|
CATH 3DRC 5FR 100cm 534576T
|
Facility
|
IP
|
$42.50
|
|
| Hospital Charge Code |
270644609C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$6.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.38
|
|
|
CATH 5F 62CM HNBR503565NSC1
|
Facility
|
OP
|
$104.85
|
|
| Hospital Charge Code |
270624957
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$52.42 |
| Rate for Payer: Aetna Commercial |
$39.84
|
| Rate for Payer: Aetna Medicare Advantage |
$31.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$26.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$26.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$26.74
|
| Rate for Payer: Cigna Commercial |
$52.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$31.45
|
| Rate for Payer: Oxford Commercial |
$20.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$20.97
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.78
|
|
|
CATH 5F 62CM HNBR503565NSC1
|
Facility
|
IP
|
$104.85
|
|
| Hospital Charge Code |
270624957
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.73 |
| Max. Negotiated Rate |
$15.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.73
|
|
|
CATH 5F,7CM,FIXER LUER W/NEEDL
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
4800950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna Commercial |
$17.10
|
| Rate for Payer: Aetna Medicare Advantage |
$13.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$11.47
|
| Rate for Payer: Cigna Commercial |
$22.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.89
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$9.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.19
|
|
|
CATH 5F,7CM,FIXER LUER W/NEEDL
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
4800950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$10.89 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.89
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$9.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.75
|
|
|
CATH 5FR 65CM 0.038 COBRA 2
|
Facility
|
IP
|
$144.00
|
|
| Hospital Charge Code |
270647846
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.60
|
|
|
CATH 5FR 65CM 0.038 COBRA 2
|
Facility
|
OP
|
$144.00
|
|
| Hospital Charge Code |
270647846
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$54.72
|
| Rate for Payer: Aetna Medicare Advantage |
$43.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$36.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$36.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$36.72
|
| Rate for Payer: Cigna Commercial |
$72.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$43.20
|
| Rate for Payer: Oxford Commercial |
$28.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$28.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.82
|
|
|
CATH 5FR 65CM W/9MM FRAG BASK.
|
Facility
|
IP
|
$3,646.15
|
|
| Hospital Charge Code |
270668156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.92 |
| Max. Negotiated Rate |
$882.37 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$729.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$882.37
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$802.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$546.92
|
|
|
CATH 5FR 65CM W/9MM FRAG BASK.
|
Facility
|
OP
|
$3,646.15
|
|
| Hospital Charge Code |
270668156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$87.87 |
| Max. Negotiated Rate |
$1,823.08 |
| Rate for Payer: Aetna Commercial |
$1,385.54
|
| Rate for Payer: Aetna Medicare Advantage |
$1,093.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$929.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$929.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$729.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$929.77
|
| Rate for Payer: Cigna Commercial |
$1,823.08
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$882.37
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$802.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$546.92
|
| Rate for Payer: UnitedHealthcare Community & State |
$87.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$96.62
|
|
|
CATH 5FR AL1 100CM 534545T
|
Facility
|
OP
|
$44.50
|
|
| Hospital Charge Code |
270644622C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$22.25 |
| Rate for Payer: Aetna Commercial |
$16.91
|
| Rate for Payer: Aetna Medicare Advantage |
$13.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$11.35
|
| Rate for Payer: Cigna Commercial |
$22.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.35
|
| Rate for Payer: Oxford Commercial |
$8.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.67
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.90
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.18
|
|
|
CATH 5FR AL1 100CM 534545T
|
Facility
|
IP
|
$44.50
|
|
| Hospital Charge Code |
270644622C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.67 |
| Max. Negotiated Rate |
$6.67 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.67
|
|
|
CATH 5FR AL1 SH
|
Facility
|
IP
|
$255.00
|
|
| Hospital Charge Code |
270640090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.25 |
