|
CATH TITAN NON-SPLIT 15FR 28CM
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
270678022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.75 |
| Max. Negotiated Rate |
$248.05 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$205.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$248.05
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$225.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.75
|
|
|
CATH TITAN NON-SPLIT 15FR 28CM
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
270678022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$512.50 |
| Rate for Payer: Aetna Commercial |
$389.50
|
| Rate for Payer: Aetna Medicare Advantage |
$307.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$261.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$261.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$205.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$261.38
|
| Rate for Payer: Cigna Commercial |
$512.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$248.05
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$225.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.16
|
|
|
CATH TITAN NON-SPLIT 15FR 32CM
|
Facility
|
OP
|
$1,025.00
|
|
| Hospital Charge Code |
270678023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$512.50 |
| Rate for Payer: Aetna Commercial |
$389.50
|
| Rate for Payer: Aetna Medicare Advantage |
$307.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$261.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$261.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$205.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$261.38
|
| Rate for Payer: Cigna Commercial |
$512.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$248.05
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$225.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.16
|
|
|
CATH TITAN NON-SPLIT 15FR 32CM
|
Facility
|
IP
|
$1,025.00
|
|
| Hospital Charge Code |
270678023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.75 |
| Max. Negotiated Rate |
$248.05 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$205.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$248.05
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$225.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.75
|
|
|
CATH TITAN NON-SPLIT 15FR 36CM
|
Facility
|
OP
|
$1,025.00
|
|
| Hospital Charge Code |
270678024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$512.50 |
| Rate for Payer: Aetna Commercial |
$389.50
|
| Rate for Payer: Aetna Medicare Advantage |
$307.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$261.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$261.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$205.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$261.38
|
| Rate for Payer: Cigna Commercial |
$512.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$248.05
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$225.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.16
|
|
|
CATH TITAN NON-SPLIT 15FR 36CM
|
Facility
|
IP
|
$1,025.00
|
|
| Hospital Charge Code |
270678024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.75 |
| Max. Negotiated Rate |
$248.05 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$205.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$248.05
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$225.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.75
|
|
|
CATH TITAN NON-SPLIT 15FR 40CM
|
Facility
|
OP
|
$1,025.00
|
|
| Hospital Charge Code |
270678025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$512.50 |
| Rate for Payer: Aetna Commercial |
$389.50
|
| Rate for Payer: Aetna Medicare Advantage |
$307.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$261.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$261.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$205.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$261.38
|
| Rate for Payer: Cigna Commercial |
$512.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$248.05
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$225.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.16
|
|
|
CATH TITAN NON-SPLIT 15FR 40CM
|
Facility
|
IP
|
$1,025.00
|
|
| Hospital Charge Code |
270678025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.75 |
| Max. Negotiated Rate |
$248.05 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$205.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$248.05
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$225.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.75
|
|
|
CATH TITAN NON-SPLIT 15FR 55CM
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
270678026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$512.50 |
| Rate for Payer: Aetna Commercial |
$389.50
|
| Rate for Payer: Aetna Medicare Advantage |
$307.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$261.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$261.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$205.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$261.38
|
| Rate for Payer: Cigna Commercial |
$512.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$248.05
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$225.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.16
|
|
|
CATH TITAN NON-SPLIT 15FR 55CM
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
270678026N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.75 |
| Max. Negotiated Rate |
$248.05 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$205.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$248.05
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$225.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.75
|
|
|
CATH TITAN NON-SPLIT 15FR 55CM
