|
CATHETER 6FR AR I 533641
|
Facility
|
OP
|
$41.20
|
|
| Hospital Charge Code |
270616020
|
|
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
|
|
|
CATHETER 6F RCB
|
Facility
|
IP
|
$47.50
|
|
| Hospital Charge Code |
2709000322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$7.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.12
|
|
|
CATHETER 6F RCB
|
Facility
|
OP
|
$47.50
|
|
| Hospital Charge Code |
2709000322
|
|
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 6FR IMA
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
2707400247
|
|
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 IMA
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
2707400247
|
|
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 JACKY 100CM
|
Facility
|
IP
|
$275.00
|
|
| Hospital Charge Code |
270675911S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.25
|
|
|
CATHETER 6FR JACKY 100CM
|
Facility
|
OP
|
$275.00
|
|
| Hospital Charge Code |
270675911S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.75 |
| Max. Negotiated Rate |
$137.50 |
| Rate for Payer: Aetna Commercial |
$82.50
|
| Rate for Payer: Aetna Medicare Advantage |
$82.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$70.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$70.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$70.12
|
| Rate for Payer: Cigna Commercial |
$137.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.75
|
| Rate for Payer: Oxford Commercial |
$137.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$137.50
|
|
|
CATHETER 6FR JACKY 100CM
|
Facility
|
IP
|
$225.00
|
|
| Hospital Charge Code |
270675911
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
CATHETER 6FR JACKY 100CM
|
Facility
|
OP
|
$225.00
|
|
| Hospital Charge Code |
270675911
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Medicare Advantage |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.38
|
| Rate for Payer: Cigna Commercial |
$112.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.25
|
| Rate for Payer: Oxford Commercial |
$112.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$112.50
|
|
|
CATHETER 6FR JL3 100CM
|
Facility
|
OP
|
$220.00
|
|
| Hospital Charge Code |
270637298N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.60 |
| 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) PPO |
$56.10
|
| Rate for Payer: Cigna Commercial |
$110.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$28.60
|
| Rate for Payer: Oxford Commercial |
$110.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$110.00
|
|
|
CATHETER 6FR JL3 100CM
|
Facility
|
IP
|
$240.00
|
|
| Hospital Charge Code |
270637298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.00
|
|
|
CATHETER 6FR JL3 100CM
|
Facility
|
IP
|
$220.00
|
|
| Hospital Charge Code |
270637298N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.00
|
|
|
CATHETER 6FR JL3 100CM
|
Facility
|
IP
|
$240.00
|
|
| Hospital Charge Code |
270637298S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.00
|
|
|
CATHETER 6FR JL3 100CM
|
Facility
|
OP
|
$240.00
|
|
| Hospital Charge Code |
270637298S
|
|
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
|
|
|
CATHETER 6FR JL3 100CM
|
Facility
|
OP
|
$240.00
|
|
| Hospital Charge Code |
270637298
|
|
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
|
|
|
CATHETER 6FR JL 3.5
|
Facility
|
OP
|
$37.90
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270655421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$18.95 |
| Rate for Payer: Aetna Commercial |
$11.37
|
| Rate for Payer: Aetna Medicare Advantage |
$11.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.66
|
| Rate for Payer: Cigna Commercial |
$18.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.68
|
|
|
CATHETER 6FR JL 3.5
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
2707400255
|
|
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 JL 3.5
|
Facility
|
OP
|
$37.90
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270655421S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$18.95 |
| Rate for Payer: Aetna Commercial |
$11.37
|
| Rate for Payer: Aetna Medicare Advantage |
$11.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.66
|
| Rate for Payer: Cigna Commercial |
$18.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.68
|
|
|
CATHETER 6FR JL 3.5
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270655421N
|
|
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 JL 3.5
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270655421N
|
|
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 JL 3.5
|
Facility
|
IP
|
$37.90
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270655421S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$9.17 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.68
|
|
|
CATHETER 6FR JL 3.5
|
Facility
|
IP
|
$37.90
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270655421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$9.17 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.68
|
|
|
CATHETER 6FR JL 3.5
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
2707400255
|
|
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 JL4
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
2707400129
|
|
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 JL4
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270647848
|
|
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
|
|