|
CATH SUCTION 10F
|
Facility
|
IP
|
$5.65
|
|
| Hospital Charge Code |
270300570
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.85
|
|
|
CATH SUCTION 14F
|
Facility
|
OP
|
$5.65
|
|
| Hospital Charge Code |
270300585
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$2.83 |
| Rate for Payer: Aetna Commercial |
$1.70
|
| Rate for Payer: Aetna Medicare Advantage |
$1.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.44
|
| Rate for Payer: Cigna Commercial |
$2.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.73
|
| Rate for Payer: Oxford Commercial |
$2.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.83
|
|
|
CATH SUCTION 14F
|
Facility
|
IP
|
$5.65
|
|
| Hospital Charge Code |
270300585
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.85
|
|
|
CATH SUCTION DELEE
|
Facility
|
IP
|
$16.85
|
|
| Hospital Charge Code |
270130045
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$2.53 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.53
|
|
|
CATH SUCTION DELEE
|
Facility
|
OP
|
$16.85
|
|
| Hospital Charge Code |
270130045
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$8.43 |
| Rate for Payer: Aetna Commercial |
$5.05
|
| Rate for Payer: Aetna Medicare Advantage |
$5.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.30
|
| Rate for Payer: Cigna Commercial |
$8.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.19
|
| Rate for Payer: Oxford Commercial |
$8.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.53
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.43
|
|
|
CATH SUCTION REGU-VAC SZ 10
|
Facility
|
OP
|
$5.65
|
|
| Hospital Charge Code |
270600477
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$2.83 |
| Rate for Payer: Aetna Commercial |
$1.70
|
| Rate for Payer: Aetna Medicare Advantage |
$1.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.44
|
| Rate for Payer: Cigna Commercial |
$2.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.73
|
| Rate for Payer: Oxford Commercial |
$2.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.83
|
|
|
CATH SUCTION REGU-VAC SZ 10
|
Facility
|
IP
|
$5.65
|
|
| Hospital Charge Code |
270600477
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.85
|
|
|
CATH SUCTION REGU-VAC SZ 8
|
Facility
|
IP
|
$9.65
|
|
| Hospital Charge Code |
270600478
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$1.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.45
|
|
|
CATH SUCTION REGU-VAC SZ 8
|
Facility
|
OP
|
$9.65
|
|
| Hospital Charge Code |
270600478
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna Commercial |
$2.90
|
| Rate for Payer: Aetna Medicare Advantage |
$2.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.46
|
| Rate for Payer: Cigna Commercial |
$4.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.25
|
| Rate for Payer: Oxford Commercial |
$4.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.83
|
|
|
CATH SUCTION REPAGYLE 10FR
|
Facility
|
OP
|
$60.00
|
|
| Hospital Charge Code |
270608303
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna Commercial |
$18.00
|
| Rate for Payer: Aetna Medicare Advantage |
$18.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15.30
|
| Rate for Payer: Cigna Commercial |
$30.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.80
|
| Rate for Payer: Oxford Commercial |
$30.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$30.00
|
|
|
CATH SUCTION REPAGYLE 10FR
|
Facility
|
IP
|
$60.00
|
|
| Hospital Charge Code |
270608303
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.00
|
|
|
CATH SUCTION STD 14FR 22 T260
|
Facility
|
IP
|
$1.80
|
|
| Hospital Charge Code |
270649066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.27
|
|
|
CATH SUCTION STD 14FR 22 T260
|
Facility
|
OP
|
$1.80
|
|
| Hospital Charge Code |
270649066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Aetna Commercial |
$0.54
|
| Rate for Payer: Aetna Medicare Advantage |
$0.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.46
|
| Rate for Payer: Cigna Commercial |
$0.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.23
|
| Rate for Payer: Oxford Commercial |
$0.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.27
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.90
|
|
|
CATH SUCTION STR PK 14FR
|
Facility
|
OP
|
$1.20
|
|
| Hospital Charge Code |
270650560
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Aetna Commercial |
$0.36
|
| Rate for Payer: Aetna Medicare Advantage |
$0.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.31
|
| Rate for Payer: Cigna Commercial |
$0.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.16
|
| Rate for Payer: Oxford Commercial |
$0.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.60
|
|
|
CATH SUCTION STR PK 14FR
|
Facility
|
IP
|
$1.20
|
|
| Hospital Charge Code |
270650560
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.18
|
|
|
CATH SUPRAPUBIC 12F
|
Facility
|
IP
|
$65.65
|
|
| Hospital Charge Code |
270600160
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$9.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.85
|
|
|
CATH SUPRAPUBIC 12F
|
Facility
|
OP
|
$65.65
|
|
| Hospital Charge Code |
270600160
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$32.83 |
| Rate for Payer: Aetna Commercial |
$19.70
|
| Rate for Payer: Aetna Medicare Advantage |
$19.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$16.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$16.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$16.74
|
| Rate for Payer: Cigna Commercial |
$32.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.53
|
| Rate for Payer: Oxford Commercial |
$32.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$32.83
|
|
|
CATH SUPRAPUBIC 8F
|
Facility
|
IP
|
$65.65
|
|
| Hospital Charge Code |
270600159
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$9.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.85
|
|
|
CATH SUPRAPUBIC 8F
|
Facility
|
OP
|
$65.65
|
|
| Hospital Charge Code |
270600159
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$32.83 |
| Rate for Payer: Aetna Commercial |
$19.70
|
| Rate for Payer: Aetna Medicare Advantage |
$19.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$16.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$16.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$16.74
|
| Rate for Payer: Cigna Commercial |
$32.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.53
|
| Rate for Payer: Oxford Commercial |
$32.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$32.83
|
|
|
CATH SUPRAPUBIC ONE STEP
|
Facility
|
OP
|
$360.80
|
|
| Hospital Charge Code |
270647887
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$46.90 |
| Max. Negotiated Rate |
$180.40 |
| Rate for Payer: Aetna Commercial |
$108.24
|
| Rate for Payer: Aetna Medicare Advantage |
$108.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$92.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$92.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$92.00
|
| Rate for Payer: Cigna Commercial |
$180.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.90
|
| Rate for Payer: Oxford Commercial |
$180.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$180.40
|
|
|
CATH SUPRAPUBIC ONE STEP
|
Facility
|
IP
|
$360.80
|
|
| Hospital Charge Code |
270647887
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$54.12 |
| Max. Negotiated Rate |
$54.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.12
|
|
|
CATH SURECROSS 5FX 150CM .014
|
Facility
|
OP
|
$675.00
|
|
| Hospital Charge Code |
270670718
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.75 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Aetna Medicare Advantage |
$202.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$172.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$172.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$172.12
|
| Rate for Payer: Cigna Commercial |
$337.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$87.75
|
| Rate for Payer: Oxford Commercial |
$337.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$101.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$337.50
|
|
|
CATH SURECROSS 5FX 150CM .014
|
Facility
|
IP
|
$675.00
|
|
| Hospital Charge Code |
270670718
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.25 |
| Max. Negotiated Rate |
$101.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$101.25
|
|
|
CATH SURECROSS 5FX 150CM .018
|
Facility
|
IP
|
$550.00
|
|
| Hospital Charge Code |
270670719
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
|
|
CATH SURECROSS 5FX 150CM .018
|
Facility
|
IP
|
$550.00
|
|
| Hospital Charge Code |
270670719N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
|