|
POLAR CATH .014 2x100 150cm
|
Facility
|
OP
|
$4,745.25
|
|
| Hospital Charge Code |
270639685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$711.79 |
| Max. Negotiated Rate |
$2,372.62 |
| Rate for Payer: Aetna Commercial |
$1,423.58
|
| Rate for Payer: Aetna Medicare Advantage |
$1,423.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,210.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,210.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$949.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,210.04
|
| Rate for Payer: Cigna Commercial |
$2,372.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,148.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$711.79
|
|
|
POLARCATH .014 2X20 150CM
|
Facility
|
IP
|
$4,232.25
|
|
| Hospital Charge Code |
270642194
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$634.84 |
| Max. Negotiated Rate |
$1,024.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$846.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,024.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$634.84
|
|
|
POLARCATH .014 2X20 150CM
|
Facility
|
OP
|
$4,232.25
|
|
| Hospital Charge Code |
270642194
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$634.84 |
| Max. Negotiated Rate |
$2,116.12 |
| Rate for Payer: Aetna Commercial |
$1,269.67
|
| Rate for Payer: Aetna Medicare Advantage |
$1,269.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,079.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,079.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$846.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,079.22
|
| Rate for Payer: Cigna Commercial |
$2,116.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,024.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$634.84
|
|
|
POLARCATH .014 3x100 150cm
|
Facility
|
OP
|
$4,745.25
|
|
| Hospital Charge Code |
270644102C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$711.79 |
| Max. Negotiated Rate |
$2,372.62 |
| Rate for Payer: Aetna Commercial |
$1,423.58
|
| Rate for Payer: Aetna Medicare Advantage |
$1,423.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,210.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,210.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$949.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,210.04
|
| Rate for Payer: Cigna Commercial |
$2,372.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,148.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$711.79
|
|
|
POLARCATH .014 3x100 150cm
|
Facility
|
IP
|
$4,745.25
|
|
| Hospital Charge Code |
270644102C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$711.79 |
| Max. Negotiated Rate |
$1,148.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$949.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,148.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$711.79
|
|
|
POLARCATH .014 4X20 150CM
|
Facility
|
IP
|
$4,232.25
|
|
| Hospital Charge Code |
270642201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$634.84 |
| Max. Negotiated Rate |
$1,024.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$846.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,024.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$634.84
|
|
|
POLARCATH .014 4X20 150CM
|
Facility
|
OP
|
$4,232.25
|
|
| Hospital Charge Code |
270642201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$634.84 |
| Max. Negotiated Rate |
$2,116.12 |
| Rate for Payer: Aetna Commercial |
$1,269.67
|
| Rate for Payer: Aetna Medicare Advantage |
$1,269.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,079.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,079.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$846.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,079.22
|
| Rate for Payer: Cigna Commercial |
$2,116.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,024.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$634.84
|
|
|
POLARCATH .014 4x40 150cm
|
Facility
|
IP
|
$4,232.25
|
|
| Hospital Charge Code |
270642202C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$634.84 |
| Max. Negotiated Rate |
$1,024.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$846.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,024.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$634.84
|
|
|
POLARCATH .014 4x40 150cm
|
Facility
|
OP
|
$4,232.25
|
|
| Hospital Charge Code |
270642202C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$634.84 |
| Max. Negotiated Rate |
$2,116.12 |
| Rate for Payer: Aetna Commercial |
$1,269.67
|
| Rate for Payer: Aetna Medicare Advantage |
$1,269.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,079.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,079.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$846.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,079.22
|
| Rate for Payer: Cigna Commercial |
$2,116.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,024.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$634.84
|
|
|
POLARCATH 035 5x150 P515012001
|
Facility
|
OP
|
$4,745.00
|
|
| Hospital Charge Code |
270644390C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$711.75 |
| Max. Negotiated Rate |
$2,372.50 |
| Rate for Payer: Aetna Commercial |
$1,423.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,423.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,209.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,209.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$949.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,209.97
|
| Rate for Payer: Cigna Commercial |
$2,372.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,148.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$711.75
|
|
|
POLARCATH 035 5x150 P515012001
|
Facility
|
IP
|
$4,745.00
|
|
| Hospital Charge Code |
270644390C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$711.75 |
| Max. Negotiated Rate |
$1,148.29 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$949.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,148.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$711.75
|
|
|
POLARCATH .035 6x100 120cm
|
Facility
|
OP
|
$3,695.50
|
|
| Hospital Charge Code |
270638810C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$554.33 |
| Max. Negotiated Rate |
$1,847.75 |
| Rate for Payer: Aetna Commercial |
$1,108.65
|
| Rate for Payer: Aetna Medicare Advantage |
