|
CATH BLN ADM XTRM.035/4/40/130
|
Facility
|
IP
|
$900.00
|
|
| Hospital Charge Code |
2700900359
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.00
|
|
|
CATH BLN DIAD 7x2x75 5.8 16497
|
Facility
|
IP
|
$653.25
|
|
| Hospital Charge Code |
270629352
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$97.99 |
| Max. Negotiated Rate |
$158.09 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$130.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$158.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$97.99
|
|
|
CATH BLN DIAD 7x2x75 5.8 16497
|
Facility
|
OP
|
$1,020.00
|
|
| Hospital Charge Code |
270629352V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna Commercial |
$306.00
|
| Rate for Payer: Aetna Medicare Advantage |
$306.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$260.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$260.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$260.10
|
| Rate for Payer: Cigna Commercial |
$510.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$246.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.00
|
|
|
CATH BLN DIAD 7x2x75 5.8 16497
|
Facility
|
IP
|
$1,020.00
|
|
| Hospital Charge Code |
270629352V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$246.84 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$204.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$246.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.00
|
|
|
CATH BLN DIAD 7x2x75 5.8 16497
|
Facility
|
OP
|
$653.25
|
|
| Hospital Charge Code |
270629352
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$97.99 |
| Max. Negotiated Rate |
$326.62 |
| Rate for Payer: Aetna Commercial |
$195.97
|
| Rate for Payer: Aetna Medicare Advantage |
$195.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$166.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$166.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$130.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$166.58
|
| Rate for Payer: Cigna Commercial |
$326.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$158.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$97.99
|
|
|
CATH BLN DIL SYM 3x4x135 10537
|
Facility
|
OP
|
$1,789.40
|
|
| Hospital Charge Code |
270628772V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.41 |
| Max. Negotiated Rate |
$894.70 |
| Rate for Payer: Aetna Commercial |
$536.82
|
| Rate for Payer: Aetna Medicare Advantage |
$536.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$456.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$456.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$357.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$456.30
|
| Rate for Payer: Cigna Commercial |
$894.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$433.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$268.41
|
|
|
CATH BLN DIL SYM 3x4x135 10537
|
Facility
|
IP
|
$1,789.40
|
|
| Hospital Charge Code |
270628772V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.41 |
| Max. Negotiated Rate |
$433.03 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$357.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$433.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$268.41
|
|
|
CATH BLN DIL SYM 5x4x135 10548
|
Facility
|
OP
|
$1,775.10
|
|
| Hospital Charge Code |
270628773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.26 |
| Max. Negotiated Rate |
$887.55 |
| Rate for Payer: Aetna Commercial |
$532.53
|
| Rate for Payer: Aetna Medicare Advantage |
$532.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$452.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$452.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$355.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$452.65
|
| Rate for Payer: Cigna Commercial |
$887.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$429.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$266.26
|
|
|
CATH BLN DIL SYM 5x4x135 10548
|
Facility
|
IP
|
$1,789.40
|
|
| Hospital Charge Code |
270628773V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.41 |
| Max. Negotiated Rate |
$433.03 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$357.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$433.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$268.41
|
|
|
CATH BLN DIL SYM 5x4x135 10548
|
Facility
|
IP
|
$1,775.10
|
|
| Hospital Charge Code |
270628773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.26 |
| Max. Negotiated Rate |
$429.57 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$355.02
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$429.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$266.26
|
|
|
CATH BLN DIL SYM 5x4x135 10548
|
Facility
|
OP
|
$1,789.40
|
|
| Hospital Charge Code |
270628773V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.41 |
| Max. Negotiated Rate |
$894.70 |
| Rate for Payer: Aetna Commercial |
$536.82
|
| Rate for Payer: Aetna Medicare Advantage |
$536.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$456.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$456.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$357.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$456.30
|
| Rate for Payer: Cigna Commercial |
$894.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$433.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$268.41
|
|
|
CATH BLN OP P5 2x135c 4195020X
|
Facility
|
OP
|
$1,264.00
|
|
| Hospital Charge Code |
270624402
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$164.32 |
| Max. Negotiated Rate |
$632.00 |
| Rate for Payer: Aetna Commercial |
$379.20
|
| Rate for Payer: Aetna Medicare Advantage |
$379.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$322.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$322.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$322.32
|
| Rate for Payer: Cigna Commercial |
$632.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$164.32
|
| Rate for Payer: Oxford Commercial |
$632.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$189.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$632.00
|
|
|
CATH BLN OP P5 2x135c 4195020X
|
Facility
|
IP
|
$1,264.00
|
|
| Hospital Charge Code |
270624402
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$189.60 |
| Max. Negotiated Rate |
$189.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$189.60
|
|
|
