|
INTRODUCER 3.6-11.5 DIAMON TIP
|
Facility
|
OP
|
$972.33
|
|
| Hospital Charge Code |
270670667
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.40 |
| Max. Negotiated Rate |
$486.17 |
| Rate for Payer: Aetna Commercial |
$291.70
|
| Rate for Payer: Aetna Medicare Advantage |
$291.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$247.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$247.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$247.94
|
| Rate for Payer: Cigna Commercial |
$486.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$126.40
|
| Rate for Payer: Oxford Commercial |
$486.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$145.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$486.17
|
|
|
INTRODUCER 3.6-11.5 DIAMON TIP
|
Facility
|
IP
|
$972.33
|
|
| Hospital Charge Code |
270670667
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.85 |
| Max. Negotiated Rate |
$145.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$145.85
|
|
|
INTRODUCER 3.6-B BEVEL TIP LNG
|
Facility
|
OP
|
$972.33
|
|
| Hospital Charge Code |
270670670
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.40 |
| Max. Negotiated Rate |
$486.17 |
| Rate for Payer: Aetna Commercial |
$291.70
|
| Rate for Payer: Aetna Medicare Advantage |
$291.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$247.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$247.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$247.94
|
| Rate for Payer: Cigna Commercial |
$486.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$126.40
|
| Rate for Payer: Oxford Commercial |
$486.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$145.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$486.17
|
|
|
INTRODUCER 3.6-B BEVEL TIP LNG
|
Facility
|
IP
|
$972.33
|
|
| Hospital Charge Code |
270670670
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.85 |
| Max. Negotiated Rate |
$145.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$145.85
|
|
|
INTRODUCER 3.6-D DMD TIP LNG
|
Facility
|
IP
|
$972.33
|
|
| Hospital Charge Code |
270670671
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.85 |
| Max. Negotiated Rate |
$145.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$145.85
|
|
|
INTRODUCER 3.6-D DMD TIP LNG
|
Facility
|
OP
|
$972.33
|
|
| Hospital Charge Code |
270670671
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.40 |
| Max. Negotiated Rate |
$486.17 |
| Rate for Payer: Aetna Commercial |
$291.70
|
| Rate for Payer: Aetna Medicare Advantage |
$291.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$247.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$247.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$247.94
|
| Rate for Payer: Cigna Commercial |
$486.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$126.40
|
| Rate for Payer: Oxford Commercial |
$486.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$145.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$486.17
|
|
|
INTRODUCER 5F 11CM 92500005
|
Facility
|
OP
|
$93.65
|
|
| Hospital Charge Code |
270617165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.17 |
| Max. Negotiated Rate |
$46.83 |
| Rate for Payer: Aetna Commercial |
$28.09
|
| Rate for Payer: Aetna Medicare Advantage |
$28.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.88
|
| Rate for Payer: Cigna Commercial |
$46.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.17
|
| Rate for Payer: Oxford Commercial |
$46.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$46.83
|
|
|
INTRODUCER 5F 11CM 92500005
|
Facility
|
IP
|
$93.65
|
|
| Hospital Charge Code |
270617165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.05
|
|
|
INTRODUCER 6F 23CM 504607T
|
Facility
|
OP
|
$91.25
|
|
| Hospital Charge Code |
270621070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.86 |
| Max. Negotiated Rate |
$45.62 |
| Rate for Payer: Aetna Commercial |
$27.38
|
| Rate for Payer: Aetna Medicare Advantage |
$27.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.27
|
| Rate for Payer: Cigna Commercial |
$45.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.86
|
| Rate for Payer: Oxford Commercial |
$45.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$45.62
|
|
|
INTRODUCER 6F 23CM 504607T
|
Facility
|
IP
|
$91.25
|
|
| Hospital Charge Code |
270621070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$13.69 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.69
|
|
|
INTRODUCER 6FR ULTIMUM
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
270663685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
INTRODUCER 6FR ULTIMUM
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
270663685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$12.00
|
| Rate for Payer: Aetna Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.20
|
| Rate for Payer: Cigna Commercial |
$20.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.20
|
| Rate for Payer: Oxford Commercial |
$20.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$20.00
|
|
|
INTRODUCER 6F SHULE SET 264163
|
Facility
|
OP
|
$580.40
|
|
| Hospital Charge Code |
270629605
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.45 |
| Max. Negotiated Rate |
$290.20 |
| Rate for Payer: Aetna Commercial |
$174.12
|
| Rate for Payer: Aetna Medicare Advantage |
$174.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$148.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$148.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$148.00
|
| Rate for Payer: Cigna Commercial |
$290.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$75.45
|
| Rate for Payer: Oxford Commercial |
$290.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$87.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$290.20
|
|
|
INTRODUCER 6F SHULE SET 264163
|
Facility
|
IP
|
$580.40
|
|
| Hospital Charge Code |
270629605
