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Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

GLIDECATH 5FR - 65 CM C2

Facility

OP

$253.25

Service Code	HCPCS C1887
Hospital Charge Code	270659859
Hospital Revenue Code	278
Min. Negotiated Rate	$7.19
Max. Negotiated Rate	$126.62
Rate for Payer: Aetna Commercial	$96.23
Rate for Payer: Aetna Medicare Advantage	$75.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.58
Rate for Payer: Cigna Commercial	$126.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.29
Rate for Payer: Qualcare PPO/HMO/WC	$37.99
Rate for Payer: UnitedHealthcare Community & State	$8.00
Rate for Payer: Wellpoint Medicaid Managed Care	$7.19

GLIDECATH 5FR - 65 CM STRAIGHT

Facility

IP

$253.25

Service Code	HCPCS C1887
Hospital Charge Code	270658284S
Hospital Revenue Code	278
Min. Negotiated Rate	$37.99
Max. Negotiated Rate	$61.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.29
Rate for Payer: Qualcare PPO/HMO/WC	$37.99

GLIDECATH 5FR - 65 CM STRAIGHT

Facility

IP

$357.00

Service Code	HCPCS C1887
Hospital Charge Code	270658284N
Hospital Revenue Code	278
Min. Negotiated Rate	$53.55
Max. Negotiated Rate	$86.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.39
Rate for Payer: Qualcare PPO/HMO/WC	$53.55

GLIDECATH 5FR - 65 CM STRAIGHT

Facility

OP

$253.25

Service Code	HCPCS C1887
Hospital Charge Code	270658284
Hospital Revenue Code	278
Min. Negotiated Rate	$7.19
Max. Negotiated Rate	$126.62
Rate for Payer: Aetna Commercial	$96.23
Rate for Payer: Aetna Medicare Advantage	$75.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.58
Rate for Payer: Cigna Commercial	$126.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.29
Rate for Payer: Qualcare PPO/HMO/WC	$37.99
Rate for Payer: UnitedHealthcare Community & State	$8.00
Rate for Payer: Wellpoint Medicaid Managed Care	$7.19

GLIDECATH 5FR - 65 CM STRAIGHT

Facility

IP

$253.25

Service Code	HCPCS C1887
Hospital Charge Code	270658284
Hospital Revenue Code	278
Min. Negotiated Rate	$37.99
Max. Negotiated Rate	$61.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.29
Rate for Payer: Qualcare PPO/HMO/WC	$37.99

GLIDECATH 5FR - 65 CM STRAIGHT

Facility

OP

$357.00

Service Code	HCPCS C1887
Hospital Charge Code	270658284N
Hospital Revenue Code	278
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$178.50
Rate for Payer: Aetna Commercial	$135.66
Rate for Payer: Aetna Medicare Advantage	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.03
Rate for Payer: Cigna Commercial	$178.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.39
Rate for Payer: Qualcare PPO/HMO/WC	$53.55
Rate for Payer: UnitedHealthcare Community & State	$11.28
Rate for Payer: Wellpoint Medicaid Managed Care	$10.14

GLIDECATH 5FR - 65 CM STRAIGHT

Facility

OP

$253.25

Service Code	HCPCS C1887
Hospital Charge Code	270658284S
Hospital Revenue Code	278
Min. Negotiated Rate	$7.19
Max. Negotiated Rate	$126.62
Rate for Payer: Aetna Commercial	$96.23
Rate for Payer: Aetna Medicare Advantage	$75.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.58
Rate for Payer: Cigna Commercial	$126.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.29
Rate for Payer: Qualcare PPO/HMO/WC	$37.99
Rate for Payer: UnitedHealthcare Community & State	$8.00
Rate for Payer: Wellpoint Medicaid Managed Care	$7.19

Glidecath 65cm angle taper

Facility

OP

$253.25

Hospital Charge Code	270626417
Hospital Revenue Code	272
Min. Negotiated Rate	$7.19
Max. Negotiated Rate	$126.62
Rate for Payer: Aetna Commercial	$96.23
Rate for Payer: Aetna Medicare Advantage	$75.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.58
Rate for Payer: Cigna Commercial	$126.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.84
Rate for Payer: Oxford Commercial	$50.65
Rate for Payer: Qualcare PPO/HMO/WC	$37.99
Rate for Payer: UnitedHealthcare Commercial	$50.65
Rate for Payer: UnitedHealthcare Community & State	$8.00
Rate for Payer: Wellpoint Medicaid Managed Care	$7.19

