
ANGIOSEAL VIP 6FR
|
Facility
|
OP
|
$12,000.00
|
|
| Hospital Charge Code |
270637740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$6,000.00 |
| Rate for Payer: Aetna Commercial |
$3,600.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,060.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,060.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,060.00
|
| Rate for Payer: Cigna Commercial |
$6,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,904.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,800.00
|
|
|
ANGIOSEAL VIP 6FR
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
270637740N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.15 |
| Max. Negotiated Rate |
$120.50 |
| Rate for Payer: Aetna Commercial |
$72.30
|
| Rate for Payer: Aetna Medicare Advantage |
$72.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$48.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.45
|
| Rate for Payer: Cigna Commercial |
$120.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$58.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.15
|
|
|
ANGIOSEAL VIP 6FR
|
Facility
|
IP
|
$995.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
270637740S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.25 |
| Max. Negotiated Rate |
$240.79 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$199.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$240.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$149.25
|
|
|
ANGIOSEAL VIP 6FR
|
Facility
|
OP
|
$995.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
270637740S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.25 |
| Max. Negotiated Rate |
$497.50 |
| Rate for Payer: Aetna Commercial |
$298.50
|
| Rate for Payer: Aetna Medicare Advantage |
$298.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$253.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$253.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$199.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$253.72
|
| Rate for Payer: Cigna Commercial |
$497.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$240.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$149.25
|
|
|
ANGIOSEAL VIP 6FR 610130
|
Facility
|
IP
|
$995.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
270637740C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.25 |
| Max. Negotiated Rate |
$240.79 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$199.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$240.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$149.25
|
|
|
ANGIOSEAL VIP 6FR 610130
|
Facility
|
OP
|
$995.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
270637740C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.25 |
| Max. Negotiated Rate |
$497.50 |
| Rate for Payer: Aetna Commercial |
$298.50
|
| Rate for Payer: Aetna Medicare Advantage |
$298.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$253.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$253.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$199.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$253.72
|
| Rate for Payer: Cigna Commercial |
$497.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$240.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$149.25
|
|
|
ANGIOSEAL VIP 8FR 610131
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
270637741S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.50 |
| Max. Negotiated Rate |
$278.30 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$230.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$278.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$172.50
|
|