|
MICROCATHETER VELOCITY
|
Facility
|
IP
|
$5,285.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270682974
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$792.75 |
| Max. Negotiated Rate |
$1,278.97 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,057.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,278.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$792.75
|
|
|
MICROCATHETER VELOCITY
|
Facility
|
OP
|
$5,285.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270682974
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.09 |
| Max. Negotiated Rate |
$2,642.50 |
| Rate for Payer: Aetna Commercial |
$2,008.30
|
| Rate for Payer: Aetna Medicare Advantage |
$1,585.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,347.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,347.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,057.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,347.67
|
| Rate for Payer: Cigna Commercial |
$2,642.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,278.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$792.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$167.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$150.09
|
|
|
MICROCATHETER VIA 17MM TIP
|
Facility
|
IP
|
$6,750.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270696910S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,012.50 |
| Max. Negotiated Rate |
$1,633.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,350.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,633.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,012.50
|
|
|
MICROCATHETER VIA 17MM TIP
|
Facility
|
OP
|
$6,750.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270696910S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$191.70 |
| Max. Negotiated Rate |
$3,375.00 |
| Rate for Payer: Aetna Commercial |
$2,565.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,025.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,721.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,721.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,721.25
|
| Rate for Payer: Cigna Commercial |
$3,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,633.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,012.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$213.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$191.70
|
|
|
MICROCATHETER VIA 17 TI 45D
|
Facility
|
OP
|
$6,750.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270697715S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$191.70 |
| Max. Negotiated Rate |
$3,375.00 |
| Rate for Payer: Aetna Commercial |
$2,565.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,025.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,721.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,721.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,721.25
|
| Rate for Payer: Cigna Commercial |
$3,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,633.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,012.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$213.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$191.70
|
|
|
MICROCATHETER VIA 17 TI 45D
|
Facility
|
IP
|
$6,750.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270697715S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,012.50 |
| Max. Negotiated Rate |
$1,633.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,350.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,633.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,012.50
|
|
|
MICROCATH VASC 2.4/1.7F 156CM
|
Facility
|
IP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270693915S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$697.50 |
| Max. Negotiated Rate |
$1,125.30 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$930.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,125.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$697.50
|
|
|
MICROCATH VASC 2.4/1.7F 156CM
|
Facility
|
OP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270693915S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.06 |
| Max. Negotiated Rate |
$2,325.00 |
| Rate for Payer: Aetna Commercial |
$1,767.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,185.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,185.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$930.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,185.75
|
| Rate for Payer: Cigna Commercial |
$2,325.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,125.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$697.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$146.94
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$132.06
|
|
|
MICROCLIPS TITANIUM HEMOSTATIC
|
Facility
|
OP
|
$51.67
|
|
| Hospital Charge Code |
270663934
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$25.84 |
| Rate for Payer: Aetna Commercial |
$19.63
|
| Rate for Payer: Aetna Medicare Advantage |
$15.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.18
|
| Rate for Payer: Cigna Commercial |
$25.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.43
|
| Rate for Payer: Oxford Commercial |
$10.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$10.33
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.47
|
|
|
MICROCLIPS TITANIUM HEMOSTATIC
|
Facility
|
IP
|
$51.67
|
|
| Hospital Charge Code |
270663934
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$7.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.75
|
|
|
MICROCOIL HILAL EMBOL .018x1CM
|
Facility
|
IP
|
$227.50
|
|
| Hospital Charge Code |
270668351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.12 |
| Max. Negotiated Rate |
$55.05 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$34.12
|
|
|
MICROCOIL HILAL EMBOL .018x1CM
|
Facility
|
OP
|
$227.50
|
|
| Hospital Charge Code |
270668351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$113.75 |
| Rate for Payer: Aetna Commercial |
$86.45
|
| Rate for Payer: Aetna Medicare Advantage |
$68.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$58.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$58.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$58.01
|
| Rate for Payer: Cigna Commercial |
$113.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$34.12
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.46
|
|
|
MICROCOIL HILAL EMBOL.018x.5CM
|
Facility
|
IP
|
$427.50
|
|
| Hospital Charge Code |