Glidecath 65cm angle taper

Facility

IP

$253.25

Hospital Charge Code	270626417
Hospital Revenue Code	272
Min. Negotiated Rate	$37.99
Max. Negotiated Rate	$37.99
Rate for Payer: Qualcare PPO/HMO/WC	$37.99

GLIDECATH ANGLE TAPER 5FR 100

Facility

OP

$1,625.00

Hospital Charge Code	270666807
Hospital Revenue Code	272
Min. Negotiated Rate	$46.15
Max. Negotiated Rate	$812.50
Rate for Payer: Aetna Commercial	$617.50
Rate for Payer: Aetna Medicare Advantage	$487.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$414.38
Rate for Payer: Cigna Commercial	$812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$422.50
Rate for Payer: Oxford Commercial	$325.00
Rate for Payer: Qualcare PPO/HMO/WC	$243.75
Rate for Payer: UnitedHealthcare Commercial	$325.00
Rate for Payer: UnitedHealthcare Community & State	$51.35
Rate for Payer: Wellpoint Medicaid Managed Care	$46.15

GLIDECATH ANGLE TAPER 5FR 100

Facility

IP

$1,625.00

Hospital Charge Code	270666807
Hospital Revenue Code	272
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$243.75
Rate for Payer: Qualcare PPO/HMO/WC	$243.75

GLIDECATH ANGL TAPER 4 32-187

Facility

OP

$253.25

Service Code	HCPCS C1887
Hospital Charge Code	270634078
Hospital Revenue Code	278
Min. Negotiated Rate	$7.19
Max. Negotiated Rate	$126.62
Rate for Payer: Aetna Commercial	$96.23
Rate for Payer: Aetna Medicare Advantage	$75.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.58
Rate for Payer: Cigna Commercial	$126.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.29
Rate for Payer: Qualcare PPO/HMO/WC	$37.99
Rate for Payer: UnitedHealthcare Community & State	$8.00
Rate for Payer: Wellpoint Medicaid Managed Care	$7.19

GLIDECATH ANGL TAPER 4 32-187

Facility

IP

$253.25

Service Code	HCPCS C1887
Hospital Charge Code	270634078S
Hospital Revenue Code	278
Min. Negotiated Rate	$37.99
Max. Negotiated Rate	$61.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.29
Rate for Payer: Qualcare PPO/HMO/WC	$37.99

GLIDECATH ANGL TAPER 4 32-187

Facility

IP

$253.25

Service Code	HCPCS C1887
Hospital Charge Code	270634078
Hospital Revenue Code	278
Min. Negotiated Rate	$37.99
Max. Negotiated Rate	$61.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.29
Rate for Payer: Qualcare PPO/HMO/WC	$37.99

GLIDECATH ANGL TAPER 4 32-187

Facility

OP

$253.25

Service Code	HCPCS C1887
Hospital Charge Code	270634078S
Hospital Revenue Code	278
Min. Negotiated Rate	$7.19
Max. Negotiated Rate	$126.62
Rate for Payer: Aetna Commercial	$96.23
Rate for Payer: Aetna Medicare Advantage	$75.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.58
Rate for Payer: Cigna Commercial	$126.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.29
Rate for Payer: Qualcare PPO/HMO/WC	$37.99
Rate for Payer: UnitedHealthcare Community & State	$8.00
Rate for Payer: Wellpoint Medicaid Managed Care	$7.19

GLIDECATH MT 5FR 65CM ANGLE

Facility

OP

$71.50

Service Code	HCPCS C1887
Hospital Charge Code	270626417N
Hospital Revenue Code	278
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$35.75
Rate for Payer: Aetna Commercial	$27.17
Rate for Payer: Aetna Medicare Advantage	$21.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.23
Rate for Payer: Cigna Commercial	$35.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.30
Rate for Payer: Qualcare PPO/HMO/WC	$10.72
Rate for Payer: UnitedHealthcare Community & State	$2.26
Rate for Payer: Wellpoint Medicaid Managed Care	$2.03

