|
CATHETER GLIDE 4FR C2 65CM
|
Facility
|
OP
|
$360.00
|
|
| Hospital Charge Code |
270669518N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.22 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$136.80
|
| Rate for Payer: Aetna Medicare Advantage |
$108.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$91.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$91.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$91.80
|
| Rate for Payer: Cigna Commercial |
$180.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$93.60
|
| Rate for Payer: Oxford Commercial |
$72.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$72.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.22
|
|
|
CATHETER GLIDE 4FR C2 65CM
|
Facility
|
OP
|
$1,775.00
|
|
| Hospital Charge Code |
270669518
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.41 |
| Max. Negotiated Rate |
$887.50 |
| Rate for Payer: Aetna Commercial |
$674.50
|
| Rate for Payer: Aetna Medicare Advantage |
$532.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$452.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$452.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$452.62
|
| Rate for Payer: Cigna Commercial |
$887.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$461.50
|
| Rate for Payer: Oxford Commercial |
$355.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$266.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$355.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$56.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$50.41
|
|
|
CATHETER GLIDE 4FR C2 65CM
|
Facility
|
IP
|
$360.00
|
|
| Hospital Charge Code |
270669518N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.00
|
|
|
CATHETER GLIDE 4FR C2 65CM
|
Facility
|
IP
|
$1,775.00
|
|
| Hospital Charge Code |
270669518
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.25 |
| Max. Negotiated Rate |
$266.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$266.25
|
|
|
CATHETER GLIDECATH SIM1 5F40CM
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270696678S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.16 |
| Max. Negotiated Rate |
$795.00 |
| Rate for Payer: Aetna Commercial |
$604.20
|
| Rate for Payer: Aetna Medicare Advantage |
$477.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$405.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$405.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$318.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$405.45
|
| Rate for Payer: Cigna Commercial |
$795.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$384.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$238.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$50.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$45.16
|
|
|
CATHETER GLIDECATH SIM1 5F40CM
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270696678S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$384.78 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$318.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$384.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$238.50
|
|
|
CATHETER GLIDECATH SIM2 5F40CM
|
Facility
|
IP
|
$1,570.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270696679S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$379.94 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$314.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$379.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$235.50
|
|
|
CATHETER GLIDECATH SIM2 5F40CM
|
Facility
|
OP
|
$1,570.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270696679S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.59 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Aetna Commercial |
$596.60
|
| Rate for Payer: Aetna Medicare Advantage |
$471.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$400.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$400.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$314.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$400.35
|
| Rate for Payer: Cigna Commercial |
$785.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$379.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$235.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$49.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$44.59
|
|
|
CATHETER GLIDECATH SIM3 5F40CM
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270696680S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.16 |
| Max. Negotiated Rate |
$795.00 |
| Rate for Payer: Aetna Commercial |
$604.20
|
| Rate for Payer: Aetna Medicare Advantage |
$477.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$405.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$405.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$318.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$405.45
|
| Rate for Payer: Cigna Commercial |
$795.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$384.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$238.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$50.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$45.16
|
|
|
CATHETER GLIDECATH SIM3 5F40CM
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270696680S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$384.78 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$318.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$384.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$238.50
|
|
|
CATHETER GLIDEX 8FR 25CM
|
Facility
|
IP
|
$436.50
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
270673021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.47 |
| Max. Negotiated Rate |
$105.63 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$87.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$105.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$65.47
|
|
|
CATHETER GLIDEX 8FR 25CM
|
Facility
|
OP
|
$436.50
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
270673021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$218.25 |
| Rate for Payer: Aetna Commercial |
$165.87
|
| Rate for Payer: Aetna Medicare Advantage |