| Max. Negotiated Rate |
$38.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.25
|
|
|
CATH 5FR AL1 SH
|
Facility
|
OP
|
$255.00
|
|
| Hospital Charge Code |
270640090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Aetna Commercial |
$96.90
|
| Rate for Payer: Aetna Medicare Advantage |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$65.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$65.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$65.03
|
| Rate for Payer: Cigna Commercial |
$127.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$76.50
|
| Rate for Payer: Oxford Commercial |
$51.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$51.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.76
|
|
|
CATH 5FR AL2 100cm 534546T
|
Facility
|
OP
|
$42.50
|
|
| Hospital Charge Code |
270644623C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Aetna Commercial |
$16.15
|
| Rate for Payer: Aetna Medicare Advantage |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.84
|
| Rate for Payer: Cigna Commercial |
$21.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.75
|
| Rate for Payer: Oxford Commercial |
$8.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.13
|
|
|
CATH 5FR AL2 100cm 534546T
|
Facility
|
IP
|
$42.50
|
|
| Hospital Charge Code |
270644623C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$6.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.38
|
|
|
CATH 5FR AL3 100cm 534547T
|
Facility
|
IP
|
$42.50
|
|
| Hospital Charge Code |
270644616C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$6.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.38
|
|
|
CATH 5FR AL3 100cm 534547T
|
Facility
|
OP
|
$42.50
|
|
| Hospital Charge Code |
270644616C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Aetna Commercial |
$16.15
|
| Rate for Payer: Aetna Medicare Advantage |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.84
|
| Rate for Payer: Cigna Commercial |
$21.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.75
|
| Rate for Payer: Oxford Commercial |
$8.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.13
|
|
|
CATH 5FR AR2 MOD 100cm
|
Facility
|
OP
|
$42.50
|
|
| Hospital Charge Code |
270644621
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Aetna Commercial |
$16.15
|
| Rate for Payer: Aetna Medicare Advantage |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.84
|
| Rate for Payer: Cigna Commercial |
$21.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.75
|
| Rate for Payer: Oxford Commercial |
$8.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.13
|
|
|
CATH 5FR AR2 MOD 100cm
|
Facility
|
IP
|
$42.50
|
|
| Hospital Charge Code |
270644621
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$6.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.38
|
|
|
CATH 5FR IM 100CM 534560T
|
Facility
|
OP
|
$44.50
|
|
| Hospital Charge Code |
270644617C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$22.25 |
| Rate for Payer: Aetna Commercial |
$16.91
|
| Rate for Payer: Aetna Medicare Advantage |
$13.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$11.35
|
| Rate for Payer: Cigna Commercial |
$22.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.35
|
| Rate for Payer: Oxford Commercial |
$8.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.67
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.90
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.18
|
|
|
CATH 5FR IM 100CM 534560T
|
Facility
|
IP
|
$44.50
|
|
| Hospital Charge Code |
270644617C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.67 |
| Max. Negotiated Rate |
$6.67 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.67
|
|
|
CATH 5FR INFINITI JL 4.0 100cm
|
Facility
|
IP
|
$42.50
|
|
| Hospital Charge Code |
270618314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$6.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.38
|
|
|
CATH 5FR INFINITI JL 4.0 100cm
|
Facility
|
OP
|
$42.50
|
|
| Hospital Charge Code |
270618314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Aetna Commercial |
$16.15
|
| Rate for Payer: Aetna Medicare Advantage |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.84
|
| Rate for Payer: Cigna Commercial |
$21.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.75
|
| Rate for Payer: Oxford Commercial |
$8.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.13
|
|
|
CATH 5FR INFINITI JR 4.0 100cm
|
Facility
|
IP
|
$42.50
|
|
| Hospital Charge Code |
270618315
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$6.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.38
|
|
|
CATH 5FR INFINITI JR 4.0 100cm
|
Facility
|
OP
|
$42.50
|
|
| Hospital Charge Code |
270618315
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Aetna Commercial |
$16.15
|
| Rate for Payer: Aetna Medicare Advantage |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.84
|
| Rate for Payer: Cigna Commercial |
$21.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.75
|
| Rate for Payer: Oxford Commercial |
$8.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.13
|
|