|
CATHETER 6FR AL1
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270658034N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.20
|
|
|
CATHETER 6FR AL1
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270658034N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial |
$2.40
|
| Rate for Payer: Aetna Medicare Advantage |
$2.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.04
|
| Rate for Payer: Cigna Commercial |
$4.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.20
|
|
|
CATHETER 6FR AL2
|
Facility
|
OP
|
$37.35
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270658037S
|
|
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 6FR AL2
|
Facility
|
OP
|
$37.35
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270658037
|
|
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 6FR AL2
|
Facility
|
OP
|
$9.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270658037N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$2.85
|
| Rate for Payer: Aetna Medicare Advantage |
$2.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.42
|
| Rate for Payer: Cigna Commercial |
$4.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.43
|
|
|
CATHETER 6FR AL2
|
Facility
|
IP
|
$9.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270658037N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.43
|
|
|
CATHETER 6FR AL2
|
Facility
|
IP
|
$37.35
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270658037S
|
|
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 6FR AL2
|
Facility
|
IP
|
$37.35
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270658037
|
|
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 6FR ANGLED PIGTAIL
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
2707400187
|
|
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 6FR ANGLED PIGTAIL
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
2707400187
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
CATHETER 6FR AR1
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
270658038N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial |
$2.40
|
| Rate for Payer: Aetna Medicare Advantage |
$2.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.04
|
| Rate for Payer: Cigna Commercial |
$4.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.20
|
|
|
CATHETER 6FR AR1
|
Facility
|
OP
|
$37.35
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
270658038S
|
|
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 6FR AR1
|
Facility
|
IP
|
$37.35
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
270658038S
|
|
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 6FR AR1
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
2707400270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
CATHETER 6FR AR1
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
2707400270
|
|
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 6FR AR1
|
Facility
|
OP
|
$37.35
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
270658038
|
|
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 6FR AR1
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
270658038N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.20
|
|
|
CATHETER 6FR AR1
|
Facility
|
IP
|
$37.35
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
270658038
|
|
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 6FR AR2
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
2707400271
|
|
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 6FR AR2
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
2707400271
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
CATHETER 6FR AR2
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270658042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.00 |
| 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) NJ Health |
$8.00
|
| 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 |
$9.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
CATHETER 6FR AR2
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270658042S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.00 |
| 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) NJ Health |
$8.00
|
| 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 |
$9.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
CATHETER 6FR AR2
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270658042S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$9.68 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
CATHETER 6FR AR2
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270658042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$9.68 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
CATHETER 6FR AR I 533641
|
Facility
|
IP
|
$41.20
|
|
| Hospital Charge Code |
270616020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$6.18 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.18
|
|