|
CATH CLASSIC CROWN 1.25mm
|
Facility
|
IP
|
$15,975.00
|
|
| Hospital Charge Code |
270642639C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,396.25 |
| Max. Negotiated Rate |
$3,865.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,195.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,865.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,396.25
|
|
|
CATH CLASSIC CROWN 1.25mm
|
Facility
|
OP
|
$15,975.00
|
|
| Hospital Charge Code |
270642639C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,396.25 |
| Max. Negotiated Rate |
$7,987.50 |
| Rate for Payer: Aetna Commercial |
$4,792.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4,792.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,073.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,073.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,195.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,073.62
|
| Rate for Payer: Cigna Commercial |
$7,987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,865.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,396.25
|
|
|
CATH CLASSIC CROWN 1.50mm
|
Facility
|
OP
|
$15,975.00
|
|
| Hospital Charge Code |
270642011C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,396.25 |
| Max. Negotiated Rate |
$7,987.50 |
| Rate for Payer: Aetna Commercial |
$4,792.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4,792.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,073.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,073.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,195.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,073.62
|
| Rate for Payer: Cigna Commercial |
$7,987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,865.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,396.25
|
|
|
CATH CLASSIC CROWN 1.50mm
|
Facility
|
IP
|
$15,975.00
|
|
| Hospital Charge Code |
270642011C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,396.25 |
| Max. Negotiated Rate |
$3,865.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,195.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,865.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,396.25
|
|
|
CATH CLASSIC CROWN 1.75 DB175L
|
Facility
|
OP
|
$15,975.00
|
|
| Hospital Charge Code |
270642012V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,396.25 |
| Max. Negotiated Rate |
$7,987.50 |
| Rate for Payer: Aetna Commercial |
$4,792.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4,792.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,073.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,073.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,195.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,073.62
|
| Rate for Payer: Cigna Commercial |
$7,987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,865.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,396.25
|
|
|
CATH CLASSIC CROWN 1.75 DB175L
|
Facility
|
IP
|
$15,975.00
|
|
| Hospital Charge Code |
270642012V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,396.25 |
| Max. Negotiated Rate |
$3,865.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,195.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,865.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,396.25
|
|
|
CATH CLASSIC CROWN 2.00mm
|
Facility
|
IP
|
$15,975.00
|
|
| Hospital Charge Code |
270642013C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,396.25 |
| Max. Negotiated Rate |
$3,865.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,195.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,865.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,396.25
|
|
|
CATH CLASSIC CROWN 2.00mm
|
Facility
|
OP
|
$15,975.00
|
|
| Hospital Charge Code |
270642013C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,396.25 |
| Max. Negotiated Rate |
$7,987.50 |
| Rate for Payer: Aetna Commercial |
$4,792.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4,792.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,073.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,073.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,195.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,073.62
|
| Rate for Payer: Cigna Commercial |
$7,987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,865.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,396.25
|
|
|
CATH CLSD SUCT TRACH DBL 14FR
|
Facility
|
IP
|
$54.07
|
|
| Hospital Charge Code |
270650303
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$8.11 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.11
|
|
|
CATH CLSD SUCT TRACH DBL 14FR
|
Facility
|
OP
|
$54.07
|
|
| Hospital Charge Code |
270650303
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$27.04 |
| Rate for Payer: Aetna Commercial |
$16.22
|
| Rate for Payer: Aetna Medicare Advantage |
$16.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.79
|
| Rate for Payer: Cigna Commercial |
$27.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.03
|
| Rate for Payer: Oxford Commercial |
$27.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.11
|
| Rate for Payer: UnitedHealthcare Commercial |
$27.04
|
|
|
CATH CLSSC CRWN 1.75mm DB-175L
|
Facility
|
OP
|
$15,975.00
|
|
| Hospital Charge Code |
270642012C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,396.25 |
| Max. Negotiated Rate |
$7,987.50 |
| Rate for Payer: Aetna Commercial |
$4,792.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4,792.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,073.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,073.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,195.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,073.62
|
| Rate for Payer: Cigna Commercial |
$7,987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,865.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,396.25
|
|
|
CATH CLSSC CRWN 1.75mm DB-175L
|
Facility
|
IP
|
$15,975.00
|
|
| Hospital Charge Code |