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
270678026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.75 |
| Max. Negotiated Rate |
$248.05 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$205.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$248.05
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$225.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.75
|
|
|
CATH TITAN NON-SPLIT 15FR 55CM
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
270678026N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$512.50 |
| Rate for Payer: Aetna Commercial |
$389.50
|
| Rate for Payer: Aetna Medicare Advantage |
$307.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$261.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$261.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$205.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$261.38
|
| Rate for Payer: Cigna Commercial |
$512.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$248.05
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$225.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.16
|
|
|
CATH TORCOM 5FR .038 x 80cmL
|
Facility
|
OP
|
$550.00
|
|
| Hospital Charge Code |
270645979
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.26 |
| 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 |
$165.00
|
| 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 |
$13.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.57
|
|
|
CATH TORCOM 5FR .038 x 80cmL
|
Facility
|
IP
|
$550.00
|
|
| Hospital Charge Code |
270645979
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
|
|
CATH TORCOM 5FR .038x80cmL MIK
|
Facility
|
IP
|
$371.50
|
|
| Hospital Charge Code |
270645979C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.73 |
| Max. Negotiated Rate |
$55.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$55.73
|
|
|
CATH TORCOM 5FR .038x80cmL MIK
|
Facility
|
OP
|
$371.50
|
|
| Hospital Charge Code |
270645979C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.95 |
| Max. Negotiated Rate |
$185.75 |
| Rate for Payer: Aetna Commercial |
$141.17
|
| Rate for Payer: Aetna Medicare Advantage |
$111.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$94.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$94.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$94.73
|
| Rate for Payer: Cigna Commercial |
$185.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$111.45
|
| Rate for Payer: Oxford Commercial |
$74.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$55.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$74.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.84
|
|
|
CATH TORCON ADVANTAG 5F G08699
|
Facility
|
OP
|
$88.55
|
|
| Hospital Charge Code |
270629970V
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$44.27 |
| Rate for Payer: Aetna Commercial |
$33.65
|
| Rate for Payer: Aetna Medicare Advantage |
$26.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$22.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$22.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$22.58
|
| Rate for Payer: Cigna Commercial |
$44.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$26.57
|
| Rate for Payer: Oxford Commercial |
$17.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$17.71
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.13
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.35
|
|
|
CATH TORCON ADVANTAG 5F G08699
|
Facility
|
IP
|
$88.55
|
|
| Hospital Charge Code |
270629970V
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$13.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.28
|
|
|
CATH TORCON DAV 5FR .035 100cm
|
Facility
|
IP
|
$125.00
|
|
| Hospital Charge Code |
270629970S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
|
|
CATH TORCON DAV 5FR .035 100cm
|
Facility
|
OP
|
$125.00
|
|
| Hospital Charge Code |
270629970S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$62.50 |
| Rate for Payer: Aetna Commercial |
$47.50
|
| Rate for Payer: Aetna Medicare Advantage |
$37.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$31.88
|
| Rate for Payer: Cigna Commercial |
$62.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$37.50
|
| Rate for Payer: Oxford Commercial |
$25.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$25.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.31
|
|
|
CATH TORCON DAV 5FR .035 100cm
|
Facility
|
OP
|
$125.00
|
|
| Hospital Charge Code |
270629970
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$62.50 |
| Rate for Payer: Aetna Commercial |
$47.50
|
| Rate for Payer: Aetna Medicare Advantage |
$37.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$31.88
|
| Rate for Payer: Cigna Commercial |
$62.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$37.50
|
| Rate for Payer: Oxford Commercial |
$25.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$25.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.31
|
|
|
CATH TORCON DAV 5FR .035 100cm
|
Facility
|
IP
|
$125.00
|
|
| Hospital Charge Code |
270629970
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
|
|
CATH TORCON DAV 5FR .035 100cm
|
Facility
|
IP
|
$550.00
|
|
| Hospital Charge Code |
270629970N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
|
|
CATH TORCON DAV 5FR .035 100cm
|
Facility
|
OP
|
$550.00
|
|
| Hospital Charge Code |
270629970N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.26 |
| 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 |
$165.00
|
| 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 |
$13.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.57
|
|
|
CATH TORCON HN5 5FR .038 100cm
|
Facility
|
IP
|
$550.00
|
|
| Hospital Charge Code |
270624804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
|