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.06 |
| Max. Negotiated Rate |
$87.06 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$87.06
|
|
|
INTRODUCER 7F 23CM 504606T
|
Facility
|
IP
|
$109.75
|
|
| Hospital Charge Code |
270621069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.46 |
| Max. Negotiated Rate |
$16.46 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.46
|
|
|
INTRODUCER 7F 23CM 504606T
|
Facility
|
OP
|
$109.75
|
|
| Hospital Charge Code |
270621069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$54.88 |
| Rate for Payer: Aetna Commercial |
$32.92
|
| Rate for Payer: Aetna Medicare Advantage |
$32.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$27.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$27.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$27.99
|
| Rate for Payer: Cigna Commercial |
$54.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.27
|
| Rate for Payer: Oxford Commercial |
$54.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.46
|
| Rate for Payer: UnitedHealthcare Commercial |
$54.88
|
|
|
INTRODUCER 8mm
|
Facility
|
OP
|
$729.15
|
|
| Hospital Charge Code |
270679219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.79 |
| Max. Negotiated Rate |
$364.57 |
| Rate for Payer: Aetna Commercial |
$218.75
|
| Rate for Payer: Aetna Medicare Advantage |
$218.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$185.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$185.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$185.93
|
| Rate for Payer: Cigna Commercial |
$364.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$94.79
|
| Rate for Payer: Oxford Commercial |
$364.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$109.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$364.57
|
|
|
INTRODUCER 8mm
|
Facility
|
IP
|
$729.15
|
|
| Hospital Charge Code |
270679219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.37 |
| Max. Negotiated Rate |
$109.37 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$109.37
|
|
|
INTRODUCER ACCUSTICK J-TIP.038
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270601332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$237.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$71.25
|
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna Medicare Advantage |
$142.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$121.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$121.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$95.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$121.12
|
| Rate for Payer: Cigna Commercial |
$237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$114.95
|
|
|
INTRODUCER ACCUSTICK J-TIP.038
|
Facility
|
IP
|
$418.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270601332S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$62.77 |
| Max. Negotiated Rate |
$101.28 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$83.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.77
|
|
|
INTRODUCER ACCUSTICK J-TIP.038
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270601332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$114.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$95.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$114.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$71.25
|
|
|
INTRODUCER ACCUSTICK J-TIP.038
|
Facility
|
IP
|
$466.25
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270601332N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.94 |
| Max. Negotiated Rate |
$112.83 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$93.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$112.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.94
|
|
|
INTRODUCER ACCUSTICK J-TIP.038
|
Facility
|
OP
|
$418.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270601332S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$62.77 |
| Max. Negotiated Rate |
$209.25 |
| Rate for Payer: Aetna Commercial |
$125.55
|
| Rate for Payer: Aetna Medicare Advantage |
$125.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$106.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$106.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$83.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$106.72
|
| Rate for Payer: Cigna Commercial |
$209.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.77
|
|
|
INTRODUCER ACCUSTICK J-TIP.038
|
Facility
|
OP
|
$466.25
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270601332N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.94 |
| Max. Negotiated Rate |
$233.12 |
| Rate for Payer: Aetna Commercial |
$139.88
|
| Rate for Payer: Aetna Medicare Advantage |
$139.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$118.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$118.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$93.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$118.89
|
| Rate for Payer: Cigna Commercial |
$233.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$112.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.94
|
|
|
INTRODUCER AIRGUARD 15 FR X 13
|
Facility
|
OP
|
$470.40
|
|
| Hospital Charge Code |
270683300
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.15 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Aetna Commercial |
$141.12
|
| Rate for Payer: Aetna Medicare Advantage |
$141.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$119.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$119.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$119.95
|
| Rate for Payer: Cigna Commercial |
$235.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$61.15
|
| Rate for Payer: Oxford Commercial |
$235.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$70.56
|
| Rate for Payer: UnitedHealthcare Commercial |
$235.20
|
|
