|
CATHETER BENCHMARK 105 CM
|
Facility
|
OP
|
$4,975.00
|
|
| Hospital Charge Code |
270685065
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$646.75 |
| Max. Negotiated Rate |
$2,487.50 |
| Rate for Payer: Aetna Commercial |
$1,492.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,492.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,268.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,268.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,268.62
|
| Rate for Payer: Cigna Commercial |
$2,487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$646.75
|
| Rate for Payer: Oxford Commercial |
$2,487.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$746.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,487.50
|
|
|
CATHETER BENCHMARK 6 FRX 95 CM
|
Facility
|
OP
|
$4,775.00
|
|
| Hospital Charge Code |
270685064
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$620.75 |
| Max. Negotiated Rate |
$2,387.50 |
| Rate for Payer: Aetna Commercial |
$1,432.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,432.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,217.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,217.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,217.62
|
| Rate for Payer: Cigna Commercial |
$2,387.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$620.75
|
| Rate for Payer: Oxford Commercial |
$2,387.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$716.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,387.50
|
|
|
CATHETER BENCHMARK 6 FRX 95 CM
|
Facility
|
IP
|
$4,775.00
|
|
| Hospital Charge Code |
270685064
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$716.25 |
| Max. Negotiated Rate |
$716.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$716.25
|
|
|
CATHETER BENCHMARK 90X125
|
Facility
|
OP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270691254S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$671.25 |
| Max. Negotiated Rate |
$2,237.50 |
| Rate for Payer: Aetna Commercial |
$1,342.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,342.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,141.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,141.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$895.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,141.12
|
| Rate for Payer: Cigna Commercial |
$2,237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,082.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$671.25
|
|
|
CATHETER BENCHMARK 90X125
|
Facility
|
IP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270691254S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$671.25 |
| Max. Negotiated Rate |
$1,082.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$895.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,082.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$671.25
|
|
|
CATHETER BENCHMARK 90X125
|
Facility
|
IP
|
$4,475.00
|
|
| Hospital Charge Code |
270691254
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$671.25 |
| Max. Negotiated Rate |
$671.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$671.25
|
|
|
CATHETER BENCHMARK 90X125
|
Facility
|
OP
|
$4,475.00
|
|
| Hospital Charge Code |
270691254
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$581.75 |
| Max. Negotiated Rate |
$2,237.50 |
| Rate for Payer: Aetna Commercial |
$1,342.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,342.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,141.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,141.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,141.12
|
| Rate for Payer: Cigna Commercial |
$2,237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$581.75
|
| Rate for Payer: Oxford Commercial |
$2,237.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$671.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,237.50
|
|
|
CATHETER BENCHMARK 95CM
|
Facility
|
OP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270698235S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$671.25 |
| Max. Negotiated Rate |
$2,237.50 |
| Rate for Payer: Aetna Commercial |
$1,342.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,342.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,141.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,141.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$895.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,141.12
|
| Rate for Payer: Cigna Commercial |
$2,237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,082.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$671.25
|
|
|
CATHETER BENCHMARK 95CM
|
Facility
|
IP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270698235S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$671.25 |
| Max. Negotiated Rate |
$1,082.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$895.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,082.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$671.25
|
|
|
CATHETER BERENSTEIN 5FR 100cm
|
Facility
|
IP
|
$55.82
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270651770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.37 |
| Max. Negotiated Rate |
$13.51 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.16
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.51
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.37
|
|
|
CATHETER BERENSTEIN 5FR 100cm
|
Facility
|
OP
|
$55.82
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270651770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.37 |
| Max. Negotiated Rate |
$27.91 |
| Rate for Payer: Aetna Commercial |
$16.75
|
| Rate for Payer: Aetna Medicare Advantage |
$16.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.23
|
| Rate for Payer: Cigna Commercial |
$27.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.51
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.37
|
|
|
CATHETER BERENSTEIN 5Fx40CM
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270678517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.50 |
| 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) NJ Health |
$18.00
|
| 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 |
$21.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.50
|
|
|
CATHETER BERENSTEIN 5Fx40CM
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270678517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$21.78 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.50
|
|
|
CATHETER BERENSTEIN 5Fx40CM
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270678517S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.50 |
| 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) NJ Health |
$18.00
|
| 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 |
$21.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.50
|
|
|
CATHETER BERENSTEIN 5Fx40CM
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270678517S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$21.78 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.50
|
|
|
CATHETER BERN 5FR 125CM
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270700328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$72.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$60.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
|
|
CATHETER BERN 5FR 125CM
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270700328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$90.00
|
| Rate for Payer: Aetna Medicare Advantage |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$76.50
|
| Rate for Payer: Cigna Commercial |
$150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
|
|
CATHETER BILLARY 10FR
|
Facility
|
IP
|
$399.95
|
|
| Hospital Charge Code |
270651773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.99 |
| Max. Negotiated Rate |
$59.99 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$59.99
|
|
|
CATHETER BILLARY 10FR
|
Facility
|
OP
|
$399.95
|
|
| Hospital Charge Code |
270651773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.99 |
| Max. Negotiated Rate |
$199.97 |
| Rate for Payer: Aetna Commercial |
$119.98
|
| Rate for Payer: Aetna Medicare Advantage |
$119.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$101.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$101.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$101.99
|
| Rate for Payer: Cigna Commercial |
$199.97
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$51.99
|
| Rate for Payer: Oxford Commercial |
$199.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$59.99
|
| Rate for Payer: UnitedHealthcare Commercial |
$199.97
|
|
|
CATHETER BILLARY 8FR
|
Facility
|
OP
|
$399.95
|
|
| Hospital Charge Code |
270654389
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.99 |
| Max. Negotiated Rate |
$199.97 |
| Rate for Payer: Aetna Commercial |
$119.98
|
| Rate for Payer: Aetna Medicare Advantage |
$119.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$101.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$101.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$101.99
|
| Rate for Payer: Cigna Commercial |
$199.97
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$51.99
|
| Rate for Payer: Oxford Commercial |
$199.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$59.99
|
| Rate for Payer: UnitedHealthcare Commercial |
$199.97
|
|
|
CATHETER BILLARY 8FR
|
Facility
|
IP
|
$399.95
|
|
| Hospital Charge Code |
270654389
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.99 |
| Max. Negotiated Rate |
$59.99 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$59.99
|
|
|
CATHETER BLACKHAWK 14X12X6D-8H
|
Facility
|
IP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,000.00 |
| Max. Negotiated Rate |
$4,840.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,840.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,000.00
|
|
|
CATHETER BLACKHAWK 14X12X6D-8H
|
Facility
|
OP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,000.00 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$6,000.00
|
| Rate for Payer: Aetna Medicare Advantage |
$6,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,100.00
|
| Rate for Payer: Cigna Commercial |
$10,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,840.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,000.00
|
|
|
CATHETER BLADDER 10FR LUMAX
|
Facility
|
OP
|
$2,000.00
|
|
| Hospital Charge Code |
270657870
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$600.00
|
| Rate for Payer: Aetna Medicare Advantage |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$510.00
|
| Rate for Payer: Cigna Commercial |
$1,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$260.00
|
| Rate for Payer: Oxford Commercial |
$1,000.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,000.00
|
|
|
CATHETER BLADDER 10FR LUMAX
|
Facility
|
IP
|
$2,000.00
|
|
| Hospital Charge Code |
270657870
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|