270642012C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,396.25 |
| Max. Negotiated Rate |
$3,865.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,195.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,865.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,396.25
|
|
|
CATH CLSSCRWN ORB ARTHR 1.50mm
|
Facility
|
OP
|
$15,975.00
|
|
| Hospital Charge Code |
2709003736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,076.75 |
| Max. Negotiated Rate |
$7,987.50 |
| Rate for Payer: Aetna Commercial |
$4,792.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4,792.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,073.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,073.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,073.62
|
| Rate for Payer: Cigna Commercial |
$7,987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,076.75
|
| Rate for Payer: Oxford Commercial |
$7,987.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,396.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$7,987.50
|
|
|
CATH CLSSCRWN ORB ARTHR 1.50mm
|
Facility
|
IP
|
$15,975.00
|
|
| Hospital Charge Code |
2709003736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,396.25 |
| Max. Negotiated Rate |
$2,396.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,396.25
|
|
|
CATH COATED GLIDEX 10FR 25CM
|
Facility
|
IP
|
$233.45
|
|
| Hospital Charge Code |
270675447
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.02 |
| Max. Negotiated Rate |
$56.49 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$46.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$56.49
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.02
|
|
|
CATH COATED GLIDEX 10FR 25CM
|
Facility
|
OP
|
$233.45
|
|
| Hospital Charge Code |
270675447
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.02 |
| Max. Negotiated Rate |
$116.72 |
| Rate for Payer: Aetna Commercial |
$70.03
|
| Rate for Payer: Aetna Medicare Advantage |
$70.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$59.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$59.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$46.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$59.53
|
| Rate for Payer: Cigna Commercial |
$116.72
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$56.49
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.02
|
|
|
CATH COBRA1 5F 65CM 0.38IN
|
Facility
|
OP
|
$90.00
|
|
| Hospital Charge Code |
270678510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Aetna Medicare Advantage |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$22.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$22.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$22.95
|
| Rate for Payer: Cigna Commercial |
$45.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.70
|
| Rate for Payer: Oxford Commercial |
$45.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$45.00
|
|
|
CATH COBRA1 5F 65CM 0.38IN
|
Facility
|
IP
|
$90.00
|
|
| Hospital Charge Code |
270678510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.50
|
|
|
CATH COBRA 5FR 65cm
|
Facility
|
IP
|
$317.50
|
|
| Hospital Charge Code |
270638835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.62 |
| Max. Negotiated Rate |
$47.62 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$47.62
|
|
|
CATH COBRA 5FR 65cm
|
Facility
|
OP
|
$317.50
|
|
| Hospital Charge Code |
270638835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.27 |
| Max. Negotiated Rate |
$158.75 |
| Rate for Payer: Aetna Commercial |
$95.25
|
| Rate for Payer: Aetna Medicare Advantage |
$95.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$80.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$80.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$80.96
|
| Rate for Payer: Cigna Commercial |
$158.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$41.27
|
| Rate for Payer: Oxford Commercial |
$158.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$47.62
|
| Rate for Payer: UnitedHealthcare Commercial |
$158.75
|
|
|
CATH COBRAI 5F 035x65 10719701
|
Facility
|
OP
|
$515.90
|
|
| Hospital Charge Code |
270634929
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.07 |
| Max. Negotiated Rate |
$257.95 |
| Rate for Payer: Aetna Commercial |
$154.77
|
| Rate for Payer: Aetna Medicare Advantage |
$154.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$131.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$131.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$131.55
|
| Rate for Payer: Cigna Commercial |
$257.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$67.07
|
| Rate for Payer: Oxford Commercial |
$257.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.39
|
| Rate for Payer: UnitedHealthcare Commercial |
$257.95
|
|
|
CATH COBRAI 5F 035x65 10719701
|
Facility
|
IP
|
$515.90
|
|
| Hospital Charge Code |
270634929
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.39 |
| Max. Negotiated Rate |
$77.39 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.39
|
|
|
CATH COCIL TIP 22F 5 220196L22
|
Facility
|
IP
|
$61.76
|
|
| Hospital Charge Code |
270633136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$9.26 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.26
|
|
|
CATH COCIL TIP 22F 5 220196L22
|
Facility
|
OP
|
$61.76
|
|
| Hospital Charge Code |
270633136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.03 |
| Max. Negotiated Rate |
$30.88 |
| Rate for Payer: Aetna Commercial |
$18.53
|
| Rate for Payer: Aetna Medicare Advantage |
$18.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15.75
|
| Rate for Payer: Cigna Commercial |
$30.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.03
|
| Rate for Payer: Oxford Commercial |
$30.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$30.88
|
|
|
CATH CONT IRR 30CC 18FR
|
Facility
|
IP
|
$125.00
|
|
| Hospital Charge Code |
270331013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
|