|
IR INS TEMP BLADDER CATH (FOLE
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
2680215
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$41.10 |
| Max. Negotiated Rate |
$41.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.10
|
|
|
IR INS TEMP BLADDER CATH (FOLE
|
Facility
|
IP
|
$623.55
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
321051702
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$93.53 |
| Max. Negotiated Rate |
$93.53 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.53
|
|
|
IR INS.TEMP IN-DWEL-CATH/FOLEY
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
3408001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$41.10 |
| Max. Negotiated Rate |
$41.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.10
|
|
|
IR INS.TEMP IN-DWEL-CATH/FOLEY
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
3408001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$35.62 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$82.20
|
| Rate for Payer: Aetna Medicare Advantage |
$82.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$69.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$69.87
|
| 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 |
$69.87
|
| Rate for Payer: Cigna Commercial |
$316.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.62
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
IR INS TUND CV CATH W/O PORT <
|
Facility
|
OP
|
$5,224.75
|
|
|
Service Code
|
HCPCS 36557
|
| Hospital Charge Code |
2101164
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$679.22 |
| Max. Negotiated Rate |
$13,251.23 |
| Rate for Payer: Aetna Commercial |
$1,567.42
|
| Rate for Payer: Aetna Medicare Advantage |
$1,567.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,332.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,332.31
|
| 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 |
$1,332.31
|
| Rate for Payer: Cigna Commercial |
$13,251.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$679.22
|
| Rate for Payer: Oxford Commercial |
$8,679.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$783.71
|
| Rate for Payer: UnitedHealthcare Commercial |
$9,851.00
|
|
|
IR INS TUND CV CATH W/O PORT <
|
Facility
|
OP
|
$5,224.75
|
|
|
Service Code
|
HCPCS 36557
|
| Hospital Charge Code |
7411449
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$679.22 |
| Max. Negotiated Rate |
$13,251.23 |
| Rate for Payer: Aetna Commercial |
$1,567.42
|
| Rate for Payer: Aetna Medicare Advantage |
$1,567.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,332.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,332.31
|
| 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 |
$1,332.31
|
| Rate for Payer: Cigna Commercial |
$13,251.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$679.22
|
| Rate for Payer: Oxford Commercial |
$8,679.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$783.71
|
| Rate for Payer: UnitedHealthcare Commercial |
$9,851.00
|
|
|
IR INS TUND CV CATH W/O PORT <
|
Facility
|
IP
|
$5,224.75
|
|
|
Service Code
|
HCPCS 36557
|
| Hospital Charge Code |
7411449
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$783.71 |
| Max. Negotiated Rate |
$783.71 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$783.71
|
|
|
IR INS TUND CV CATH W/O PORT <
|
Facility
|
IP
|
$5,224.75
|
|
|
Service Code
|
HCPCS 36557
|
| Hospital Charge Code |
2101164
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$783.71 |
| Max. Negotiated Rate |
$783.71 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$783.71
|
|
|
IR INS TUND CV CATH W/O PORT>5
|
Facility
|
IP
|
$14,614.45
|
|
|
Service Code
|
HCPCS 36558
|
| Hospital Charge Code |
366836558
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,192.17 |
| Max. Negotiated Rate |
$2,192.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,192.17
|
|
|
IR INS TUND CV CATH W/O PORT>5
|
Facility
|
OP
|
$14,614.45
|
|
|
Service Code
|
HCPCS 36558
|
| Hospital Charge Code |
7411451
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$7,519.21 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,192.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,873.00
|
| Rate for Payer: Aetna Commercial |
$4,384.34
|
| Rate for Payer: Aetna Medicare Advantage |
$4,384.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,726.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,726.68
|
| 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 |
$3,726.68
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,899.88
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
|
|
IR INS TUND CV CATH W/O PORT>5
|
Facility
|
IP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 36558
|
| Hospital Charge Code |
2011097
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,320.28 |
| Max. Negotiated Rate |
$2,320.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,320.28
|
|
|
IR INS TUND CV CATH W/O PORT>5
|
Facility
|
IP
|
$12,462.85
|
|
|
Service Code
|
HCPCS 36558
|
| Hospital Charge Code |
411036558
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,869.43 |
| Max. Negotiated Rate |
$1,869.43 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,869.43
|
|
|
IR INS TUND CV CATH W/O PORT>5
|
Facility
|
IP
|
$14,614.45
|
|
|
Service Code
|
HCPCS 36558
|
| Hospital Charge Code |
7411451
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,192.17 |
| Max. Negotiated Rate |
$2,192.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,192.17
|
|
|
IR INS TUND CV CATH W/O PORT>5
|
Facility
|
OP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 36558
|
| Hospital Charge Code |
2011097
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$7,519.21 |
| Rate for Payer: Aetna Commercial |
$4,640.55
|
| Rate for Payer: Aetna Medicare Advantage |
$4,640.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,944.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,944.47
