|
CATH PLACE CARDIO BRACHYTX
|
Facility
|
OP
|
$12,500.00
|
|
|
Service Code
|
HCPCS 92974
|
| Hospital Charge Code |
411092974
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$149.24 |
| Max. Negotiated Rate |
$4,350.00 |
| Rate for Payer: Aetna Commercial |
$3,750.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,187.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,187.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,187.50
|
| Rate for Payer: Cigna Commercial |
$149.24
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,625.00
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,875.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
CATH PLACE CARDIO BRACHYTX
|
Facility
|
IP
|
$12,500.00
|
|
|
Service Code
|
HCPCS 92974
|
| Hospital Charge Code |
411092974
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$1,875.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,875.00
|
|
|
CATH PLACEMENT VEN 2ND LT
|
Facility
|
OP
|
$2,919.00
|
|
|
Service Code
|
HCPCS 36012LT
|
| Hospital Charge Code |
7412048
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$379.47 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$875.70
|
| Rate for Payer: Aetna Medicare Advantage |
$875.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$744.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$744.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$744.35
|
| Rate for Payer: Cigna Commercial |
$1,459.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$379.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$437.85
|
|
|
CATH PLACEMENT VEN 2ND LT
|
Facility
|
IP
|
$2,919.00
|
|
|
Service Code
|
HCPCS 36012LT
|
| Hospital Charge Code |
7412048
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$437.85 |
| Max. Negotiated Rate |
$437.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$437.85
|
|
|
CATH PLACEMENT VEN 2ND RT
|
Facility
|
OP
|
$2,919.00
|
|
|
Service Code
|
HCPCS 36012RT
|
| Hospital Charge Code |
7412049
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$379.47 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$875.70
|
| Rate for Payer: Aetna Medicare Advantage |
$875.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$744.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$744.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$744.35
|
| Rate for Payer: Cigna Commercial |
$1,459.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$379.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$437.85
|
|
|
CATH PLACEMENT VEN 2ND RT
|
Facility
|
IP
|
$2,919.00
|
|
|
Service Code
|
HCPCS 36012RT
|
| Hospital Charge Code |
7412049
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$437.85 |
| Max. Negotiated Rate |
$437.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$437.85
|
|
|
CATH PLUG/DRAIN TUBE
|
Facility
|
OP
|
$1.34
|
|
| Hospital Charge Code |
270649624
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Aetna Commercial |
$0.40
|
| Rate for Payer: Aetna Medicare Advantage |
$0.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.34
|
| Rate for Payer: Cigna Commercial |
$0.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.17
|
| Rate for Payer: Oxford Commercial |
$0.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.67
|
|
|
CATH PLUG/DRAIN TUBE
|
Facility
|
IP
|
$1.34
|
|
| Hospital Charge Code |
270649624
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.20
|
|
|
CATH PLX BLN 5x3 135c 4205030X
|
Facility
|
OP
|
$1,264.00
|
|
| Hospital Charge Code |
270624435
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$164.32 |
| Max. Negotiated Rate |
$632.00 |
| Rate for Payer: Aetna Commercial |
$379.20
|
| Rate for Payer: Aetna Medicare Advantage |
$379.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$322.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$322.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$322.32
|
| Rate for Payer: Cigna Commercial |
$632.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$164.32
|
| Rate for Payer: Oxford Commercial |
$632.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$189.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$632.00
|
|
|
CATH PLX BLN 5x3 135c 4205030X
|
Facility
|
IP
|
$1,264.00
|
|
| Hospital Charge Code |
270624435
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$189.60 |
| Max. Negotiated Rate |
$189.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$189.60
|
|
|
CATH PLX BLN 6x3 135c 4208030X
|
Facility
|
IP
|
$1,264.00
|
|
| Hospital Charge Code |
270624397
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$189.60 |
| Max. Negotiated Rate |
$189.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$189.60
|
|
|
CATH PLX BLN 6x3 135c 4208030X
|
Facility
|
OP
|
$1,264.00
|
|
| Hospital Charge Code |
270624397
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$164.32 |
| Max. Negotiated Rate |
$632.00 |
| Rate for Payer: Aetna Commercial |
$379.20
|
| Rate for Payer: Aetna Medicare Advantage |
$379.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$322.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$322.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$322.32
|
| Rate for Payer: Cigna Commercial |
$632.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$164.32
|
| Rate for Payer: Oxford Commercial |
$632.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$189.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$632.00
|
|
|
CATH POWERMIDLINE PICC KT 3FR
|
Facility
|
IP
|
$735.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270684374S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$177.87 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$147.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$177.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$110.25
