|
CATHETER JL6.0 6FR/100CM/.035
|
Facility
|
OP
|
$37.35
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270658052
|
|
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 JR6.06FR/100CM/.038
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
2709000393
|
|
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 JR6.06FR/100CM/.038
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
2709000393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
CATHETER JR6.0FR.100CM/.038
|
Facility
|
OP
|
$45.25
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270658031S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$22.62 |
| Rate for Payer: Aetna Commercial |
$13.57
|
| Rate for Payer: Aetna Medicare Advantage |
$13.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$11.54
|
| Rate for Payer: Cigna Commercial |
$22.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.79
|
|
|
CATHETER JR6.0FR.100CM/.038
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270658031N
|
|
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 JR6.0FR.100CM/.038
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270658031N
|
|
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 JR6.0FR.100CM/.038
|
Facility
|
OP
|
$47.25
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270658031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.09 |
| Max. Negotiated Rate |
$23.62 |
| Rate for Payer: Aetna Commercial |
$14.18
|
| Rate for Payer: Aetna Medicare Advantage |
$14.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.05
|
| Rate for Payer: Cigna Commercial |
$23.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.09
|
|
|
CATHETER JR6.0FR.100CM/.038
|
Facility
|
IP
|
$47.25
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270658031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.09 |
| Max. Negotiated Rate |
$11.43 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.09
|
|
|
CATHETER JR6.0FR.100CM/.038
|
Facility
|
IP
|
$45.25
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270658031S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$10.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.79
|
|
|
CATHETER JUDKINS RIGH T6FR .07
|
Facility
|
IP
|
$90.00
|
|
| Hospital Charge Code |
270667182
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.50
|
|
|
CATHETER JUDKINS RIGH T6FR .07
|
Facility
|
OP
|
$90.00
|
|
| Hospital Charge Code |
270667182
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.70 |
| 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) PPO |
$22.95
|
| Rate for Payer: Cigna Commercial |
$45.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.70
|
| Rate for Payer: Oxford Commercial |
$45.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$45.00
|
|
|
CATHETER KIT INFANT 5FR
|
Facility
|
IP
|
$8.67
|
|
|
Service Code
|
HCPCS A4338
|
| Hospital Charge Code |
270650094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.30
|
|
|
CATHETER KIT INFANT 5FR
|
Facility
|
OP
|
$8.67
|
|
|
Service Code
|
HCPCS A4338
|
| Hospital Charge Code |
270650094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$15.03 |
| Rate for Payer: Aetna Commercial |
$2.60
|
| Rate for Payer: Aetna Medicare Advantage |
$2.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.21
|
| Rate for Payer: Cigna Commercial |
$15.03
|
| Rate for Payer: Cigna Medicare Advantage |
$9.02
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.13
|
| Rate for Payer: Oxford Commercial |
$4.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.33
|
|
|
CATHETER KIT TENCKHOFF 42CM
|
Facility
|
IP
|
$438.95
|
|
| Hospital Charge Code |
270660019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.84 |
| Max. Negotiated Rate |
$65.84 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$65.84
|
|
|
CATHETER KIT TENCKHOFF 42CM
|
Facility
|
OP
|
$438.95
|
|
| Hospital Charge Code |
270660019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.06 |
| Max. Negotiated Rate |
$219.47 |
| Rate for Payer: Aetna Commercial |
$131.69
|
| Rate for Payer: Aetna Medicare Advantage |
$131.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$111.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$111.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$111.93
|
| Rate for Payer: Cigna Commercial |
$219.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$57.06
|
| Rate for Payer: Oxford Commercial |
$219.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$65.84
|
| Rate for Payer: UnitedHealthcare Commercial |
$219.47
|
|
|
CATHETER KIT UROFORCE 4MMx6CM
|
Facility
|
OP
|
$813.40
|
|
| Hospital Charge Code |
270682632
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.74 |
| Max. Negotiated Rate |
$406.70 |
| Rate for Payer: Aetna Commercial |
$244.02
|
| Rate for Payer: Aetna Medicare Advantage |
$244.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$207.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$207.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$207.42
|
| Rate for Payer: Cigna Commercial |
$406.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$105.74
|
| Rate for Payer: Oxford Commercial |
$406.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$122.01
|
| Rate for Payer: UnitedHealthcare Commercial |
$406.70
|
|
|
CATHETER KIT UROFORCE 4MMx6CM
|
Facility
|
IP
|
$813.40
|
|
| Hospital Charge Code |
270682632
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.01 |
| Max. Negotiated Rate |
$122.01 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$122.01
|
|
|
CATHETER L 160 CM X 2.5 ML PRO
|
Facility
|
IP
|
$2,800.00
|
|
| Hospital Charge Code |
270688445
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
|
|
CATHETER L 160 CM X 2.5 ML PRO
|
Facility
|
OP
|
$2,800.00
|
|
| Hospital Charge Code |
270688445
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$840.00
|
| Rate for Payer: Aetna Medicare Advantage |
$840.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$714.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$714.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$714.00
|
| Rate for Payer: Cigna Commercial |
$1,400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$364.00
|
| Rate for Payer: Oxford Commercial |
$1,400.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,400.00
|
|
|
CATHETER LEAD PACE 4FR 38MM
|
Facility
|
OP
|
$3,300.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
270699655S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$495.00 |
| Max. Negotiated Rate |
$1,650.00 |
| Rate for Payer: Aetna Commercial |
$990.00
|
| Rate for Payer: Aetna Medicare Advantage |
$990.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$841.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$841.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$660.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$841.50
|
| Rate for Payer: Cigna Commercial |
$1,650.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$798.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$495.00
|
|
|
CATHETER LEAD PACE 4FR 38MM
|
Facility
|
IP
|
$3,300.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
270699655S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$495.00 |
| Max. Negotiated Rate |
$798.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$660.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$798.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$495.00
|
|
|
CATHETER LOCKING DRAINAGE 12FR
|
Facility
|
OP
|
$346.75
|
|
| Hospital Charge Code |
270655075N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.08 |
| Max. Negotiated Rate |
$173.38 |
| Rate for Payer: Aetna Commercial |
$104.03
|
| Rate for Payer: Aetna Medicare Advantage |
$104.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$88.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$88.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$88.42
|
| Rate for Payer: Cigna Commercial |
$173.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$45.08
|
| Rate for Payer: Oxford Commercial |
$173.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.01
|
| Rate for Payer: UnitedHealthcare Commercial |
$173.38
|
|
|
CATHETER LOCKING DRAINAGE 12FR
|
Facility
|
IP
|
$328.00
|
|
| Hospital Charge Code |
270655075R
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$49.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.20
|
|
|
CATHETER LOCKING DRAINAGE 12FR
|
Facility
|
IP
|
$328.00
|
|
| Hospital Charge Code |
270655075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$49.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.20
|
|
|
CATHETER LOCKING DRAINAGE 12FR
|
Facility
|
IP
|
$328.00
|
|
| Hospital Charge Code |
270655075S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$49.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.20
|
|