GLIDECATH MT 5FR 65CM ANGLE

Facility

IP

$253.25

Service Code	HCPCS C1887
Hospital Charge Code	270626417S
Hospital Revenue Code	278
Min. Negotiated Rate	$37.99
Max. Negotiated Rate	$61.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.29
Rate for Payer: Qualcare PPO/HMO/WC	$37.99

GLIDECATH MT 5FR 65CM ANGLE

Facility

OP

$253.25

Service Code	HCPCS C1887
Hospital Charge Code	270626417S
Hospital Revenue Code	278
Min. Negotiated Rate	$7.19
Max. Negotiated Rate	$126.62
Rate for Payer: Aetna Commercial	$96.23
Rate for Payer: Aetna Medicare Advantage	$75.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.58
Rate for Payer: Cigna Commercial	$126.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.29
Rate for Payer: Qualcare PPO/HMO/WC	$37.99
Rate for Payer: UnitedHealthcare Community & State	$8.00
Rate for Payer: Wellpoint Medicaid Managed Care	$7.19

GLIDECATH MT 5FR 65CM ANGLE

Facility

IP

$71.50

Service Code	HCPCS C1887
Hospital Charge Code	270626417N
Hospital Revenue Code	278
Min. Negotiated Rate	$10.72
Max. Negotiated Rate	$17.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.30
Rate for Payer: Qualcare PPO/HMO/WC	$10.72

GLIDECATH N/TAPER 4F 100 32172

Facility

OP

$253.25

Service Code	HCPCS C1887
Hospital Charge Code	270630470S
Hospital Revenue Code	278
Min. Negotiated Rate	$7.19
Max. Negotiated Rate	$126.62
Rate for Payer: Aetna Commercial	$96.23
Rate for Payer: Aetna Medicare Advantage	$75.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.58
Rate for Payer: Cigna Commercial	$126.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.29
Rate for Payer: Qualcare PPO/HMO/WC	$37.99
Rate for Payer: UnitedHealthcare Community & State	$8.00
Rate for Payer: Wellpoint Medicaid Managed Care	$7.19

GLIDECATH N/TAPER 4F 100 32172

Facility

IP

$253.25

Service Code	HCPCS C1887
Hospital Charge Code	270630470
Hospital Revenue Code	278
Min. Negotiated Rate	$37.99
Max. Negotiated Rate	$61.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.29
Rate for Payer: Qualcare PPO/HMO/WC	$37.99

GLIDECATH N/TAPER 4F 100 32172

Facility

IP

$253.25

Service Code	HCPCS C1887
Hospital Charge Code	270630470S
Hospital Revenue Code	278
Min. Negotiated Rate	$37.99
Max. Negotiated Rate	$61.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.29
Rate for Payer: Qualcare PPO/HMO/WC	$37.99

GLIDECATH N/TAPER 4F 100 32172

Facility

OP

$307.60

Service Code	HCPCS C1887
Hospital Charge Code	270630470N
Hospital Revenue Code	278
Min. Negotiated Rate	$8.74
Max. Negotiated Rate	$153.80
Rate for Payer: Aetna Commercial	$116.89
Rate for Payer: Aetna Medicare Advantage	$92.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.44
Rate for Payer: Cigna Commercial	$153.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.44
Rate for Payer: Qualcare PPO/HMO/WC	$46.14
Rate for Payer: UnitedHealthcare Community & State	$9.72
Rate for Payer: Wellpoint Medicaid Managed Care	$8.74

GLIDECATH N/TAPER 4F 100 32172

Facility

IP

$307.60

Service Code	HCPCS C1887
Hospital Charge Code	270630470N
Hospital Revenue Code	278
Min. Negotiated Rate	$46.14
Max. Negotiated Rate	$74.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.44
Rate for Payer: Qualcare PPO/HMO/WC	$46.14

GLIDECATH N/TAPER 4F 100 32172

Facility

OP

$253.25

Service Code	HCPCS C1887
Hospital Charge Code	270630470
Hospital Revenue Code	278
Min. Negotiated Rate	$7.19
Max. Negotiated Rate	$126.62
Rate for Payer: Aetna Commercial	$96.23
Rate for Payer: Aetna Medicare Advantage	$75.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.58
Rate for Payer: Cigna Commercial	$126.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.29
Rate for Payer: Qualcare PPO/HMO/WC	$37.99
Rate for Payer: UnitedHealthcare Community & State	$8.00
Rate for Payer: Wellpoint Medicaid Managed Care	$7.19