|
CATHETER ENDOTRACHEAL 35FR
|
Facility
|
OP
|
$586.00
|
|
| Hospital Charge Code |
270331066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.64 |
| Max. Negotiated Rate |
$293.00 |
| Rate for Payer: Aetna Commercial |
$222.68
|
| Rate for Payer: Aetna Medicare Advantage |
$175.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$149.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$149.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$149.43
|
| Rate for Payer: Cigna Commercial |
$293.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$152.36
|
| Rate for Payer: Oxford Commercial |
$117.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$87.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$117.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.64
|
|
|
CATHETER ENDOTRACHEAL 37 FR
|
Facility
|
IP
|
$501.00
|
|
| Hospital Charge Code |
270330818
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.15 |
| Max. Negotiated Rate |
$75.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.15
|
|
|
CATHETER ENDOTRACHEAL 37 FR
|
Facility
|
OP
|
$501.00
|
|
| Hospital Charge Code |
270330818
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.23 |
| Max. Negotiated Rate |
$250.50 |
| Rate for Payer: Aetna Commercial |
$190.38
|
| Rate for Payer: Aetna Medicare Advantage |
$150.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$127.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$127.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$127.75
|
| Rate for Payer: Cigna Commercial |
$250.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$130.26
|
| Rate for Payer: Oxford Commercial |
$100.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$100.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.23
|
|
|
CATHETER ENDOTRACHEAL 39FR
|
Facility
|
OP
|
$501.00
|
|
| Hospital Charge Code |
270331109
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.23 |
| Max. Negotiated Rate |
$250.50 |
| Rate for Payer: Aetna Commercial |
$190.38
|
| Rate for Payer: Aetna Medicare Advantage |
$150.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$127.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$127.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$127.75
|
| Rate for Payer: Cigna Commercial |
$250.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$130.26
|
| Rate for Payer: Oxford Commercial |
$100.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$100.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.23
|
|
|
CATHETER ENDOTRACHEAL 39FR
|
Facility
|
IP
|
$501.00
|
|
| Hospital Charge Code |
270331109
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.15 |
| Max. Negotiated Rate |
$75.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.15
|
|
|
CATHETER ENVOY 5F 90CM
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270697878S
|
|
Hospital Revenue Code
|
278
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.00
|
| Rate for Payer: Aetna Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.00
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.00
|
|
|
CATHETER ENVOY 5F 90CM
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270697878S
|
|
Hospital Revenue Code
|
278
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$0.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
CATHETER EQUISTREAM 14.5 X 23C
|
Facility
|
IP
|
$1,925.00
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
270660249
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.75 |
| Max. Negotiated Rate |
$465.85 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$385.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$465.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$288.75
|
|
|
CATHETER EQUISTREAM 14.5 X 23C
|
Facility
|
OP
|
$1,925.00
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
270660249
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$54.67 |
| Max. Negotiated Rate |
$962.50 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Aetna Medicare Advantage |
$577.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$490.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$490.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$385.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$490.88
|
| Rate for Payer: Cigna Commercial |
$962.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$465.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$288.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$60.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$54.67
|
|
|
CATHETER EVD ANTIBIOTIC
|
Facility
|
IP
|
$1,390.50
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
270670472
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$208.57 |
| Max. Negotiated Rate |
$336.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$278.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$336.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$208.57
|
|
|
CATHETER EVD ANTIBIOTIC
|
Facility
|
OP
|
$1,390.50
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
270670472
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.49 |
| Max. Negotiated Rate |
$695.25 |
| Rate for Payer: Aetna Commercial |
$528.39
|
| Rate for Payer: Aetna Medicare Advantage |
$417.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$354.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$354.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$278.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$354.58
|
| Rate for Payer: Cigna Commercial |
$695.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$336.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$208.57
|
| Rate for Payer: UnitedHealthcare Community & State |
$43.94
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$39.49
|
|
|
CATHETER EXCELSIOR SL-10
|
Facility
|
IP
|
$5,027.25
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270695286S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$754.09 |
| Max. Negotiated Rate |
$1,216.59 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,005.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,216.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$754.09
|
|
|
CATHETER EXCELSIOR SL-10
|
Facility
|
OP
|
$5,027.25
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270695286S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.77 |
| Max. Negotiated Rate |
$2,513.62 |
| Rate for Payer: Aetna Commercial |
$1,910.36
|
| Rate for Payer: Aetna Medicare Advantage |
$1,508.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,281.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,281.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,005.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,281.95
|
| Rate for Payer: Cigna Commercial |
$2,513.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,216.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$754.09
|
| Rate for Payer: UnitedHealthcare Community & State |
$158.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$142.77
|
|
|
CATHETER EXCELSIOR SL 10 PS J
|
Facility
|
OP
|
$5,027.25
