|
CATH PWERFLEX 5x4 80c 4205040S
|
Facility
|
IP
|
$1,325.00
|
|
| Hospital Charge Code |
270630176V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.75 |
| Max. Negotiated Rate |
$320.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$265.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$320.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$198.75
|
|
|
CATH PWERFLEX 5x4 80c 4205040S
|
Facility
|
OP
|
$1,325.00
|
|
| Hospital Charge Code |
270630176V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.75 |
| Max. Negotiated Rate |
$662.50 |
| Rate for Payer: Aetna Commercial |
$397.50
|
| Rate for Payer: Aetna Medicare Advantage |
$397.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$337.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$337.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$265.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$337.88
|
| Rate for Payer: Cigna Commercial |
$662.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$320.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$198.75
|
|
|
CATH QUICKCROSS .014 135CM
|
Facility
|
IP
|
$985.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270636734N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.75 |
| Max. Negotiated Rate |
$238.37 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$197.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$238.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.75
|
|
|
CATH QUICKCROSS .014 135CM
|
Facility
|
OP
|
$985.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270636734C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.75 |
| Max. Negotiated Rate |
$492.50 |
| Rate for Payer: Aetna Commercial |
$295.50
|
| Rate for Payer: Aetna Medicare Advantage |
$295.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$251.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$251.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$197.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$251.18
|
| Rate for Payer: Cigna Commercial |
$492.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$238.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.75
|
|
|
CATH QUICKCROSS .014 135CM
|
Facility
|
OP
|
$985.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270636734N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.75 |
| Max. Negotiated Rate |
$492.50 |
| Rate for Payer: Aetna Commercial |
$295.50
|
| Rate for Payer: Aetna Medicare Advantage |
$295.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$251.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$251.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$197.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$251.18
|
| Rate for Payer: Cigna Commercial |
$492.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$238.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.75
|
|
|
CATH QUICKCROSS .014 135CM
|
Facility
|
IP
|
$985.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270636734C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.75 |
| Max. Negotiated Rate |
$238.37 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$197.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$238.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.75
|
|
|
CATH QUICK-CROSS .014 150cm
|
Facility
|
IP
|
$835.00
|
|
| Hospital Charge Code |
270640493C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.25 |
| Max. Negotiated Rate |
$202.07 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$167.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$202.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.25
|
|
|
CATH QUICK-CROSS .014 150cm
|
Facility
|
OP
|
$835.00
|
|
| Hospital Charge Code |
270640493C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.25 |
| Max. Negotiated Rate |
$417.50 |
| Rate for Payer: Aetna Commercial |
$250.50
|
| Rate for Payer: Aetna Medicare Advantage |
$250.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$212.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$212.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$167.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$212.93
|
| Rate for Payer: Cigna Commercial |
$417.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$202.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.25
|
|
|
CATH QUICK-CROSS .018 150cm
|
Facility
|
OP
|
$835.00
|
|
| Hospital Charge Code |
270642211C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.25 |
| Max. Negotiated Rate |
$417.50 |
| Rate for Payer: Aetna Commercial |
$250.50
|
| Rate for Payer: Aetna Medicare Advantage |
$250.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$212.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$212.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$167.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$212.93
|
| Rate for Payer: Cigna Commercial |
$417.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$202.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.25
|
|
|
CATH QUICK-CROSS .018 150cm
|
Facility
|
IP
|
$835.00
|
|
| Hospital Charge Code |
270642211C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.25 |
| Max. Negotiated Rate |
$202.07 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$167.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$202.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.25
|
|
|
CATH QUICKCROSS .018 X 135MM
|
Facility
|
IP
|
$985.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270646752C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.75 |
| Max. Negotiated Rate |
$238.37 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$197.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$238.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.75
|
|
|
CATH QUICKCROSS .018 X 135MM
|
Facility
|
OP
|
$985.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270646752C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.75 |
| Max. Negotiated Rate |
$492.50 |
| Rate for Payer: Aetna Commercial |
$295.50
|
| Rate for Payer: Aetna Medicare Advantage |
$295.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$251.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$251.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$197.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$251.18
|
| Rate for Payer: Cigna Commercial |
$492.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$238.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.75
