|
SHEATH 6.5FR 12CM 0.038 50CM
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
270661685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
SHEATH 6.5FR 12CM 0.038 50CM
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
270661685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$15.20
|
| 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 |
$10.40
|
| Rate for Payer: Oxford Commercial |
$8.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.14
|
|
|
SHEATH 6F 088 NEURON MAX LONG
|
Facility
|
OP
|
$2,475.00
|
|
| Hospital Charge Code |
270684222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.29 |
| Max. Negotiated Rate |
$1,237.50 |
| Rate for Payer: Aetna Commercial |
$940.50
|
| Rate for Payer: Aetna Medicare Advantage |
$742.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$631.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$631.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$631.12
|
| Rate for Payer: Cigna Commercial |
$1,237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$643.50
|
| Rate for Payer: Oxford Commercial |
$495.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$371.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$495.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$78.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$70.29
|
|
|
SHEATH 6F 088 NEURON MAX LONG
|
Facility
|
IP
|
$2,475.00
|
|
| Hospital Charge Code |
270684222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$371.25 |
| Max. Negotiated Rate |
$371.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$371.25
|
|
|
SHEATH 6FR 45CM
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
270667642N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$133.00
|
| Rate for Payer: Aetna Medicare Advantage |
$105.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$89.25
|
| Rate for Payer: Cigna Commercial |
$175.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$91.00
|
| Rate for Payer: Oxford Commercial |
$70.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$70.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.94
|
|
|
SHEATH 6FR 45CM
|
Facility
|
OP
|
$251.50
|
|
| Hospital Charge Code |
270667642S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.14 |
| Max. Negotiated Rate |
$125.75 |
| Rate for Payer: Aetna Commercial |
$95.57
|
| Rate for Payer: Aetna Medicare Advantage |
$75.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.13
|
| Rate for Payer: Cigna Commercial |
$125.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$65.39
|
| Rate for Payer: Oxford Commercial |
$50.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$50.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.14
|
|
|
SHEATH 6FR 45CM
|
Facility
|
OP
|
$251.50
|
|
| Hospital Charge Code |
270667642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.14 |
| Max. Negotiated Rate |
$125.75 |
| Rate for Payer: Aetna Commercial |
$95.57
|
| Rate for Payer: Aetna Medicare Advantage |
$75.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.13
|
| Rate for Payer: Cigna Commercial |
$125.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$65.39
|
| Rate for Payer: Oxford Commercial |
$50.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$50.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.14
|
|
|
SHEATH 6FR 45CM
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
270667642N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.50
|
|
|
SHEATH 6FR 45CM
|
Facility
|
IP
|
$251.50
|
|
| Hospital Charge Code |
270667642S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$37.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.73
|
|
|
SHEATH 6FR 45CM
|
Facility
|
IP
|
$251.50
|
|
| Hospital Charge Code |
270667642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$37.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.73
|
|
|
SHEATH 6 FR NEURON 80 STR
|
Facility
|
IP
|
$2,475.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270685061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$371.25 |
| Max. Negotiated Rate |
$598.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$495.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$598.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$371.25
|
|
|
SHEATH 6 FR NEURON 80 STR
|
Facility
|
OP
|
$2,475.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270685061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.29 |
| Max. Negotiated Rate |
$1,237.50 |
| Rate for Payer: Aetna Commercial |
$940.50
|
| Rate for Payer: Aetna Medicare Advantage |
$742.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$631.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$631.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$495.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$631.12
|
| Rate for Payer: Cigna Commercial |
$1,237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$598.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$371.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$78.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$70.29
|
|
|
SHEATH 6 FR NEURON 90 MP
|
Facility
|
IP
|
$2,475.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270685063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$371.25 |
| Max. Negotiated Rate |
$598.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$495.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$598.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$371.25
|
|
|
SHEATH 6 FR NEURON 90 MP
|
Facility
|
OP
|
$2,475.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270685063S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.29 |
| Max. Negotiated Rate |
$1,237.50 |
| Rate for Payer: Aetna Commercial |
$940.50
|
| Rate for Payer: Aetna Medicare Advantage |
$742.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$631.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$631.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$495.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$631.12
|
| Rate for Payer: Cigna Commercial |