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270695284S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.77 |
| Max. Negotiated Rate |
$2,513.62 |
| Rate for Payer: Aetna Commercial |
$1,910.36
|
| Rate for Payer: Aetna Medicare Advantage |
$1,508.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,281.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,281.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,005.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,281.95
|
| Rate for Payer: Cigna Commercial |
$2,513.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,216.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$754.09
|
| Rate for Payer: UnitedHealthcare Community & State |
$158.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$142.77
|
|
|
CATHETER EXCELSIOR SL 10 PS J
|
Facility
|
IP
|
$5,463.75
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270695284
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$819.56 |
| Max. Negotiated Rate |
$1,322.23 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,092.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,322.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$819.56
|
|
|
CATHETER EXCELSIOR SL 10 PS J
|
Facility
|
IP
|
$5,027.25
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270695284S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$754.09 |
| Max. Negotiated Rate |
$1,216.59 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,005.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,216.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$754.09
|
|
|
CATHETER EXCELSIOR SL 10 PS J
|
Facility
|
OP
|
$5,463.75
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270695284
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$155.17 |
| Max. Negotiated Rate |
$2,731.88 |
| Rate for Payer: Aetna Commercial |
$2,076.22
|
| Rate for Payer: Aetna Medicare Advantage |
$1,639.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,393.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,393.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,092.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,393.26
|
| Rate for Payer: Cigna Commercial |
$2,731.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,322.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$819.56
|
| Rate for Payer: UnitedHealthcare Community & State |
$172.65
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$155.17
|
|
|
CATHETER EXCELSIOR XT17 PS45
|
Facility
|
OP
|
$5,463.75
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270695288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$155.17 |
| Max. Negotiated Rate |
$2,731.88 |
| Rate for Payer: Aetna Commercial |
$2,076.22
|
| Rate for Payer: Aetna Medicare Advantage |
$1,639.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,393.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,393.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,092.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,393.26
|
| Rate for Payer: Cigna Commercial |
$2,731.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,322.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$819.56
|
| Rate for Payer: UnitedHealthcare Community & State |
$172.65
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$155.17
|
|
|
CATHETER EXCELSIOR XT17 PS45
|
Facility
|
IP
|
$5,463.75
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270695288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$819.56 |
| Max. Negotiated Rate |
$1,322.23 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,092.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,322.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$819.56
|
|
|
CATHETER EXCELSIOR XT-17 STD
|
Facility
|
OP
|
$5,463.75
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270695289
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$155.17 |
| Max. Negotiated Rate |
$2,731.88 |
| Rate for Payer: Aetna Commercial |
$2,076.22
|
| Rate for Payer: Aetna Medicare Advantage |
$1,639.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,393.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,393.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,092.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,393.26
|
| Rate for Payer: Cigna Commercial |
$2,731.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,322.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$819.56
|
| Rate for Payer: UnitedHealthcare Community & State |
$172.65
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$155.17
|
|
|
CATHETER EXCELSIOR XT-17 STD
|
Facility
|
IP
|
$5,463.75
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270695289
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$819.56 |
| Max. Negotiated Rate |
$1,322.23 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,092.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,322.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$819.56
|
|
|
CATHETER FEMORAL AORTIC FLUSH
|
Facility
|
OP
|
$115.00
|
|
| Hospital Charge Code |
270331514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$57.50 |
| Rate for Payer: Aetna Commercial |
$43.70
|
| Rate for Payer: Aetna Medicare Advantage |
$34.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$29.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$29.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$29.32
|
| Rate for Payer: Cigna Commercial |
$57.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.90
|
| Rate for Payer: Oxford Commercial |
$23.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$23.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.27
|
|
|
CATHETER FEMORAL AORTIC FLUSH
|
Facility
|
IP
|
$115.00
|
|
| Hospital Charge Code |
270331514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.25
|
|
|
CATHETER FLOWGATE 8F 85CM
|
Facility
|
IP
|
$6,151.25
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
270685309S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.69 |
| Max. Negotiated Rate |
$1,488.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,230.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,488.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$922.69
|
|
|
CATHETER FLOWGATE 8F 85CM
|
Facility
|
OP
|
$6,151.25
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
270685309S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$174.70 |
| Max. Negotiated Rate |
$3,075.62 |
| Rate for Payer: Aetna Commercial |
$2,337.47
|
| Rate for Payer: Aetna Medicare Advantage |
$1,845.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,568.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,568.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,230.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,568.57
|
| Rate for Payer: Cigna Commercial |
$3,075.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,488.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$922.69
|
| Rate for Payer: UnitedHealthcare Community & State |
$194.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$174.70
|
|