|
CATH 5FR MPA2 125cm
|
Facility
|
IP
|
$42.50
|
|
| Hospital Charge Code |
270644599
|
|
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 MPA2 125cm
|
Facility
|
OP
|
$42.50
|
|
| Hospital Charge Code |
270644599
|
|
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 RCB 100cm
|
Facility
|
OP
|
$42.50
|
|
| Hospital Charge Code |
270644618
|
|
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 RCB 100cm
|
Facility
|
IP
|
$42.50
|
|
| Hospital Charge Code |
270644618
|
|
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 SRC 100cm 534574T
|
Facility
|
OP
|
$44.50
|
|
| Hospital Charge Code |
270644610S
|
|
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 SRC 100cm 534574T
|
Facility
|
IP
|
$44.50
|
|
| Hospital Charge Code |
270644610C
|
|
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 SRC 100cm 534574T
|
Facility
|
OP
|
$44.50
|
|
| Hospital Charge Code |
270644610C
|
|
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 SRC 100cm 534574T
|
Facility
|
IP
|
$44.50
|
|
| Hospital Charge Code |
270644610S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.67 |
| Max. Negotiated Rate |
$6.67 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.67
|
|
|
CATH 6*****
|
Facility
|
OP
|
$181.00
|
|
| Hospital Charge Code |
8003451
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$90.50 |
| Rate for Payer: Aetna Commercial |
$54.30
|
| Rate for Payer: Aetna Medicare Advantage |
$54.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.16
|
| Rate for Payer: Cigna Commercial |
$90.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$23.53
|
| Rate for Payer: Oxford Commercial |
$90.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$90.50
|
|
|
CATH 6*****
|
Facility
|
IP
|
$181.00
|
|
| Hospital Charge Code |
8003451
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$27.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.15
|
|
|
CATH 6F AL I 533645
|
Facility
|
IP
|
$42.25
|
|
| Hospital Charge Code |
270604409
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.34
|
|
|
CATH 6F AL I 533645
|
Facility
|
OP
|
$42.25
|
|
| Hospital Charge Code |
270604409
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.49 |
| Max. Negotiated Rate |
$21.12 |
| Rate for Payer: Aetna Commercial |
$12.68
|
| Rate for Payer: Aetna Medicare Advantage |
$12.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.77
|
| Rate for Payer: Cigna Commercial |
$21.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.49
|
| Rate for Payer: Oxford Commercial |
$21.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$21.12
|
|
|
CATH 6F AR I MODFD 533641T
|
Facility
|
IP
|
$49.65
|
|
| Hospital Charge Code |
270614270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.45 |
| Max. Negotiated Rate |
$7.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.45
|
|
|
CATH 6F AR I MODFD 533641T
|
Facility
|
OP
|
$49.65
|
|
| Hospital Charge Code |
270614270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.45 |
| Max. Negotiated Rate |
$24.82 |
| Rate for Payer: Aetna Commercial |
$14.89
|
| Rate for Payer: Aetna Medicare Advantage |
$14.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.66
|
| Rate for Payer: Cigna Commercial |
$24.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.45
|
| Rate for Payer: Oxford Commercial |
$24.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$24.82
|
|
|
CATH 6F INFINITI TL 534674T
|
Facility
|
IP
|
$44.50
|
|
| Hospital Charge Code |
270618311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.67 |
| Max. Negotiated Rate |
$6.67 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.67
|
|
|
CATH 6F INFINITI TL 534674T
|
Facility
|
OP
|
$44.50
|
|
| Hospital Charge Code |
270618311
|
|
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 6F JR 5 0 100 533623
|
Facility
|
IP
|
$41.20
|
|
| Hospital Charge Code |
270616022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$6.18 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.18
|
|
|
CATH 6F JR 5 0 100 533623
|
Facility
|
OP
|
$41.20
|
|
| Hospital Charge Code |
270616022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$20.60 |
| Rate for Payer: Aetna Commercial |
$12.36
|
| Rate for Payer: Aetna Medicare Advantage |
$12.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.51
|
| Rate for Payer: Cigna Commercial |
$20.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.36
|
| Rate for Payer: Oxford Commercial |
$20.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$20.60
|
|
|
CATH 6F LCB
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270639849
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Medicare Advantage |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$48.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.20
|
| Rate for Payer: Cigna Commercial |
$120.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$58.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.00
|
|
|
CATH 6F LCB
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270639849
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$58.08 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$48.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$58.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.00
|
|
|
CATH 6 F MPA 1
|
Facility
|
OP
|
$54.95
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636331N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$27.48 |
| Rate for Payer: Aetna Commercial |
$16.48
|
| Rate for Payer: Aetna Medicare Advantage |
$16.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.01
|
| Rate for Payer: Cigna Commercial |
$27.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.24
|
|
|
CATH 6 F MPA 1
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$58.08 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$48.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$58.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.00
|
|
|
CATH 6 F MPA 1
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636331S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$58.08 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$48.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$58.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.00
|
|
|
CATH 6 F MPA 1
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Medicare Advantage |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$48.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.20
|
| Rate for Payer: Cigna Commercial |
$120.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$58.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.00
|
|
|
CATH 6 F MPA 1
|
Facility
|
IP
|
$54.95
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636331N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$13.30 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.99
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.24
|
|