$130.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$111.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$111.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$87.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$111.31
|
| Rate for Payer: Cigna Commercial |
$218.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$105.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$65.47
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.79
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.40
|
|
|
CATHETER GPC 5FR .038X100
|
Facility
|
IP
|
$550.00
|
|
| Hospital Charge Code |
270658316
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
|
|
CATHETER GPC 5FR .038X100
|
Facility
|
OP
|
$550.00
|
|
| Hospital Charge Code |
270658316
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.62 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna Commercial |
$209.00
|
| Rate for Payer: Aetna Medicare Advantage |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$140.25
|
| Rate for Payer: Cigna Commercial |
$275.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$143.00
|
| Rate for Payer: Oxford Commercial |
$110.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$110.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.62
|
|
|
CATHETER GUIDE 6FR XB 4.5
|
Facility
|
IP
|
$217.50
|
|
| Hospital Charge Code |
270675271
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.62 |
| Max. Negotiated Rate |
$32.62 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.62
|
|
|
CATHETER GUIDE 6FR XB 4.5
|
Facility
|
OP
|
$217.50
|
|
| Hospital Charge Code |
270675271
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$108.75 |
| Rate for Payer: Aetna Commercial |
$82.65
|
| Rate for Payer: Aetna Medicare Advantage |
$65.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$55.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$55.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$55.46
|
| Rate for Payer: Cigna Commercial |
$108.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$56.55
|
| Rate for Payer: Oxford Commercial |
$43.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.62
|
| Rate for Payer: UnitedHealthcare Commercial |
$43.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.18
|
|
|
CATHETER GUIDE 6FR XBLAD 3 SH
|
Facility
|
OP
|
$220.00
|
|
| Hospital Charge Code |
270675270N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna Commercial |
$83.60
|
| Rate for Payer: Aetna Medicare Advantage |
$66.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$56.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$56.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$56.10
|
| Rate for Payer: Cigna Commercial |
$110.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$57.20
|
| Rate for Payer: Oxford Commercial |
$44.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$44.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.25
|
|
|
CATHETER GUIDE 6FR XBLAD 3 SH
|
Facility
|
OP
|
$240.00
|
|
| Hospital Charge Code |
270675270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$91.20
|
| Rate for Payer: Aetna Medicare Advantage |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.20
|
| Rate for Payer: Cigna Commercial |
$120.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$62.40
|
| Rate for Payer: Oxford Commercial |
$48.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$48.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.82
|
|
|
CATHETER GUIDE 6FR XBLAD 3 SH
|
Facility
|
IP
|
$240.00
|
|
| Hospital Charge Code |
270675270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.00
|
|
|
CATHETER GUIDE 6FR XBLAD 3 SH
|
Facility
|
OP
|
$240.00
|
|
| Hospital Charge Code |
270675270S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$91.20
|
| Rate for Payer: Aetna Medicare Advantage |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.20
|
| Rate for Payer: Cigna Commercial |
$120.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$62.40
|
| Rate for Payer: Oxford Commercial |
$48.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$48.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.82
|
|
|
CATHETER GUIDE 6FR XBLAD 3 SH
|
Facility
|
IP
|
$220.00
|
|
| Hospital Charge Code |
270675270N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.00
|
|
|
CATHETER GUIDE 6FR XBLAD 3 SH
|
Facility
|
IP
|
$240.00
|
|
| Hospital Charge Code |
270675270S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.00
|
|
|
CATHETER,GUIDING
|
Facility
|
IP
|
$899.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4800935
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.85 |
| Max. Negotiated Rate |
$217.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$179.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$217.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$134.85
|
|
|
CATHETER,GUIDING
|
Facility
|
OP
|
$899.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4800935
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.53 |
| Max. Negotiated Rate |
$449.50 |
| Rate for Payer: Aetna Commercial |
$341.62
|
| Rate for Payer: Aetna Medicare Advantage |
$269.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$229.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$229.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$179.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$229.25
|
| Rate for Payer: Cigna Commercial |
$449.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$217.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$134.85
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.53
|
|
|
CATHETER GUIDING C1
|
Facility
|
OP
|
$437.75
|
|
| Hospital Charge Code |
270666825
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.43 |
| Max. Negotiated Rate |
$218.88 |
| Rate for Payer: Aetna Commercial |
$166.34
|
| Rate for Payer: Aetna Medicare Advantage |
$131.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$111.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$111.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$87.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$111.63
|
| Rate for Payer: Cigna Commercial |
$218.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$105.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$65.66
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.43
|
|