270676280
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$64.12 |
| Max. Negotiated Rate |
$103.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$85.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$103.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.12
|
|
|
MICROCOIL HILAL EMBOL.018x.5CM
|
Facility
|
OP
|
$427.50
|
|
| Hospital Charge Code |
270676280
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.14 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Aetna Commercial |
$162.45
|
| 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) NJ Health |
$85.50
|
| 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 |
$103.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.12
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.51
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.14
|
|
|
MICRODEBRIDER EZ IFF
|
Facility
|
OP
|
$5,729.80
|
|
| Hospital Charge Code |
270677008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$162.73 |
| Max. Negotiated Rate |
$2,864.90 |
| Rate for Payer: Aetna Commercial |
$2,177.32
|
| Rate for Payer: Aetna Medicare Advantage |
$1,718.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,461.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,461.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,461.10
|
| Rate for Payer: Cigna Commercial |
$2,864.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,489.75
|
| Rate for Payer: Oxford Commercial |
$1,145.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$859.47
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,145.96
|
| Rate for Payer: UnitedHealthcare Community & State |
$181.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$162.73
|
|
|
MICRODEBRIDER EZ IFF
|
Facility
|
IP
|
$5,729.80
|
|
| Hospital Charge Code |
270677008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$859.47 |
| Max. Negotiated Rate |
$859.47 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$859.47
|
|
|
MICRO DRILL 1.5 MM
|
Facility
|
IP
|
$1,925.00
|
|
| Hospital Charge Code |
270682454
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$288.75 |
| Max. Negotiated Rate |
$288.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$288.75
|
|
|
MICRO DRILL 1.5 MM
|
Facility
|
OP
|
$1,925.00
|
|
| Hospital Charge Code |
270682454
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.67 |
| Max. Negotiated Rate |
$962.50 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Aetna Medicare Advantage |
$577.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$490.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$490.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$490.88
|
| Rate for Payer: Cigna Commercial |
$962.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$500.50
|
| Rate for Payer: Oxford Commercial |
$385.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$288.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$385.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$60.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$54.67
|
|
|
MICROFILARIAE DETECTION
|
Facility
|
OP
|
$45.90
|
|
|
Service Code
|
HCPCS 87015
|
| Hospital Charge Code |
39990163A
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$18.17
|
| Rate for Payer: Aetna Medicare Advantage |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$24.23
|
| Rate for Payer: Cigna Commercial |
$22.95
|
| Rate for Payer: Cigna Medicare Advantage |
$6.68
|
| Rate for Payer: Clover Medicare Advantage |
$6.35
|
| Rate for Payer: EmblemHealth Commercial |
$20.04
|
| Rate for Payer: Humana Medicare Advantage |
$6.88
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.93
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.68
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.30
|
|
|
MICROFILARIAE DETECTION
|
Facility
|
IP
|
$45.90
|
|
|
Service Code
|
HCPCS 87015
|
| Hospital Charge Code |
39990163A
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$6.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.88
|
|
|
MICROFILARIAE DETECTION
|
Facility
|
IP
|
$29.35
|
|
|
Service Code
|
HCPCS 87210
|
| Hospital Charge Code |
39990163B
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$4.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.40
|
|
|
MICROFILARIAE DETECTION
|
Facility
|
OP
|
$29.35
|
|
|
Service Code
|
HCPCS 87210
|
| Hospital Charge Code |
39990163B
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$15.83
|
| Rate for Payer: Aetna Medicare Advantage |
$18.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$21.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$21.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$21.11
|
| Rate for Payer: Cigna Commercial |
$14.68
|
| Rate for Payer: Cigna Medicare Advantage |
$5.82
|
| Rate for Payer: Clover Medicare Advantage |
$5.53
|
| Rate for Payer: EmblemHealth Commercial |
$17.46
|
| Rate for Payer: Humana Medicare Advantage |
$5.99
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.63
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.66
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.83
|
|
|
MICRO HOOK MIS SHAVER SH SET
|
Facility
|
OP
|
$3,775.90
|
|
| Hospital Charge Code |
270695989
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.24 |
| Max. Negotiated Rate |
$1,887.95 |
| Rate for Payer: Aetna Commercial |
$1,434.84
|
| Rate for Payer: Aetna Medicare Advantage |
$1,132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$962.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$962.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$962.85
|
| Rate for Payer: Cigna Commercial |
$1,887.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$981.73
|
| Rate for Payer: Oxford Commercial |
$755.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$566.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$755.18
|
| Rate for Payer: UnitedHealthcare Community & State |
$119.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$107.24
|
|
|
MICRO HOOK MIS SHAVER SH SET
|
Facility
|
IP
|
$3,775.90
|
|
| Hospital Charge Code |
270695989
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$566.38 |
| Max. Negotiated Rate |
$566.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$566.38
|
|
|
MICRO KOVER ZEISS MD 20X56
|
Facility
|
IP
|
$263.00
|
|
| Hospital Charge Code |
270652779
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.45 |
| Max. Negotiated Rate |
$39.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.45
|
|