|
CATH 5FR JL5 100CM 534522T
|
Facility
|
OP
|
$44.50
|
|
| Hospital Charge Code |
270644608C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$22.25 |
| Rate for Payer: Aetna Commercial |
$13.35
|
| Rate for Payer: Aetna Medicare Advantage |
$13.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$11.35
|
| Rate for Payer: Cigna Commercial |
$22.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.79
|
| Rate for Payer: Oxford Commercial |
$22.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.67
|
| Rate for Payer: UnitedHealthcare Commercial |
$22.25
|
|
|
CATH 5FR JL6 100cm
|
Facility
|
OP
|
$42.50
|
|
| Hospital Charge Code |
270644600
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Aetna Commercial |
$12.75
|
| Rate for Payer: Aetna Medicare Advantage |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.84
|
| Rate for Payer: Cigna Commercial |
$21.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.53
|
| Rate for Payer: Oxford Commercial |
$21.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$21.25
|
|
|
CATH 5FR JL6 100cm
|
Facility
|
IP
|
$42.50
|
|
| Hospital Charge Code |
270644600
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$6.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.38
|
|
|
CATH 5FR JR3.5 100cm 534519T
|
Facility
|
IP
|
$44.50
|
|
| Hospital Charge Code |
270644601C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.67 |
| Max. Negotiated Rate |
$6.67 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.67
|
|
|
CATH 5FR JR3.5 100cm 534519T
|
Facility
|
OP
|
$44.50
|
|
| Hospital Charge Code |
270644601C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$22.25 |
| Rate for Payer: Aetna Commercial |
$13.35
|
| Rate for Payer: Aetna Medicare Advantage |
$13.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$11.35
|
| Rate for Payer: Cigna Commercial |
$22.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.79
|
| Rate for Payer: Oxford Commercial |
$22.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.67
|
| Rate for Payer: UnitedHealthcare Commercial |
$22.25
|
|
|
CATH 5FR JR3.5 100cm 534519T
|
Facility
|
IP
|
$275.00
|
|
| Hospital Charge Code |
270644601
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.25
|
|
|
CATH 5FR JR3.5 100cm 534519T
|
Facility
|
OP
|
$275.00
|
|
| Hospital Charge Code |
270644601
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$35.75 |
| Max. Negotiated Rate |
$137.50 |
| Rate for Payer: Aetna Commercial |
$82.50
|
| Rate for Payer: Aetna Medicare Advantage |
$82.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$70.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$70.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$70.12
|
| Rate for Payer: Cigna Commercial |
$137.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.75
|
| Rate for Payer: Oxford Commercial |
$137.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$137.50
|
|
|
CATH 5FR JR4 100cm
|
Facility
|
IP
|
$275.00
|
|
| Hospital Charge Code |
270644602
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.25
|
|
|
CATH 5FR JR4 100cm
|
Facility
|
OP
|
$275.00
|
|
| Hospital Charge Code |
270644602
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$35.75 |
| Max. Negotiated Rate |
$137.50 |
| Rate for Payer: Aetna Commercial |
$82.50
|
| Rate for Payer: Aetna Medicare Advantage |
$82.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$70.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$70.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$70.12
|
| Rate for Payer: Cigna Commercial |
$137.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.75
|
| Rate for Payer: Oxford Commercial |
$137.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$137.50
|
|
|
CATH 5FR JR4 MOD 100cm 534528T
|
Facility
|
OP
|
$42.50
|
|
| Hospital Charge Code |
270644613C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Aetna Commercial |
$12.75
|
| Rate for Payer: Aetna Medicare Advantage |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.84
|
| Rate for Payer: Cigna Commercial |
$21.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.53
|
| Rate for Payer: Oxford Commercial |
$21.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$21.25
|
|
|
CATH 5FR JR4 MOD 100cm 534528T
|
Facility
|
IP
|
$42.50
|
|
| Hospital Charge Code |
270644613C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$6.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.38
|
|
|
CATH 5FR JR4 RB 100cm 534516T
|
Facility
|
OP
|
$42.50
|
|
| Hospital Charge Code |
270644612C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Aetna Commercial |
$12.75
|