CATH BLN POWFLEX 9x4 4209040S
|
Facility
|
OP
|
$1,325.00
|
|
| Hospital Charge Code |
270630174V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.75 |
| Max. Negotiated Rate |
$662.50 |
| Rate for Payer: Aetna Commercial |
$397.50
|
| Rate for Payer: Aetna Medicare Advantage |
$397.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$337.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$337.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$265.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$337.88
|
| Rate for Payer: Cigna Commercial |
$662.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$320.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$198.75
|
|
|
CATH BLN POWFLEX 9x4 4209040S
|
Facility
|
IP
|
$1,325.00
|
|
| Hospital Charge Code |
270630174V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.75 |
| Max. Negotiated Rate |
$320.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$265.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$320.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$198.75
|
|
|
CATH BLN POWFLEX 9x4 4209040S
|
Facility
|
OP
|
$1,314.45
|
|
| Hospital Charge Code |
270630174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.17 |
| Max. Negotiated Rate |
$657.23 |
| Rate for Payer: Aetna Commercial |
$394.33
|
| Rate for Payer: Aetna Medicare Advantage |
$394.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$335.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$335.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$262.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$335.18
|
| Rate for Payer: Cigna Commercial |
$657.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$318.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$197.17
|
|
|
CATH BLN POWFLEX 9x4 4209040S
|
Facility
|
IP
|
$1,314.45
|
|
| Hospital Charge Code |
270630174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.17 |
| Max. Negotiated Rate |
$318.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$262.89
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$318.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$197.17
|
|
|
CATH BLN SLM 6x4x135 4386040XP
|
Facility
|
IP
|
$1,325.00
|
|
| Hospital Charge Code |
270632653V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.75 |
| Max. Negotiated Rate |
$320.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$265.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$320.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$198.75
|
|
|
CATH BLN SLM 6x4x135 4386040XP
|
Facility
|
OP
|
$1,884.85
|
|
| Hospital Charge Code |
270632652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$282.73 |
| Max. Negotiated Rate |
$942.42 |
| Rate for Payer: Aetna Commercial |
$565.46
|
| Rate for Payer: Aetna Medicare Advantage |
$565.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$480.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$480.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$376.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$480.64
|
| Rate for Payer: Cigna Commercial |
$942.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$456.13
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$282.73
|
|
|
CATH BLN SLM 6x4x135 4386040XP
|
Facility
|
OP
|
$1,900.00
|
|
| Hospital Charge Code |
270632652V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$285.00 |
| Max. Negotiated Rate |
$950.00 |
| Rate for Payer: Aetna Commercial |
$570.00
|
| Rate for Payer: Aetna Medicare Advantage |
$570.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$484.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$484.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$380.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$484.50
|
| Rate for Payer: Cigna Commercial |
$950.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$459.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$285.00
|
|
|
CATH BLN SLM 6x4x135 4386040XP
|
Facility
|
IP
|
$1,884.85
|
|
| Hospital Charge Code |
270632652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$282.73 |
| Max. Negotiated Rate |
$456.13 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$376.97
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$456.13
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$282.73
|
|
|
CATH BLN SLM 6x4x135 4386040XP
|
Facility
|
IP
|
$1,900.00
|
|
| Hospital Charge Code |
270632652V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$285.00 |
| Max. Negotiated Rate |
$459.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$380.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$459.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$285.00
|
|
|
CATH BLN SLM 6x4x135 4386040XP
|
Facility
|
OP
|
$1,325.00
|
|
| Hospital Charge Code |
270632653V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.75 |
| Max. Negotiated Rate |
$662.50 |
| Rate for Payer: Aetna Commercial |
$397.50
|
| Rate for Payer: Aetna Medicare Advantage |
$397.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$337.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$337.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$265.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$337.88
|
| Rate for Payer: Cigna Commercial |
$662.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$320.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$198.75
|
|
|
CATH CANATA 2.5FR 135cm
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270645715C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.00 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$510.00
|
| Rate for Payer: Aetna Medicare Advantage |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$433.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$433.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$340.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$433.50
|
| Rate for Payer: Cigna Commercial |
$850.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$411.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$255.00
|
|
|
CATH CANATA 2.5FR 135cm
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270645715C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.00 |
| Max. Negotiated Rate |
$411.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$340.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$411.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$255.00
|
|
