|
CATH GUID 6F MACH 5.0 3435675
|
Facility
|
OP
|
$310.00
|
|
| Hospital Charge Code |
270641798C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.50 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna Commercial |
$93.00
|
| Rate for Payer: Aetna Medicare Advantage |
$93.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$79.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$79.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$62.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$79.05
|
| Rate for Payer: Cigna Commercial |
$155.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$75.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.50
|
|
|
CATH GUID 6F MACH 5.0 3435675
|
Facility
|
IP
|
$310.00
|
|
| Hospital Charge Code |
270641798C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.50 |
| Max. Negotiated Rate |
$75.02 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$62.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$75.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.50
|
|
|
CATH GUID 8FR XB 4.0 588894
|
Facility
|
OP
|
$255.00
|
|
| Hospital Charge Code |
270637965C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.25 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Medicare Advantage |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$65.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$65.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$51.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$65.03
|
| Rate for Payer: Cigna Commercial |
$127.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$61.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.25
|
|
|
CATH GUID 8FR XB 4.0 588894
|
Facility
|
IP
|
$255.00
|
|
| Hospital Charge Code |
270637965C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.25 |
| Max. Negotiated Rate |
$61.71 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$51.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$61.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.25
|
|
|
CATH GUIDE 6F PTFE RENAL CRV
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270662342S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$67.76 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$56.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$67.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.00
|
|
|
CATH GUIDE 6F PTFE RENAL CRV
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270662342S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna Commercial |
$84.00
|
| Rate for Payer: Aetna Medicare Advantage |
$84.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$71.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$71.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$56.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$71.40
|
| Rate for Payer: Cigna Commercial |
$140.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$67.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.00
|
|
|
CATH GUIDE 6F PTFE RENAL CRVD
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270662342
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna Commercial |
$84.00
|
| Rate for Payer: Aetna Medicare Advantage |
$84.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$71.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$71.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$56.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$71.40
|
| Rate for Payer: Cigna Commercial |
$140.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$67.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.00
|
|
|
CATH GUIDE 6F PTFE RENAL CRVD
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270662342
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$67.76 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$56.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$67.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.00
|
|
|
CATH GUIDE 6FR .070 MPA-1 90CM
|
Facility
|
OP
|
$427.00
|
|
| Hospital Charge Code |
270646506C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$64.05 |
| Max. Negotiated Rate |
$213.50 |
| Rate for Payer: Aetna Commercial |
$128.10
|
| Rate for Payer: Aetna Medicare Advantage |
$128.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$108.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$108.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$85.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$108.89
|
| Rate for Payer: Cigna Commercial |
$213.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$103.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.05
|
|
|
CATH GUIDE 6FR .070 MPA-1 90CM
|
Facility
|
IP
|
$427.00
|
|
| Hospital Charge Code |
270646506C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$64.05 |
| Max. Negotiated Rate |
$103.33 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$85.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$103.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.05
|
|
|
CATH GUIDE AMPLATZ 6F AL .75
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270651090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$54.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
CATH GUIDE AMPLATZ 6F AL .75
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270651090N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Medicare Advantage |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.38
|
| Rate for Payer: Cigna Commercial |
$112.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
CATH GUIDE AMPLATZ 6F AL .75
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270651090N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$54.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
CATH GUIDE AMPLATZ 6F AL .75
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270651090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Medicare Advantage |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.38
|
| Rate for Payer: Cigna Commercial |
$112.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
CATH GUIDE AMPLATZ LA6AL75
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270651090C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Medicare Advantage |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.38
|
| Rate for Payer: Cigna Commercial |
$112.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
CATH GUIDE AMPLATZ LA6AL75
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270651090C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$54.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
CATH GUIDE CONCIERGE 6F ULT1
|
Facility
|
OP
|
$225.00
|
|
| Hospital Charge Code |
270669767
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Medicare Advantage |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.38
|
| Rate for Payer: Cigna Commercial |
$112.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
CATH GUIDE CONCIERGE 6F ULT1
|
Facility
|
IP
|
$225.00
|
|
| Hospital Charge Code |
270669767
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$54.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
CATH GUIDE CONCIERGE 6F ULT2
|
Facility
|
IP
|
$225.00
|
|
| Hospital Charge Code |
270669768
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
CATH GUIDE CONCIERGE 6F ULT2
|
Facility
|
OP
|
$225.00
|
|
| Hospital Charge Code |
270669768
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Medicare Advantage |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.38
|
| Rate for Payer: Cigna Commercial |
$112.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.25
|
| Rate for Payer: Oxford Commercial |
$112.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$112.50
|
|
|
CATH GUIDE LAUNCHER 6FR JL 3.0
|
Facility
|
OP
|
$225.00
|
|
| Hospital Charge Code |
270669991
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Medicare Advantage |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.38
|
| Rate for Payer: Cigna Commercial |
$112.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.25
|
| Rate for Payer: Oxford Commercial |
$112.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$112.50
|
|
|
CATH GUIDE LAUNCHER 6FR JL 3.0
|
Facility
|
IP
|
$225.00
|
|
| Hospital Charge Code |
270669991
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
CATH GUIDE LAUNCHER LA6HSI
|
Facility
|
OP
|
$225.00
|
|
| Hospital Charge Code |
270651094C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Medicare Advantage |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.38
|
| Rate for Payer: Cigna Commercial |
$112.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
CATH GUIDE LAUNCHER LA6HSI
|
Facility
|
IP
|
$225.00
|
|
| Hospital Charge Code |
270651094C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$54.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
CATH GUIDE LAUNCHER LA6JL35
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270651102C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Medicare Advantage |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.38
|
| Rate for Payer: Cigna Commercial |
$112.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|