|
|
|
CATH QUICKCROSS .018 X 135MM
|
Facility
|
OP
|
$985.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270646752N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.75 |
| Max. Negotiated Rate |
$492.50 |
| Rate for Payer: Aetna Commercial |
$295.50
|
| Rate for Payer: Aetna Medicare Advantage |
$295.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$251.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$251.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$197.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$251.18
|
| Rate for Payer: Cigna Commercial |
$492.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$238.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.75
|
|
|
CATH QUICKCROSS .018 X 135MM
|
Facility
|
IP
|
$985.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270646752N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.75 |
| Max. Negotiated Rate |
$238.37 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$197.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$238.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.75
|
|
|
CATH QUICK CROSS .035 150CM
|
Facility
|
OP
|
$835.00
|
|
| Hospital Charge Code |
270642212C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.25 |
| Max. Negotiated Rate |
$417.50 |
| Rate for Payer: Aetna Commercial |
$250.50
|
| Rate for Payer: Aetna Medicare Advantage |
$250.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$212.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$212.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$167.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$212.93
|
| Rate for Payer: Cigna Commercial |
$417.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$202.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.25
|
|
|
CATH QUICK CROSS .035 150CM
|
Facility
|
IP
|
$835.00
|
|
| Hospital Charge Code |
270642212C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.25 |
| Max. Negotiated Rate |
$202.07 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$167.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$202.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.25
|
|
|
CATH QUIK CAT EXTRA 6FR6009001
|
Facility
|
OP
|
$2,250.00
|
|
| Hospital Charge Code |
270648208C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$1,125.00 |
| Rate for Payer: Aetna Commercial |
$675.00
|
| Rate for Payer: Aetna Medicare Advantage |
$675.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$573.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$573.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$573.75
|
| Rate for Payer: Cigna Commercial |
$1,125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$544.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
|
|
CATH QUIK CAT EXTRA 6FR6009001
|
Facility
|
IP
|
$2,250.00
|
|
| Hospital Charge Code |
270648208C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$544.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$544.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
|
|
CATH QUIK CAT EXTRA 6FR6009001
|
Facility
|
IP
|
$2,250.00
|
|
| Hospital Charge Code |
270640389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$544.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$544.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
|
|
CATH QUIK CAT EXTRA 6FR6009001
|
Facility
|
OP
|
$2,250.00
|
|
| Hospital Charge Code |
270640389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$1,125.00 |
| Rate for Payer: Aetna Commercial |
$675.00
|
| Rate for Payer: Aetna Medicare Advantage |
$675.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$573.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$573.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$573.75
|
| Rate for Payer: Cigna Commercial |
$1,125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$544.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
|
|
CATH RBU 3.5 W/SIDE LA6RBU35SH
|
Facility
|
IP
|
$650.00
|
|
| Hospital Charge Code |
270639610C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$157.30 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$130.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$157.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$97.50
|
|
|
CATH RBU 3.5 W/SIDE LA6RBU35SH
|
Facility
|
OP
|
$650.00
|
|
| Hospital Charge Code |
270639610C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna Commercial |
$195.00
|
| Rate for Payer: Aetna Medicare Advantage |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$165.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$165.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$130.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$165.75
|
| Rate for Payer: Cigna Commercial |
$325.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$157.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$97.50
|
|
|
CATH RBU 4.0 W/SH
|
Facility
|
IP
|
$650.00
|
|
| Hospital Charge Code |
270639611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$157.30 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$130.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$157.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$97.50
|
|
|
CATH RBU 4.0 W/SH
|
Facility
|
OP
|
$650.00
|
|
| Hospital Charge Code |
270639611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna Commercial |
$195.00
|
| Rate for Payer: Aetna Medicare Advantage |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$165.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$165.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$130.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$165.75
|
| Rate for Payer: Cigna Commercial |
$325.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$157.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$97.50
|
|
|
CATH RBU LAUNCHER 6FR 3.5
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636781N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna Commercial |
$195.00
|
| Rate for Payer: Aetna Medicare Advantage |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$165.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$165.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$130.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$165.75
|
| Rate for Payer: Cigna Commercial |
$325.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$157.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$97.50
|
|