|
CATHETER JETSTREAM G3 SF 1.85
|
Facility
|
OP
|
$16,500.00
|
|
| Hospital Charge Code |
2709007406
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,145.00 |
| Max. Negotiated Rate |
$8,250.00 |
| Rate for Payer: Aetna Commercial |
$4,950.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,950.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,207.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,207.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,207.50
|
| Rate for Payer: Cigna Commercial |
$8,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,145.00
|
| Rate for Payer: Oxford Commercial |
$8,250.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,475.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,250.00
|
|
|
CATHETER JETSTREAM G3 SF 1.85
|
Facility
|
OP
|
$16,125.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
270661977
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,418.75 |
| Max. Negotiated Rate |
$8,062.50 |
| Rate for Payer: Aetna Commercial |
$4,837.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4,837.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,111.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,111.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,111.88
|
| Rate for Payer: Cigna Commercial |
$8,062.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,902.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,418.75
|
|
|
CATHETER JETSTREAM NAVITUS
|
Facility
|
IP
|
$16,500.00
|
|
| Hospital Charge Code |
2709007404
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,475.00 |
| Max. Negotiated Rate |
$2,475.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,475.00
|
|
|
CATHETER JETSTREAM NAVITUS
|
Facility
|
OP
|
$16,500.00
|
|
| Hospital Charge Code |
2709007404
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,145.00 |
| Max. Negotiated Rate |
$8,250.00 |
| Rate for Payer: Aetna Commercial |
$4,950.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,950.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,207.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,207.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,207.50
|
| Rate for Payer: Cigna Commercial |
$8,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,145.00
|
| Rate for Payer: Oxford Commercial |
$8,250.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,475.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,250.00
|
|
|
CATHETER JETSTREAM NAVITUS
|
Facility
|
IP
|
$16,500.00
|
|
| Hospital Charge Code |
270CH0004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,475.00 |
| Max. Negotiated Rate |
$2,475.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,475.00
|
|
|
CATHETER JETSTREAM NAVITUS
|
Facility
|
OP
|
$16,500.00
|
|
| Hospital Charge Code |
270CH0004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,145.00 |
| Max. Negotiated Rate |
$8,250.00 |
| Rate for Payer: Aetna Commercial |
$4,950.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,950.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,207.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,207.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,207.50
|
| Rate for Payer: Cigna Commercial |
$8,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,145.00
|
| Rate for Payer: Oxford Commercial |
$8,250.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,475.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,250.00
|
|
|
CATHETER JETSTREAM NAVITUS-L
|
Facility
|
OP
|
$16,500.00
|
|
| Hospital Charge Code |
270CH0003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,145.00 |
| Max. Negotiated Rate |
$8,250.00 |
| Rate for Payer: Aetna Commercial |
$4,950.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,950.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,207.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,207.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,207.50
|
| Rate for Payer: Cigna Commercial |
$8,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,145.00
|
| Rate for Payer: Oxford Commercial |
$8,250.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,475.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,250.00
|
|
|
CATHETER JETSTREAM NAVITUS-L
|
Facility
|
IP
|
$16,500.00
|
|
| Hospital Charge Code |
2709007403
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,475.00 |
| Max. Negotiated Rate |
$2,475.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,475.00
|
|
|
CATHETER JETSTREAM NAVITUS-L
|
Facility
|
OP
|
$16,500.00
|
|
| Hospital Charge Code |
2709007403
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,145.00 |
| Max. Negotiated Rate |
$8,250.00 |
| Rate for Payer: Aetna Commercial |
$4,950.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,950.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,207.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,207.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,207.50
|
| Rate for Payer: Cigna Commercial |
$8,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,145.00
|
| Rate for Payer: Oxford Commercial |
$8,250.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,475.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,250.00
|
|
|
CATHETER JETSTREAM NAVITUS-L
|
Facility
|
IP
|
$16,500.00
|
|
| Hospital Charge Code |
270CH0003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,475.00 |
| Max. Negotiated Rate |
$2,475.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,475.00
|
|
|
CATHETER JETSTREAM XC 2.1/3MM
|
Facility
|
OP
|
$16,125.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
270643857S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,418.75 |
| Max. Negotiated Rate |
$8,062.50 |
| Rate for Payer: Aetna Commercial |
$4,837.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4,837.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,111.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,111.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,111.88
|
| Rate for Payer: Cigna Commercial |
