|
SHEATH PINNACLE SUPR 10FR 11CM
|
Facility
|
IP
|
$88.80
|
|
| Hospital Charge Code |
270628419C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$21.49 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.76
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.49
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.32
|
|
|
SHEATH PINNACLE SUPR 10FR 11CM
|
Facility
|
OP
|
$88.80
|
|
| Hospital Charge Code |
270628419C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$44.40 |
| Rate for Payer: Aetna Commercial |
$26.64
|
| Rate for Payer: Aetna Medicare Advantage |
$26.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$22.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$22.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$22.64
|
| Rate for Payer: Cigna Commercial |
$44.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.49
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.32
|
|
|
SHEATH PINNACLE SUPR 11FR 25cm
|
Facility
|
IP
|
$113.85
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270635131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.08 |
| Max. Negotiated Rate |
$27.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$22.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.08
|
|
|
SHEATH PINNACLE SUPR 11FR 25cm
|
Facility
|
OP
|
$113.85
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270635131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.08 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna Commercial |
$34.16
|
| Rate for Payer: Aetna Medicare Advantage |
$34.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$29.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$29.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$22.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$29.03
|
| Rate for Payer: Cigna Commercial |
$56.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.08
|
|
|
SHEATH PINNACLE SUPR 11FR 25cm
|
Facility
|
IP
|
$113.85
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270635131O
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.08 |
| Max. Negotiated Rate |
$27.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$22.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.08
|
|
|
SHEATH PINNACLE SUPR 11FR 25cm
|
Facility
|
OP
|
$113.85
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270635131O
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.08 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna Commercial |
$34.16
|
| Rate for Payer: Aetna Medicare Advantage |
$34.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$29.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$29.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$22.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$29.03
|
| Rate for Payer: Cigna Commercial |
$56.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.08
|
|
|
SHEATH PINNACLE SUPR 11FR 25CM
|
Facility
|
OP
|
$165.60
|
|
| Hospital Charge Code |
270635131C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Aetna Commercial |
$49.68
|
| Rate for Payer: Aetna Medicare Advantage |
$49.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$42.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$42.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$42.23
|
| Rate for Payer: Cigna Commercial |
$82.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$40.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.84
|
|
|
SHEATH PINNACLE SUPR 11FR 25CM
|
Facility
|
IP
|
$165.60
|
|
| Hospital Charge Code |
270635131C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$40.08 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$33.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$40.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.84
|
|
|
SHEATH PINNACLE TERUMO 4.5CM
|
Facility
|
OP
|
$427.50
|
|
| Hospital Charge Code |
270652539
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.58 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Aetna Commercial |
$128.25
|
| Rate for Payer: Aetna Medicare Advantage |
$128.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$109.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$109.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$109.01
|
| Rate for Payer: Cigna Commercial |
$213.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.58
|
| Rate for Payer: Oxford Commercial |
$213.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$213.75
|
|
|
SHEATH PINNACLE TERUMO 4.5CM
|
Facility
|
IP
|
$427.50
|
|
| Hospital Charge Code |
270652539
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.12 |
| Max. Negotiated Rate |
$64.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.12
|
|
|
SHEATH PIN R/O IIIN 5X6 RSB501
|
Facility
|
IP
|
$148.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270654336N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.27 |
| Max. Negotiated Rate |
$35.94 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.27
|
|
|
SHEATH PIN R/O IIIN 5X6 RSB501
|
Facility
|
OP
|
$121.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270654336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.23 |
| Max. Negotiated Rate |
$60.75 |
| Rate for Payer: Aetna Commercial |
$36.45
|
| Rate for Payer: Aetna Medicare Advantage |
$36.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$30.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$30.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$30.98
|
| Rate for Payer: Cigna Commercial |
$60.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.23
