|
SHEATH PINNACLE SUPR 10FR 11cm
|
Facility
|
IP
|
$48.76
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270628419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$11.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.31
|
|
|
SHEATH PINNACLE SUPR 11FR 25cm
|
Facility
|
IP
|
$113.85
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270635131O
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.08 |
| Max. Negotiated Rate |
$27.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$22.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.08
|
|
|
SHEATH PINNACLE SUPR 11FR 25cm
|
Facility
|
OP
|
$113.85
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270635131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna Commercial |
$43.26
|
| Rate for Payer: Aetna Medicare Advantage |
$34.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$29.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$29.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$22.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$29.03
|
| Rate for Payer: Cigna Commercial |
$56.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.08
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.23
|
|
|
SHEATH PINNACLE SUPR 11FR 25cm
|
Facility
|
OP
|
$113.85
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270635131O
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna Commercial |
$43.26
|
| Rate for Payer: Aetna Medicare Advantage |
$34.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$29.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$29.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$22.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$29.03
|
| Rate for Payer: Cigna Commercial |
$56.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.08
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.23
|
|
|
SHEATH PINNACLE SUPR 11FR 25cm
|
Facility
|
IP
|
$113.85
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270635131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.08 |
| Max. Negotiated Rate |
$27.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$22.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.08
|
|
|
SHEATH PINNACLE TERUMO 4.5CM
|
Facility
|
OP
|
$427.50
|
|
| Hospital Charge Code |
270652539
|
|
Hospital Revenue Code
|
272
|
| 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) PPO |
$109.01
|
| Rate for Payer: Cigna Commercial |
$213.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$111.15
|
| Rate for Payer: Oxford Commercial |
$85.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$85.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.51
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.14
|
|
|
SHEATH PINNACLE TERUMO 4.5CM
|
Facility
|
IP
|
$427.50
|
|
| Hospital Charge Code |
270652539
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.12 |
| Max. Negotiated Rate |
$64.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.12
|
|
|
SHEATH PIN R/O IIIN 5X6 RSB501
|
Facility
|
IP
|
$121.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270654336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.23 |
| Max. Negotiated Rate |
$29.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.23
|
|
|
SHEATH PIN R/O IIIN 5X6 RSB501
|
Facility
|
OP
|
$148.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270654336N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$74.25 |
| Rate for Payer: Aetna Commercial |
$56.43
|
| Rate for Payer: Aetna Medicare Advantage |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$37.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$37.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$37.87
|
| Rate for Payer: Cigna Commercial |
$74.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.27
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.69
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.22
|
|
|
SHEATH PIN R/O IIIN 5X6 RSB501
|
Facility
|
IP
|
$121.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270654336S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.23 |
| Max. Negotiated Rate |
$29.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.23
|
|
|
SHEATH PIN R/O IIIN 5X6 RSB501
|
Facility
|
OP
|
$121.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270654336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$60.75 |
| Rate for Payer: Aetna Commercial |
$46.17
|
| Rate for Payer: Aetna Medicare Advantage |
$36.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$30.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$30.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$30.98
|
| Rate for Payer: Cigna Commercial |
$60.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.23
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.45
|
|
|
SHEATH PIN R/O IIIN 5X6 RSB501
|
Facility
|
IP
|
$148.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270654336N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.27 |
| Max. Negotiated Rate |
$35.94 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.27
|
|
|
SHEATH PIN R/O IIIN 5X6 RSB501
|
Facility
|
OP
|
$121.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270654336S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$60.75 |
| Rate for Payer: Aetna Commercial |
$46.17
|
| Rate for Payer: Aetna Medicare Advantage |
$36.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$30.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$30.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$30.98
|
| Rate for Payer: Cigna Commercial |
$60.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.23
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.45
|
|
|
SHEATH PNCLE 11F 10Cx038 15727
|
Facility
|
IP
|
$51.73
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270628465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.76 |
| Max. Negotiated Rate |
$12.52 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.76
|
|
|
SHEATH PNCLE 11F 10Cx038 15727
|
Facility
|
OP
|
$51.73
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270628465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$25.86 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Medicare Advantage |
$15.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.19
|
| Rate for Payer: Cigna Commercial |
$25.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.76
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.47
|
|
|
SHEATH PRECUTANEOUS INTROD 7FR
|
Facility
|
IP
|
$168.77
|
|
| Hospital Charge Code |
270649711
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.32 |
| Max. Negotiated Rate |
$25.32 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.32
|
|
|
SHEATH PRECUTANEOUS INTROD 7FR
|
Facility
|
OP
|
$168.77
|
|
| Hospital Charge Code |
270649711
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$84.39 |
| Rate for Payer: Aetna Commercial |
$64.13
|
| Rate for Payer: Aetna Medicare Advantage |
$50.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.04
|
| Rate for Payer: Cigna Commercial |
$84.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$43.88
|
| Rate for Payer: Oxford Commercial |
$33.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$33.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.33
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.79
|
|
|
SHEATH R2P DEST SLEN 6FR 119CM
|
Facility
|
IP
|
$1,508.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270691239S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.31 |
| Max. Negotiated Rate |
$365.12 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$301.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$365.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$226.31
|
|
|
SHEATH R2P DEST SLEN 6FR 119CM
|
Facility
|
OP
|
$1,508.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270691239S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.85 |
| Max. Negotiated Rate |
$754.38 |
| Rate for Payer: Aetna Commercial |
$573.33
|
| Rate for Payer: Aetna Medicare Advantage |
$452.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$384.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$384.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$301.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$384.73
|
| Rate for Payer: Cigna Commercial |
$754.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$365.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$226.31
|
| Rate for Payer: UnitedHealthcare Community & State |
$47.68
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$42.85
|
|
|
SHEATH RAABE FLEXOR 5FR 90cm
|
Facility
|
OP
|
$277.00
|
|
| Hospital Charge Code |
270665568
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$138.50 |
| Rate for Payer: Aetna Commercial |
$105.26
|
| Rate for Payer: Aetna Medicare Advantage |
$83.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$70.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$70.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$70.64
|
| Rate for Payer: Cigna Commercial |
$138.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.02
|
| Rate for Payer: Oxford Commercial |
$55.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$55.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.87
|
|
|
SHEATH RAABE FLEXOR 5FR 90cm
|
Facility
|
IP
|
$277.00
|
|
| Hospital Charge Code |
270665568
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.55 |
| Max. Negotiated Rate |
$41.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.55
|
|
|
SHEATH RADIAL 6F
|
Facility
|
OP
|
$225.00
|
|
| Hospital Charge Code |
270676664N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.39 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$85.50
|
| 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 |
$58.50
|
| Rate for Payer: Oxford Commercial |
$45.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$45.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.39
|
|
|
SHEATH RADIAL 6F
|
Facility
|
IP
|
$225.00
|
|
| Hospital Charge Code |
270676664
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
SHEATH RADIAL 6F
|
Facility
|
OP
|
$225.00
|
|
| Hospital Charge Code |
270676664
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.39 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$85.50
|
| 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 |
$58.50
|
| Rate for Payer: Oxford Commercial |
$45.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$45.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.39
|
|
|
SHEATH RADIAL 6F
|
Facility
|
IP
|
$225.00
|
|
| Hospital Charge Code |
270676664N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
