|
POWERPICC SV CATHETER 4 FR
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270686571
|
|
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
|
|
|
POWERPICC SV CATHETER 4 FR
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270686571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.50 |
| Max. Negotiated Rate |
$575.00 |
| Rate for Payer: Aetna Commercial |
$345.00
|
| Rate for Payer: Aetna Medicare Advantage |
$345.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$293.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$293.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$230.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$293.25
|
| Rate for Payer: Cigna Commercial |
$575.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$278.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$172.50
|
|
|
POWERPICK 45 DEG 6MM
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270681576
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.75 |
| Max. Negotiated Rate |
$252.50 |
| Rate for Payer: Aetna Commercial |
$151.50
|
| Rate for Payer: Aetna Medicare Advantage |
$151.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$128.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$128.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$101.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$128.78
|
| Rate for Payer: Cigna Commercial |
$252.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$122.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.75
|
|
|
POWERPICK 45 DEG 6MM
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270681576
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.75 |
| Max. Negotiated Rate |
$122.21 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$101.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$122.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.75
|
|
|
POWERPICK 45 DEG SMALL HUB
|
Facility
|
IP
|
$505.00
|
|
| Hospital Charge Code |
270691052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.75 |
| Max. Negotiated Rate |
$75.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.75
|
|
|
POWERPICK 45 DEG SMALL HUB
|
Facility
|
OP
|
$505.00
|
|
| Hospital Charge Code |
270691052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.65 |
| Max. Negotiated Rate |
$252.50 |
| Rate for Payer: Aetna Commercial |
$151.50
|
| Rate for Payer: Aetna Medicare Advantage |
$151.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$128.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$128.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$128.78
|
| Rate for Payer: Cigna Commercial |
$252.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$65.65
|
| Rate for Payer: Oxford Commercial |
$252.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$252.50
|
|
|
POWER PORT 6.6FR XCELRA
|
Facility
|
OP
|
$1.25
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
270639788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.63 |
| Rate for Payer: Aetna Commercial |
$0.38
|
| Rate for Payer: Aetna Medicare Advantage |
$0.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$0.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.32
|
| Rate for Payer: Cigna Commercial |
$0.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.19
|
|
|
POWER PORT 6.6FR XCELRA
|
Facility
|
IP
|
$1.25
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
270639788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$0.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.19
|
|
|
POWER PORT 6FR 1706061
|
Facility
|
IP
|
$2,375.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270639787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$356.25 |
| Max. Negotiated Rate |
$574.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$475.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$574.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$356.25
|
|
|
POWER PORT 6FR 1706061
|
Facility
|
OP
|
$2,375.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270639787V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$356.25 |
| Max. Negotiated Rate |
$1,187.50 |
| Rate for Payer: Aetna Commercial |
$712.50
|
| Rate for Payer: Aetna Medicare Advantage |
$712.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$605.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$605.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$475.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$605.62
|
| Rate for Payer: Cigna Commercial |
$1,187.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$574.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$356.25
|
|
|
POWER PORT 6FR 1706061
|
Facility
|
IP
|
$2,375.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270639787V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$356.25 |
| Max. Negotiated Rate |
$574.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$475.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$574.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$356.25
|
|
|
POWER PORT 6FR 1706061
|
Facility
|
OP
|
$2,375.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270639787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$356.25 |
| Max. Negotiated Rate |
$1,187.50 |
| Rate for Payer: Aetna Commercial |
$712.50
|
| Rate for Payer: Aetna Medicare Advantage |
$712.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$605.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$605.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$475.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$605.62
|
| Rate for Payer: Cigna Commercial |
$1,187.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$574.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$356.25
|
|
|
POWER PORT 8 FR VUE
|
Facility
|
IP
|
$1,895.50
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
270654845N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.32 |
| Max. Negotiated Rate |
$458.71 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$379.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$458.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$284.32
|
|
|
POWER PORT 8 FR VUE
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
270654845S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$423.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$350.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$423.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$262.50
|
|
|
POWER PORT 8 FR VUE
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
270654845
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna Commercial |
$525.00
|
| Rate for Payer: Aetna Medicare Advantage |
$525.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$446.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$446.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$446.25
|
| Rate for Payer: Cigna Commercial |
$875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$423.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$262.50
|
|
|
POWER PORT 8 FR VUE
|
Facility
|
OP
|
$1,895.50
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
270654845N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.32 |
| Max. Negotiated Rate |
$947.75 |
| Rate for Payer: Aetna Commercial |
$568.65
|
| Rate for Payer: Aetna Medicare Advantage |
$568.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$483.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$483.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$379.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$483.35
|
| Rate for Payer: Cigna Commercial |
$947.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$458.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$284.32
|
|
|
POWER PORT 8 FR VUE
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
270654845S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna Commercial |
$525.00
|
| Rate for Payer: Aetna Medicare Advantage |
$525.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$446.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$446.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$446.25
|
| Rate for Payer: Cigna Commercial |
$875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$423.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$262.50
|
|
|
POWER PORT 8 FR VUE
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
270654845
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$423.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$350.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$423.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$262.50
|
|
|
POWER PORT DUO IMPLANT (BARD
|
Facility
|
OP
|
$3,980.00
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
270660216
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$597.00 |
| Max. Negotiated Rate |
$1,990.00 |
| Rate for Payer: Aetna Commercial |
$1,194.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,194.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,014.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,014.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$796.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,014.90
|
| Rate for Payer: Cigna Commercial |
$1,990.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$963.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$597.00
|
|
|
POWER PORT DUO IMPLANT (BARD
|
Facility
|
IP
|
$3,980.00
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
270660216
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$597.00 |
| Max. Negotiated Rate |
$963.16 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$796.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$963.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$597.00
|
|
|
POWER PORT VUE 6FR 61cm
|
Facility
|
IP
|
$1,550.00
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
270648423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$232.50 |
| Max. Negotiated Rate |
$375.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$310.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$375.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$232.50
|
|
|
POWER PORT VUE 6FR 61cm
|
Facility
|
OP
|
$1,550.00
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
270648423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$232.50 |
| Max. Negotiated Rate |
$775.00 |
| Rate for Payer: Aetna Commercial |
$465.00
|
| Rate for Payer: Aetna Medicare Advantage |
$465.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$395.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$395.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$310.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$395.25
|
| Rate for Payer: Cigna Commercial |
$775.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$375.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$232.50
|
|
|
POWERPORT VUE IMPL MRI 8F
|
Facility
|
OP
|
$15,653.00
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
270698817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,347.95 |
| Max. Negotiated Rate |
$7,826.50 |
| Rate for Payer: Aetna Commercial |
$4,695.90
|
| Rate for Payer: Aetna Medicare Advantage |
$4,695.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,991.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,991.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,130.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,991.51
|
| Rate for Payer: Cigna Commercial |
$7,826.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,788.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,347.95
|
|
|
POWERPORT VUE IMPL MRI 8F
|
Facility
|
IP
|
$15,653.00
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
270698817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,347.95 |
| Max. Negotiated Rate |
$3,788.03 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,130.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,788.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,347.95
|
|
|
POWER PORT VUE MRI 6FR
|
Facility
|
IP
|
$0.01
|
|
| Hospital Charge Code |
270659532
|
|
Hospital Revenue Code
|
278
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$0.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|