$8,062.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,902.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,418.75
|
|
|
CATHETER JETSTREAM XC 2.1/3MM
|
Facility
|
IP
|
$16,125.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
270643857
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,418.75 |
| Max. Negotiated Rate |
$3,902.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,225.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,902.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,418.75
|
|
|
CATHETER JETSTREAM XC 2.1/3MM
|
Facility
|
OP
|
$16,125.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
270643857
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,418.75 |
| Max. Negotiated Rate |
$8,062.50 |
| Rate for Payer: Aetna Commercial |
$4,837.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4,837.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,111.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,111.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,111.88
|
| Rate for Payer: Cigna Commercial |
$8,062.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,902.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,418.75
|
|
|
CATHETER JETSTREAM XC 2.1/3MM
|
Facility
|
OP
|
$16,125.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
270643857N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,418.75 |
| Max. Negotiated Rate |
$8,062.50 |
| Rate for Payer: Aetna Commercial |
$4,837.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4,837.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,111.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,111.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,111.88
|
| Rate for Payer: Cigna Commercial |
$8,062.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,902.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,418.75
|
|
|
CATHETER JETSTREAM XC 2.1/3MM
|
Facility
|
IP
|
$16,125.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
270643857S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,418.75 |
| Max. Negotiated Rate |
$3,902.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,225.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,902.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,418.75
|
|
|
CATHETER JETSTREAM XC 2.1/3MM
|
Facility
|
IP
|
$16,125.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
270643857N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,418.75 |
| Max. Negotiated Rate |
$3,902.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,225.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,902.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,418.75
|
|
|
CATHETER JETSTREAM XC, 2.4MM
|
Facility
|
IP
|
$16,125.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
270647519N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,418.75 |
| Max. Negotiated Rate |
$3,902.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,225.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,902.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,418.75
|
|
|
CATHETER JETSTREAM XC, 2.4MM
|
Facility
|
OP
|
$16,125.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
270647519S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,418.75 |
| Max. Negotiated Rate |
$8,062.50 |
| Rate for Payer: Aetna Commercial |
$4,837.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4,837.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,111.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,111.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,111.88
|
| Rate for Payer: Cigna Commercial |
$8,062.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,902.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,418.75
|
|
|
CATHETER JETSTREAM XC, 2.4MM
|
Facility
|
IP
|
$16,125.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
270647519S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,418.75 |
| Max. Negotiated Rate |
$3,902.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,225.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,902.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,418.75
|
|
|
CATHETER JETSTREAM XC, 2.4MM
|
Facility
|
OP
|
$16,125.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
270647519N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,418.75 |
| Max. Negotiated Rate |
$8,062.50 |
| Rate for Payer: Aetna Commercial |
$4,837.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4,837.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,111.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,111.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,111.88
|
| Rate for Payer: Cigna Commercial |
$8,062.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,902.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,418.75
|
|
|
CATHETER JL6.0/100CM/.035
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
2709000392
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
CATHETER JL6.0/100CM/.035
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
2709000392
|
|
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
|
|
|
CATHETER JL6.0 6FR/100CM/.035
|
Facility
|
OP
|
$37.35
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270658022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$18.68 |
| Rate for Payer: Aetna Commercial |
$11.21
|
| Rate for Payer: Aetna Medicare Advantage |
$11.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.52
|
| Rate for Payer: Cigna Commercial |
$18.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.60
|
|
|
CATHETER JL6.0 6FR/100CM/.035
|
Facility
|
IP
|
$37.35
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270658022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$9.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.60
|
|
|
CATHETER JL6.0 6FR/100CM/.035
|
Facility
|
IP
|
$37.35
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270658052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$9.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.60
|
|