|
|
|
SHEATH PIN R/O IIIN 5X6 RSB501
|
Facility
|
IP
|
$121.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270654336S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.23 |
| Max. Negotiated Rate |
$29.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.23
|
|
|
SHEATH PIN R/O IIIN 5X6 RSB501
|
Facility
|
IP
|
$121.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270654336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.23 |
| Max. Negotiated Rate |
$29.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.23
|
|
|
SHEATH PIN R/O IIIN 5X6 RSB501
|
Facility
|
OP
|
$121.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270654336S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.23 |
| Max. Negotiated Rate |
$60.75 |
| Rate for Payer: Aetna Commercial |
$36.45
|
| Rate for Payer: Aetna Medicare Advantage |
$36.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$30.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$30.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$30.98
|
| Rate for Payer: Cigna Commercial |
$60.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.23
|
|
|
SHEATH PIN R/O IIIN 5X6 RSB501
|
Facility
|
OP
|
$148.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270654336N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.27 |
| Max. Negotiated Rate |
$74.25 |
| Rate for Payer: Aetna Commercial |
$44.55
|
| Rate for Payer: Aetna Medicare Advantage |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$37.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$37.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$37.87
|
| Rate for Payer: Cigna Commercial |
$74.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.27
|
|
|
SHEATH PNCLE 11F 10Cx038 15727
|
Facility
|
IP
|
$51.73
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270628465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.76 |
| Max. Negotiated Rate |
$12.52 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.76
|
|
|
SHEATH PNCLE 11F 10Cx038 15727
|
Facility
|
OP
|
$51.73
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270628465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.76 |
| Max. Negotiated Rate |
$25.86 |
| Rate for Payer: Aetna Commercial |
$15.52
|
| Rate for Payer: Aetna Medicare Advantage |
$15.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.19
|
| Rate for Payer: Cigna Commercial |
$25.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.76
|
|
|
SHEATH POLYPECTOMY SNARE
|
Facility
|
IP
|
$300.85
|
|
| Hospital Charge Code |
270600988
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.13 |
| Max. Negotiated Rate |
$45.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.13
|
|
|
SHEATH POLYPECTOMY SNARE
|
Facility
|
OP
|
$300.85
|
|
| Hospital Charge Code |
270600988
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.11 |
| Max. Negotiated Rate |
$150.43 |
| Rate for Payer: Aetna Commercial |
$90.25
|
| Rate for Payer: Aetna Medicare Advantage |
$90.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$76.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$76.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$76.72
|
| Rate for Payer: Cigna Commercial |
$150.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$39.11
|
| Rate for Payer: Oxford Commercial |
$150.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$150.43
|
|
|
SHEATH PRECUTANEOUS INTROD 7FR
|
Facility
|
OP
|
$168.77
|
|
| Hospital Charge Code |
270649711
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.94 |
| Max. Negotiated Rate |
$84.39 |
| Rate for Payer: Aetna Commercial |
$50.63
|
| Rate for Payer: Aetna Medicare Advantage |
$50.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.04
|
| Rate for Payer: Cigna Commercial |
$84.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.94
|
| Rate for Payer: Oxford Commercial |
$84.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$84.39
|
|
|
SHEATH PRECUTANEOUS INTROD 7FR
|
Facility
|
IP
|
$168.77
|
|
| Hospital Charge Code |
270649711
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.32 |
| Max. Negotiated Rate |
$25.32 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.32
|
|
|
SHEATH R2P DEST SLEN 6FR 119CM
|
Facility
|
IP
|
$1,508.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270691239S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.31 |
| Max. Negotiated Rate |
$365.12 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$301.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$365.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$226.31
|
|
|
SHEATH R2P DEST SLEN 6FR 119CM
|
Facility
|
OP
|
$1,508.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270691239S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.31 |
| Max. Negotiated Rate |
$754.38 |
| Rate for Payer: Aetna Commercial |
$452.62
|
| Rate for Payer: Aetna Medicare Advantage |
$452.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$384.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$384.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$301.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$384.73
|
| Rate for Payer: Cigna Commercial |
$754.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$365.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$226.31
|
|
|
SHEATH RAABE FLEXOR 5FR 90cm
|
Facility
|
IP
|
$277.00
|
|
| Hospital Charge Code |
270665568
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.55 |
| Max. Negotiated Rate |
$41.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.55
|
|
