|
CATHETER BMK70MP 120BER 95CM
|
Facility
|
IP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270690321S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$671.25 |
| Max. Negotiated Rate |
$671.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$671.25
|
|
|
CATHETER BMK70MP 120BER 95CM
|
Facility
|
OP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270690321S
|
|
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 BONNANO 14G-18G
|
Facility
|
IP
|
$273.95
|
|
| Hospital Charge Code |
270649749
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.09 |
| Max. Negotiated Rate |
$41.09 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.09
|
|
|
CATHETER BONNANO 14G-18G
|
Facility
|
OP
|
$273.95
|
|
| Hospital Charge Code |
270649749
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.61 |
| Max. Negotiated Rate |
$136.97 |
| Rate for Payer: Aetna Commercial |
$82.19
|
| Rate for Payer: Aetna Medicare Advantage |
$82.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$69.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$69.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$69.86
|
| Rate for Payer: Cigna Commercial |
$136.97
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.61
|
| Rate for Payer: Oxford Commercial |
$136.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.09
|
| Rate for Payer: UnitedHealthcare Commercial |
$136.97
|
|
|
CATHETER, BROVIAC
|
Facility
|
OP
|
$449.00
|
|
| Hospital Charge Code |
270335415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.35 |
| Max. Negotiated Rate |
$224.50 |
| Rate for Payer: Aetna Commercial |
$134.70
|
| Rate for Payer: Aetna Medicare Advantage |
$134.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$114.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$114.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$89.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$114.50
|
| Rate for Payer: Cigna Commercial |
$224.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$108.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.35
|
|
|
CATHETER, BROVIAC
|
Facility
|
IP
|
$449.00
|
|
| Hospital Charge Code |
270335415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.35 |
| Max. Negotiated Rate |
$108.66 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$89.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$108.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.35
|
|
|
CATHETER BROVIAL 6.6 SINGLE
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
270665543
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$437.50 |
| Rate for Payer: Aetna Commercial |
$262.50
|
| Rate for Payer: Aetna Medicare Advantage |
$262.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$223.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$223.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$175.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$223.12
|
| Rate for Payer: Cigna Commercial |
$437.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$211.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.25
|
|
|
CATHETER BROVIAL 6.6 SINGLE
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
270665543
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$211.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$175.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$211.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.25
|
|
|
CATHETER CARDIOVASCULAR VISTA
|
Facility
|
OP
|
$217.50
|
|
| Hospital Charge Code |
270639851
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.27 |
| Max. Negotiated Rate |
$108.75 |
| Rate for Payer: Aetna Commercial |
$65.25
|
| Rate for Payer: Aetna Medicare Advantage |
$65.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$55.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$55.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$55.46
|
| Rate for Payer: Cigna Commercial |
$108.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$28.27
|
| Rate for Payer: Oxford Commercial |
$108.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.62
|
| Rate for Payer: UnitedHealthcare Commercial |
$108.75
|
|
|
CATHETER CARDIOVASCULAR VISTA
|
Facility
|
IP
|
$217.50
|
|
| Hospital Charge Code |
270639851
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.62 |
| Max. Negotiated Rate |
$32.62 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.62
|
|
|
Catheter Cart 24D x 30W x 79
|
Facility
|
IP
|
$4,080.00
|
|
| Hospital Charge Code |
270665972
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$612.00 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$612.00
|
|
|
Catheter Cart 24D x 30W x 79
|
Facility
|
OP
|
$4,080.00
|
|
| Hospital Charge Code |
270665972
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$530.40 |
| Max. Negotiated Rate |
$2,040.00 |
| Rate for Payer: Aetna Commercial |
$1,224.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,224.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,040.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,040.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,040.40
|
| Rate for Payer: Cigna Commercial |
$2,040.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$530.40
|
| Rate for Payer: Oxford Commercial |
$2,040.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$612.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,040.00
|
|
|
CATHETER CENTEZE 5 FR 10 CM
|
Facility
|
OP
|
$80.00
|
|
| Hospital Charge Code |
270685418
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna Commercial |
$24.00
|
| Rate for Payer: Aetna Medicare Advantage |
$24.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20.40
|
| Rate for Payer: Cigna Commercial |
$40.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.40
|
| Rate for Payer: Oxford Commercial |
$40.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$40.00
|
|
|
CATHETER CENTEZE 5 FR 10 CM
|
Facility
|
IP
|
$80.00
|
|
| Hospital Charge Code |
270685418
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.00
|
|
|
CATHETER CENTEZE 5 FR 15 CM
|
Facility
|
IP
|
$85.00
|
|
| Hospital Charge Code |
270685420
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$12.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.75
|
|
|
CATHETER CENTEZE 5 FR 15 CM
|
Facility
|
OP
|
$85.00
|
|
| Hospital Charge Code |
270685420
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: Aetna Medicare Advantage |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$21.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$21.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$21.68
|
| Rate for Payer: Cigna Commercial |
$42.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.05
|
| Rate for Payer: Oxford Commercial |
$42.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$42.50
|
|
|
CATHETER CENTEZE 5FR 7 CM
|
Facility
|
OP
|
$80.00
|
|
| Hospital Charge Code |
270685419
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna Commercial |
$24.00
|
| Rate for Payer: Aetna Medicare Advantage |
$24.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20.40
|
| Rate for Payer: Cigna Commercial |
$40.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.40
|
| Rate for Payer: Oxford Commercial |
$40.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$40.00
|
|
|
CATHETER CENTEZE 5FR 7 CM
|
Facility
|
IP
|
$80.00
|
|
| Hospital Charge Code |
270685419
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.00
|
|
|
CATHETER CENT HEMO 15Fr X 50cm
|
Facility
|
OP
|
$1,975.00
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
270680765
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$987.50 |
| Rate for Payer: Aetna Commercial |
$592.50
|
| Rate for Payer: Aetna Medicare Advantage |
$592.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$503.62
|
| Rate for Payer: Cigna Commercial |
$987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
CATHETER CENT HEMO 15Fr X 50cm
|
Facility
|
IP
|
$1,975.00
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
270680765
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$477.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
CATHETER CHIKAI BLACK 18 200 M
|
Facility
|
OP
|
$2,745.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270698018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.75 |
| Max. Negotiated Rate |
$1,372.50 |
| Rate for Payer: Aetna Commercial |
$823.50
|
| Rate for Payer: Aetna Medicare Advantage |
$823.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$699.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$699.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$549.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$699.98
|
| Rate for Payer: Cigna Commercial |
$1,372.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$664.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$411.75
|
|
|
CATHETER CHIKAI BLACK 18 200 M
|
Facility
|
IP
|
$2,745.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270698018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.75 |
| Max. Negotiated Rate |
$664.29 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$549.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$664.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$411.75
|
|
|
CATHETER CHOCOLATE 2.5 X 120 C
|
Facility
|
IP
|
$5,750.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270684606
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.50 |
| Max. Negotiated Rate |
$1,391.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,391.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$862.50
|
|
|
CATHETER CHOCOLATE 2.5 X 120 C
|
Facility
|
OP
|
$5,750.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270684606
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.50 |
| Max. Negotiated Rate |
$2,875.00 |
| Rate for Payer: Aetna Commercial |
$1,725.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,725.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,466.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,466.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,466.25
|
| Rate for Payer: Cigna Commercial |
$2,875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,391.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$862.50
|
|
|
CATHETER CHOCOLATE 2.5X40CM
|
Facility
|
IP
|
$3,825.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
4046687518
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.75 |
| Max. Negotiated Rate |
$925.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$765.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$925.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$573.75
|
|