|
| 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 |
$3,944.47
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,010.90
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,320.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,873.00
|
|
|
IR INS TUND CV CATH W/O PORT>5
|
Facility
|
IP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 36558
|
| Hospital Charge Code |
321036558
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,320.28 |
| Max. Negotiated Rate |
$2,320.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,320.28
|
|
|
IR INS TUND CV CATH W/O PORT>5
|
Facility
|
OP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 36558
|
| Hospital Charge Code |
321036558
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$7,519.21 |
| Rate for Payer: Aetna Commercial |
$4,640.55
|
| Rate for Payer: Aetna Medicare Advantage |
$4,640.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,944.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,944.47
|
| 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 |
$3,944.47
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,010.90
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,320.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,873.00
|
|
|
IR INS TUND CV CATH W/O PORT>5
|
Facility
|
OP
|
$12,462.85
|
|
|
Service Code
|
HCPCS 36558
|
| Hospital Charge Code |
411036558
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,620.17 |
| Max. Negotiated Rate |
$7,519.21 |
| Rate for Payer: Aetna Commercial |
$3,738.86
|
| Rate for Payer: Aetna Medicare Advantage |
$3,738.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,178.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,178.03
|
| 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 |
$3,178.03
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,620.17
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,869.43
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,873.00
|
|
|
IR INS TUND CV CATH W/O PORT>5
|
Facility
|
OP
|
$14,614.45
|
|
|
Service Code
|
HCPCS 36558
|
| Hospital Charge Code |
366836558
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$7,519.21 |
| Rate for Payer: Aetna Commercial |
$4,384.34
|
| Rate for Payer: Aetna Medicare Advantage |
$4,384.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,726.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,726.68
|
| 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 |
$3,726.68
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,899.88
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,192.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,873.00
|
|
|
IR INS TUND CV CATH W PORT <5
|
Facility
|
OP
|
$13,510.10
|
|
|
Service Code
|
HCPCS 36560
|
| Hospital Charge Code |
5600125
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,756.31 |
| Max. Negotiated Rate |
$7,519.21 |
| Rate for Payer: Aetna Commercial |
$4,053.03
|
| Rate for Payer: Aetna Medicare Advantage |
$4,053.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,445.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,445.08
|
| 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 |
$3,445.08
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,756.31
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,026.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,873.00
|
|
|
IR INS TUND CV CATH W PORT <5
|
Facility
|
OP
|
$14,614.45
|
|
|
Service Code
|
HCPCS 36560
|
| Hospital Charge Code |
366836560
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$7,519.21 |
| Rate for Payer: Aetna Commercial |
$4,384.34
|
| Rate for Payer: Aetna Medicare Advantage |
$4,384.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,726.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,726.68
|
| 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 |
$3,726.68
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,899.88
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,192.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,873.00
|
|
|
IR INS TUND CV CATH W PORT <5
|
Facility
|
IP
|
$14,614.45
|
|
|
Service Code
|
HCPCS 36560
|
| Hospital Charge Code |
7411452
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,192.17 |
| Max. Negotiated Rate |
$2,192.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,192.17
|
|
|
IR INS TUND CV CATH W PORT <5
|
Facility
|
IP
|
$13,510.10
|
|
|
Service Code
|
HCPCS 36560
|
| Hospital Charge Code |
5600125
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,026.52 |
| Max. Negotiated Rate |
$2,026.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,026.52
|
|
|
IR INS TUND CV CATH W PORT <5
|
Facility
|
OP
|
$14,614.45
|
|
|
Service Code
|
HCPCS 36560
|
| Hospital Charge Code |
7411452
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$7,519.21 |
| Rate for Payer: Aetna Commercial |
$4,384.34
|
| Rate for Payer: Aetna Medicare Advantage |
$4,384.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,726.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,726.68
|
| 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 |
$3,726.68
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,899.88
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,192.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,873.00
|
|
|
IR INS TUND CV CATH W PORT <5
|
Facility
|
IP
|
$14,614.45
|
|
|
Service Code
|
HCPCS 36560
|
| Hospital Charge Code |
366836560
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,192.17 |
| Max. Negotiated Rate |
$2,192.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,192.17
|
|
|
IR INS TUND CV CATH W PORT>5
|
Facility
|
IP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 36561
|
| Hospital Charge Code |
321036561
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,320.28 |
| Max. Negotiated Rate |
$2,320.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,320.28
|
|
