|
CATH 6FR JL 6.0
|
Facility
|
IP
|
$240.00
|
|
| Hospital Charge Code |
270637299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.00
|
|
|
CATH 6FR JL 6.0
|
Facility
|
OP
|
$240.00
|
|
| Hospital Charge Code |
270637299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| 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) PPO |
$61.20
|
| Rate for Payer: Cigna Commercial |
$120.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$31.20
|
| Rate for Payer: Oxford Commercial |
$120.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$120.00
|
|
|
CATH 6FR JL 6 0 533824
|
Facility
|
OP
|
$41.20
|
|
| Hospital Charge Code |
270616021
|
|
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 6FR JL 6 0 533824
|
Facility
|
IP
|
$41.20
|
|
| Hospital Charge Code |
270616021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$6.18 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.18
|
|
|
CATH 6FR JL 6.0 67001000
|
Facility
|
OP
|
$255.00
|
|
| Hospital Charge Code |
270637299C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.25 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Medicare Advantage |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$65.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$65.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$51.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$65.03
|
| Rate for Payer: Cigna Commercial |
$127.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$61.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.25
|
|
|
CATH 6FR JL 6.0 67001000
|
Facility
|
IP
|
$255.00
|
|
| Hospital Charge Code |
270637299C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.25 |
| Max. Negotiated Rate |
$61.71 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$51.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$61.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.25
|
|
|
CATH 6FR JR 3.0 W/SH
|
Facility
|
IP
|
$245.00
|
|
| Hospital Charge Code |
270638299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$36.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
|
|
CATH 6FR JR 3.0 W/SH
|
Facility
|
OP
|
$245.00
|
|
| Hospital Charge Code |
270638299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.85 |
| Max. Negotiated Rate |
$122.50 |
| Rate for Payer: Aetna Commercial |
$73.50
|
| Rate for Payer: Aetna Medicare Advantage |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$62.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$62.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$62.48
|
| Rate for Payer: Cigna Commercial |
$122.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$31.85
|
| Rate for Payer: Oxford Commercial |
$122.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$122.50
|
|
|
CATH 6FR JR 4.0
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636299S
|
|
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 6FR JR 4.0
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636299
|
|
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 6FR JR 4.0
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636299N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna Commercial |
$66.00
|
| Rate for Payer: Aetna Medicare Advantage |
$66.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$56.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$56.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$44.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$56.10
|
| Rate for Payer: Cigna Commercial |
$110.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$53.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.00
|
|
|
CATH 6FR JR 4.0
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636299S
|
|
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 6FR JR 4.0
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636299
|
|
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 6FR JR 4.0
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636299N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$53.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$44.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$53.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.00
|
|
|
CATH 6FR LCB SH .07 670-181-00
|
Facility
|
IP
|
$255.00
|
|
| Hospital Charge Code |
270639850C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.25 |
| Max. Negotiated Rate |
$61.71 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$51.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$61.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.25
|
|
|
CATH 6FR LCB SH .07 670-181-00
|
Facility
|
OP
|
$255.00
|
|
| Hospital Charge Code |
270639850C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.25 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Medicare Advantage |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$65.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$65.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$51.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$65.03
|
| Rate for Payer: Cigna Commercial |
$127.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$61.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.25
|
|
|
CATH 6FR MPA1 100CM
|
Facility
|
IP
|
$45.25
|
|
| Hospital Charge Code |
270640531
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$6.79 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.79
|
|
|
CATH 6FR MPA1 100CM
|
Facility
|
OP
|
$45.25
|
|
| Hospital Charge Code |
270640531
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$22.62 |
| Rate for Payer: Aetna Commercial |
$13.57
|
| Rate for Payer: Aetna Medicare Advantage |
$13.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$11.54
|
| Rate for Payer: Cigna Commercial |
$22.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.88
|
| Rate for Payer: Oxford Commercial |
$22.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.79
|
| Rate for Payer: UnitedHealthcare Commercial |
$22.62
|
|
|
CATH 6FR MPA1 SUPERTORQUE PLUS
|
Facility
|
IP
|
$42.25
|
|
| Hospital Charge Code |
270662055
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.34
|
|
|
CATH 6FR MPA1 SUPERTORQUE PLUS
|
Facility
|
OP
|
$42.25
|
|
| Hospital Charge Code |
270662055
|
|
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 6FR RCB SH .07
|
Facility
|
IP
|
$279.85
|
|
| Hospital Charge Code |
270639852
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.98 |
| Max. Negotiated Rate |
$41.98 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.98
|
|
|
CATH 6FR RCB SH .07
|
Facility
|
OP
|
$279.85
|
|
| Hospital Charge Code |
270639852
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.38 |
| Max. Negotiated Rate |
$139.93 |
| Rate for Payer: Aetna Commercial |
$83.95
|
| Rate for Payer: Aetna Medicare Advantage |
$83.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$71.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$71.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$71.36
|
| Rate for Payer: Cigna Commercial |
$139.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.38
|
| Rate for Payer: Oxford Commercial |
$139.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.98
|
| Rate for Payer: UnitedHealthcare Commercial |
$139.93
|
|
|
CATH 6FR SH JL 4.0 67000500
|
Facility
|
OP
|
$255.00
|
|
| Hospital Charge Code |
270636295C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.25 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Medicare Advantage |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$65.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$65.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$51.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$65.03
|
| Rate for Payer: Cigna Commercial |
$127.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$61.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.25
|
|
|
CATH 6FR SH JL 4.0 67000500
|
Facility
|
IP
|
$255.00
|
|
| Hospital Charge Code |
270636295C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.25 |
| Max. Negotiated Rate |
$61.71 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$51.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$61.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.25
|
|
|
CATH 6FR SH JR 4.0
|
Facility
|
OP
|
$217.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636300S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$32.62 |
| Max. Negotiated Rate |
$108.75 |
| Rate for Payer: Aetna Commercial |
$65.25
|
| Rate for Payer: Aetna Medicare Advantage |
$65.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$55.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$55.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$43.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$55.46
|
| Rate for Payer: Cigna Commercial |
$108.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$52.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.62
|
|