| Rate for Payer: Aetna Medicare Advantage |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.84
|
| Rate for Payer: Cigna Commercial |
$21.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.53
|
| Rate for Payer: Oxford Commercial |
$21.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$21.25
|
|
|
CATH 5FR JR4 RB 100cm 534516T
|
Facility
|
IP
|
$42.50
|
|
| Hospital Charge Code |
270644612C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$6.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.38
|
|
|
CATH 5FR JR4 ST 100cm
|
Facility
|
OP
|
$42.50
|
|
| Hospital Charge Code |
270644603
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Aetna Commercial |
$12.75
|
| Rate for Payer: Aetna Medicare Advantage |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.84
|
| Rate for Payer: Cigna Commercial |
$21.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.53
|
| Rate for Payer: Oxford Commercial |
$21.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$21.25
|
|
|
CATH 5FR JR4 ST 100cm
|
Facility
|
IP
|
$42.50
|
|
| Hospital Charge Code |
270644603
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$6.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.38
|
|
|
CATH 5FR JR5 100CM 534523T
|
Facility
|
IP
|
$41.75
|
|
| Hospital Charge Code |
270644614C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$6.26 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.26
|
|
|
CATH 5FR JR5 100CM 534523T
|
Facility
|
OP
|
$41.75
|
|
| Hospital Charge Code |
270644614C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$20.88 |
| Rate for Payer: Aetna Commercial |
$12.53
|
| Rate for Payer: Aetna Medicare Advantage |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.65
|
| Rate for Payer: Cigna Commercial |
$20.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.43
|
| Rate for Payer: Oxford Commercial |
$20.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$20.88
|
|
|
CATH 5FR JR5 MOD 100cm
|
Facility
|
IP
|
$42.50
|
|
| Hospital Charge Code |
270644596
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$6.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.38
|
|
|
CATH 5FR JR5 MOD 100cm
|
Facility
|
OP
|
$42.50
|
|
| Hospital Charge Code |
270644596
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Aetna Commercial |
$12.75
|
| Rate for Payer: Aetna Medicare Advantage |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.84
|
| Rate for Payer: Cigna Commercial |
$21.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.53
|
| Rate for Payer: Oxford Commercial |
$21.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$21.25
|
|
|
CATH 5FR JR6 100cm
|
Facility
|
OP
|
$42.50
|
|
| Hospital Charge Code |
270644597
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Aetna Commercial |
$12.75
|
| Rate for Payer: Aetna Medicare Advantage |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.84
|
| Rate for Payer: Cigna Commercial |
$21.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.53
|
| Rate for Payer: Oxford Commercial |
$21.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$21.25
|
|
|
CATH 5FR JR6 100cm
|
Facility
|
IP
|
$42.50
|
|
| Hospital Charge Code |
270644597
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$6.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.38
|
|
|
CATH 5FR LCB 100cm
|
Facility
|
OP
|
$42.50
|
|
| Hospital Charge Code |
270644619
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Aetna Commercial |
$12.75
|
| Rate for Payer: Aetna Medicare Advantage |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.84
|
| Rate for Payer: Cigna Commercial |
$21.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.53
|
| Rate for Payer: Oxford Commercial |
$21.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$21.25
|
|
|
CATH 5FR LCB 100cm
|
Facility
|
OP
|
$42.50
|
|
| Hospital Charge Code |
270644619S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Aetna Commercial |
$12.75
|
| Rate for Payer: Aetna Medicare Advantage |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.84
|
| Rate for Payer: Cigna Commercial |
$21.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.53
|
| Rate for Payer: Oxford Commercial |
$21.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$21.25
|
|
|
CATH 5FR LCB 100cm
|
Facility
|
IP
|
$42.50
|
|
| Hospital Charge Code |
270644619S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$6.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.38
|
|
|
CATH 5FR LCB 100cm
|
Facility
|
IP
|
$42.50
|
|
| Hospital Charge Code |
270644619
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$6.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.38
|
|