$1,237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$598.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$371.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$78.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$70.29
|
|
|
SHEATH 6 FR NEURON 90 MP
|
Facility
|
OP
|
$2,475.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270685063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.29 |
| Max. Negotiated Rate |
$1,237.50 |
| Rate for Payer: Aetna Commercial |
$940.50
|
| Rate for Payer: Aetna Medicare Advantage |
$742.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$631.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$631.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$495.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$631.12
|
| Rate for Payer: Cigna Commercial |
$1,237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$598.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$371.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$78.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$70.29
|
|
|
SHEATH 6 FR NEURON 90 MP
|
Facility
|
IP
|
$2,475.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270685063S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$371.25 |
| Max. Negotiated Rate |
$598.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$495.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$598.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$371.25
|
|
|
SHEATH 6 FR NEURON 90 STR
|
Facility
|
OP
|
$2,475.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270685062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.29 |
| Max. Negotiated Rate |
$1,237.50 |
| Rate for Payer: Aetna Commercial |
$940.50
|
| Rate for Payer: Aetna Medicare Advantage |
$742.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$631.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$631.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$495.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$631.12
|
| Rate for Payer: Cigna Commercial |
$1,237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$598.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$371.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$78.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$70.29
|
|
|
SHEATH 6 FR NEURON 90 STR
|
Facility
|
IP
|
$2,475.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270685062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$371.25 |
| Max. Negotiated Rate |
$598.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$495.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$598.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$371.25
|
|
|
SHEATH AFX INTRODUCER
|
Facility
|
OP
|
$1,675.00
|
|
| Hospital Charge Code |
270646238O
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.57 |
| Max. Negotiated Rate |
$837.50 |
| Rate for Payer: Aetna Commercial |
$636.50
|
| Rate for Payer: Aetna Medicare Advantage |
$502.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$427.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$427.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$427.12
|
| Rate for Payer: Cigna Commercial |
$837.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$435.50
|
| Rate for Payer: Oxford Commercial |
$335.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$251.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$335.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$52.93
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$47.57
|
|
|
SHEATH AFX INTRODUCER
|
Facility
|
IP
|
$1,675.00
|
|
| Hospital Charge Code |
270646238O
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.25 |
| Max. Negotiated Rate |
$251.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$251.25
|
|
|
SHEATH AFX INTRODUCER
|
Facility
|
OP
|
$1,675.00
|
|
| Hospital Charge Code |
270646238
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.57 |
| Max. Negotiated Rate |
$837.50 |
| Rate for Payer: Aetna Commercial |
$636.50
|
| Rate for Payer: Aetna Medicare Advantage |
$502.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$427.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$427.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$427.12
|
| Rate for Payer: Cigna Commercial |
$837.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$435.50
|
| Rate for Payer: Oxford Commercial |
$335.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$251.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$335.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$52.93
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$47.57
|
|
|
SHEATH AFX INTRODUCER
|
Facility
|
IP
|
$1,675.00
|
|
| Hospital Charge Code |
270646238
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.25 |
| Max. Negotiated Rate |
$251.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$251.25
|
|
|
SHEATH ANSEL 7FR 45CM
|
Facility
|
IP
|
$251.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270677225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$60.86 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$50.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$60.86
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.73
|
|
|
SHEATH ANSEL 7FR 45CM
|
Facility
|
OP
|
$251.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270677225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.14 |
| Max. Negotiated Rate |
$125.75 |
| Rate for Payer: Aetna Commercial |
$95.57
|
| Rate for Payer: Aetna Medicare Advantage |
$75.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$50.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.13
|
| Rate for Payer: Cigna Commercial |
$125.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$60.86
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.73
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.14
|
|
|
SHEATH ANSEL 7FR 45CM
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270677225N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$90.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$75.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$90.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
|