|
CATHETER 3-WAY CONTINUOUS
|
Facility
|
IP
|
$63.00
|
|
| Hospital Charge Code |
270331097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$9.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.45
|
|
|
CATHETER 3-WAY CONTINUOUS
|
Facility
|
OP
|
$63.00
|
|
| Hospital Charge Code |
270331097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Commercial |
$18.90
|
| Rate for Payer: Aetna Medicare Advantage |
$18.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$16.07
|
| Rate for Payer: Cigna Commercial |
$31.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.19
|
| Rate for Payer: Oxford Commercial |
$31.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$31.50
|
|
|
CATHETER 4 MAX W TUBE
|
Facility
|
IP
|
$8,750.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270682966
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,312.50 |
| Max. Negotiated Rate |
$2,117.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,117.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,312.50
|
|
|
CATHETER 4 MAX W TUBE
|
Facility
|
OP
|
$8,750.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270682966
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,312.50 |
| Max. Negotiated Rate |
$4,375.00 |
| Rate for Payer: Aetna Commercial |
$2,625.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,625.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,231.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,231.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,231.25
|
| Rate for Payer: Cigna Commercial |
$4,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,117.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,312.50
|
|
|
CATHETER 5F AL1
|
Facility
|
IP
|
$37.35
|
|
| Hospital Charge Code |
270658170S
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.60
|
|
|
CATHETER 5F AL1
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
270658170N
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$12.00
|
| Rate for Payer: Aetna Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.20
|
| Rate for Payer: Cigna Commercial |
$20.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.20
|
| Rate for Payer: Oxford Commercial |
$20.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$20.00
|
|
|
CATHETER 5F AL1
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
2709000306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
CATHETER 5F AL1
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
2709000306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$12.00
|
| Rate for Payer: Aetna Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.20
|
| Rate for Payer: Cigna Commercial |
$20.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.20
|
| Rate for Payer: Oxford Commercial |
$20.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$20.00
|
|
|
CATHETER 5F AL1
|
Facility
|
OP
|
$37.35
|
|
| Hospital Charge Code |
270658170S
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$18.68 |
| Rate for Payer: Aetna Commercial |
$11.21
|
| Rate for Payer: Aetna Medicare Advantage |
$11.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.52
|
| Rate for Payer: Cigna Commercial |
$18.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.86
|
| Rate for Payer: Oxford Commercial |
$18.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$18.68
|
|
|
CATHETER 5F AL1
|
Facility
|
IP
|
$37.35
|
|
| Hospital Charge Code |
270658170
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.60
|
|
|
CATHETER 5F AL1
|
Facility
|
OP
|
$37.35
|
|
| Hospital Charge Code |
270658170
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$18.68 |
| Rate for Payer: Aetna Commercial |
$11.21
|
| Rate for Payer: Aetna Medicare Advantage |
$11.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.52
|
| Rate for Payer: Cigna Commercial |
$18.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.86
|
| Rate for Payer: Oxford Commercial |
$18.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$18.68
|
|
|
CATHETER 5F AL1
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
270658170N
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
CATHETER 5F AL2
|
Facility
|
IP
|
$37.35
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270658171
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$9.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.60
|
|
|
CATHETER 5F AL2
|
Facility
|
OP
|
$37.35
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270658171
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$18.68 |
| Rate for Payer: Aetna Commercial |
$11.21
|
| Rate for Payer: Aetna Medicare Advantage |
$11.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.52
|
| Rate for Payer: Cigna Commercial |
$18.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.60
|
|
|
CATHETER 5F AL2
|
Facility
|
OP
|
$47.50
|
|
| Hospital Charge Code |
2709000307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.17 |
| Max. Negotiated Rate |
$23.75 |
| Rate for Payer: Aetna Commercial |
$14.25
|
| Rate for Payer: Aetna Medicare Advantage |
$14.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.11
|
| Rate for Payer: Cigna Commercial |
$23.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.17
|
| Rate for Payer: Oxford Commercial |
$23.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$23.75
|
|
|
CATHETER 5F AL2
|
Facility
|
IP
|
$47.50
|
|
| Hospital Charge Code |
2709000307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$7.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.12
|
|
|
CATHETER 5F ANGLED PIGTAIL
|
Facility
|
IP
|
$47.50
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
270658269N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$11.49 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.49
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.12
|
|
|
CATHETER 5F ANGLED PIGTAIL
|
Facility
|
OP
|
$37.35
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
270658269S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$18.68 |
| Rate for Payer: Aetna Commercial |
$11.21
|
| Rate for Payer: Aetna Medicare Advantage |
$11.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.52
|
| Rate for Payer: Cigna Commercial |
$18.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.60
|
|
|
CATHETER 5F ANGLED PIGTAIL
|
Facility
|
IP
|
$37.35
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
270658269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$9.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.60
|
|
|
CATHETER 5F ANGLED PIGTAIL
|
Facility
|
IP
|
$37.35
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
270658269S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$9.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.60
|
|
|
CATHETER 5F ANGLED PIGTAIL
|
Facility
|
OP
|
$47.50
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
270658269N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$23.75 |
| Rate for Payer: Aetna Commercial |
$14.25
|
| Rate for Payer: Aetna Medicare Advantage |
$14.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.11
|
| Rate for Payer: Cigna Commercial |
$23.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.49
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.12
|
|
|
CATHETER 5F ANGLED PIGTAIL
|
Facility
|
OP
|
$37.35
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
270658269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$18.68 |
| Rate for Payer: Aetna Commercial |
$11.21
|
| Rate for Payer: Aetna Medicare Advantage |
$11.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.52
|
| Rate for Payer: Cigna Commercial |
$18.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.60
|
|
|
CATHETER 5F ANGLED PIGTAIL
|
Facility
|
OP
|
$47.50
|
|
| Hospital Charge Code |
2709000314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.17 |
| Max. Negotiated Rate |
$23.75 |
| Rate for Payer: Aetna Commercial |
$14.25
|
| Rate for Payer: Aetna Medicare Advantage |
$14.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.11
|
| Rate for Payer: Cigna Commercial |
$23.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.17
|
| Rate for Payer: Oxford Commercial |
$23.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$23.75
|
|
|
CATHETER 5F ANGLED PIGTAIL
|
Facility
|
IP
|
$47.50
|
|
| Hospital Charge Code |
2709000314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$7.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.12
|
|
|
CATHETER 5F AR1
|
Facility
|
IP
|
$37.35
|
|
| Hospital Charge Code |
270658172
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.60
|
|