|
|
|
CATH POWERMIDLINE PICC KT 3FR
|
Facility
|
OP
|
$735.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270684374S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Medicare Advantage |
$220.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$187.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$187.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$187.43
|
| Rate for Payer: Cigna Commercial |
$367.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$177.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$110.25
|
|
|
CATH POWERMIDLINE PICC KT 3FR
|
Facility
|
OP
|
$735.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270684374N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Medicare Advantage |
$220.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$187.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$187.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$187.43
|
| Rate for Payer: Cigna Commercial |
$367.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$177.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$110.25
|
|
|
CATH POWERMIDLINE PICC KT 3FR
|
Facility
|
IP
|
$735.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270684374N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$177.87 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$147.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$177.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$110.25
|
|
|
CATH POWERMIDLINE PICC KT 4FR
|
Facility
|
OP
|
$865.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270684375N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.75 |
| Max. Negotiated Rate |
$432.50 |
| Rate for Payer: Aetna Commercial |
$259.50
|
| Rate for Payer: Aetna Medicare Advantage |
$259.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$220.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$220.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$173.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$220.57
|
| Rate for Payer: Cigna Commercial |
$432.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$209.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$129.75
|
|
|
CATH POWERMIDLINE PICC KT 4FR
|
Facility
|
IP
|
$865.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270684375N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.75 |
| Max. Negotiated Rate |
$209.33 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$173.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$209.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$129.75
|
|
|
CATH POWER PICC 4FR SNGL 135CM
|
Facility
|
OP
|
$518.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270675028N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.78 |
| Max. Negotiated Rate |
$259.25 |
| Rate for Payer: Aetna Commercial |
$155.55
|
| Rate for Payer: Aetna Medicare Advantage |
$155.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$132.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$132.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$103.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$132.22
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.78
|
|
|
CATH POWER PICC 4FR SNGL 135CM
|
Facility
|
IP
|
$518.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270675028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.78 |
| Max. Negotiated Rate |
$125.48 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$103.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.78
|
|
|
CATH POWER PICC 4FR SNGL 135CM
|
Facility
|
OP
|
$518.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270675028S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.78 |
| Max. Negotiated Rate |
$259.25 |
| Rate for Payer: Aetna Commercial |
$155.55
|
| Rate for Payer: Aetna Medicare Advantage |
$155.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$132.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$132.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$103.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$132.22
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.78
|
|
|
CATH POWER PICC 4FR SNGL 135CM
|
Facility
|
IP
|
$518.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270675028N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.78 |
| Max. Negotiated Rate |
$125.48 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$103.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.78
|
|
|
CATH POWER PICC 4FR SNGL 135CM
|
Facility
|
IP
|
$518.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270675028S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.78 |
| Max. Negotiated Rate |
$125.48 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$103.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.78
|
|
|
CATH POWER PICC 4FR SNGL 135CM
|
Facility
|
OP
|
$518.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270675028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.78 |
| Max. Negotiated Rate |
$259.25 |
| Rate for Payer: Aetna Commercial |
$155.55
|
| Rate for Payer: Aetna Medicare Advantage |
$155.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$132.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$132.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$103.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$132.22
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.78
|
|
|
CATH POWER PICC 4FR SNGL 70CM
|
Facility
|
IP
|
$518.50
|
|
| Hospital Charge Code |
270677809
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.78 |
| Max. Negotiated Rate |
$125.48 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$103.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.78
|
|