$1,108.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$942.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$942.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$739.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$942.35
|
| Rate for Payer: Cigna Commercial |
$1,847.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$894.31
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$554.33
|
|
|
POLARCATH .035 6x100 120cm
|
Facility
|
IP
|
$3,695.50
|
|
| Hospital Charge Code |
270638810C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$554.33 |
| Max. Negotiated Rate |
$894.31 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$739.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$894.31
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$554.33
|
|
|
POLARCATH .035 6x150
|
Facility
|
OP
|
$4,745.00
|
|
| Hospital Charge Code |
270644391C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$711.75 |
| Max. Negotiated Rate |
$2,372.50 |
| Rate for Payer: Aetna Commercial |
$1,423.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,423.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,209.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,209.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$949.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,209.97
|
| Rate for Payer: Cigna Commercial |
$2,372.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,148.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$711.75
|
|
|
POLARCATH .035 6x150
|
Facility
|
IP
|
$4,745.00
|
|
| Hospital Charge Code |
270644391C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$711.75 |
| Max. Negotiated Rate |
$1,148.29 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$949.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,148.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$711.75
|
|
|
POLARCATH 25x100 T2510015001
|
Facility
|
IP
|
$4,745.25
|
|
| Hospital Charge Code |
270638612C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$711.79 |
| Max. Negotiated Rate |
$1,148.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$949.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,148.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$711.79
|
|
|
POLARCATH 25x100 T2510015001
|
Facility
|
OP
|
$4,745.25
|
|
| Hospital Charge Code |
270638612C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$711.79 |
| Max. Negotiated Rate |
$2,372.62 |
| Rate for Payer: Aetna Commercial |
$1,423.58
|
| Rate for Payer: Aetna Medicare Advantage |
$1,423.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,210.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,210.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$949.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,210.04
|
| Rate for Payer: Cigna Commercial |
$2,372.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,148.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$711.79
|
|
|
POLARCATH .35 6X20 120CM
|
Facility
|
IP
|
$3,000.00
|
|
| Hospital Charge Code |
270642203
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$726.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$600.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$726.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$450.00
|
|
|
POLARCATH .35 6X20 120CM
|
Facility
|
OP
|
$3,000.00
|
|
| Hospital Charge Code |
270642203
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$900.00
|
| Rate for Payer: Aetna Medicare Advantage |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$726.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$450.00
|
|
|
POLARCATH .35 7X20 120CM
|
Facility
|
IP
|
$3,000.00
|
|
| Hospital Charge Code |
270642204
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$726.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$600.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$726.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$450.00
|
|
|
POLARCATH .35 7X20 120CM
|
Facility
|
OP
|
$3,000.00
|
|
| Hospital Charge Code |
270642204
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$900.00
|
| Rate for Payer: Aetna Medicare Advantage |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$726.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$450.00
|
|
|
POLARCATH 3x20 150 T302015001
|
Facility
|
IP
|
$4,232.25
|
|
| Hospital Charge Code |
270642199C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$634.84 |
| Max. Negotiated Rate |
$1,024.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$846.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,024.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$634.84
|
|
|
POLARCATH 3x20 150 T302015001
|
Facility
|
OP
|
$4,232.25
|
|
| Hospital Charge Code |
270642199C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$634.84 |
| Max. Negotiated Rate |
$2,116.12 |
| Rate for Payer: Aetna Commercial |
$1,269.67
|
| Rate for Payer: Aetna Medicare Advantage |
$1,269.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,079.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,079.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$846.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,079.22
|
| Rate for Payer: Cigna Commercial |
$2,116.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,024.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$634.84
|
|
|
POLAR CATH 4.0mmx100mmx120cm
|
Facility
|
IP
|
$3,890.00
|
|
| Hospital Charge Code |
2709006409
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$583.50 |
| Max. Negotiated Rate |
$583.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$583.50
|
|
|
POLAR CATH 4.0mmx100mmx120cm
|
Facility
|
OP
|
$3,890.00
|
|
| Hospital Charge Code |
2709006409
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$505.70 |
| Max. Negotiated Rate |
$1,945.00 |
| Rate for Payer: Aetna Commercial |
$1,167.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,167.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$991.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$991.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$991.95
|
| Rate for Payer: Cigna Commercial |
$1,945.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$505.70
|
| Rate for Payer: Oxford Commercial |
$1,945.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$583.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,945.00
|
|