|
CATH PIGTAIL 145 5FR 110cm
|
Facility
|
IP
|
$44.50
|
|
| Hospital Charge Code |
270644615C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.67 |
| Max. Negotiated Rate |
$6.67 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.67
|
|
|
CATH PIGTAIL 6FR ANGLED
|
Facility
|
IP
|
$37.35
|
|
| Hospital Charge Code |
270653800N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.60
|
|
|
CATH PIGTAIL 6FR ANGLED
|
Facility
|
OP
|
$37.35
|
|
| Hospital Charge Code |
270653800N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$18.68 |
| Rate for Payer: Aetna Commercial |
$14.19
|
| 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) PPO |
$9.52
|
| Rate for Payer: Cigna Commercial |
$18.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.71
|
| Rate for Payer: Oxford Commercial |
$7.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$7.47
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.06
|
|
|
CATH PIGTAIL 6FR ANGLED
|
Facility
|
OP
|
$37.90
|
|
| Hospital Charge Code |
270653800
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$18.95 |
| Rate for Payer: Aetna Commercial |
$14.40
|
| 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) PPO |
$9.66
|
| Rate for Payer: Cigna Commercial |
$18.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.85
|
| Rate for Payer: Oxford Commercial |
$7.58
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$7.58
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.08
|
|
|
CATH PIGTAIL 6FR ANGLED
|
Facility
|
IP
|
$37.90
|
|
| Hospital Charge Code |
270653800
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$5.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.68
|
|
|
CATH PIGTAIL 6FR ANGLED
|
Facility
|
IP
|
$37.90
|
|
| Hospital Charge Code |
270653800S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$5.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.68
|
|
|
CATH PIGTAIL 6FR ANGLED
|
Facility
|
OP
|
$37.90
|
|
| Hospital Charge Code |
270653800S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$18.95 |
| Rate for Payer: Aetna Commercial |
$14.40
|
| 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) PPO |
$9.66
|
| Rate for Payer: Cigna Commercial |
$18.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.85
|
| Rate for Payer: Oxford Commercial |
$7.58
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$7.58
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.08
|
|
|
CATH PIGTAIL 6FR DUAL LUMEN
|
Facility
|
IP
|
$695.00
|
|
| Hospital Charge Code |
270653766
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$104.25 |
| Max. Negotiated Rate |
$104.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$104.25
|
|
|
CATH PIGTAIL 6FR DUAL LUMEN
|
Facility
|
IP
|
$695.00
|
|
| Hospital Charge Code |
270653766S
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$104.25 |
| Max. Negotiated Rate |
$104.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$104.25
|
|
|
CATH PIGTAIL 6FR DUAL LUMEN
|
Facility
|
OP
|
$695.00
|
|
| Hospital Charge Code |
270653766S
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.74 |
| Max. Negotiated Rate |
$347.50 |
| Rate for Payer: Aetna Commercial |
$264.10
|
| Rate for Payer: Aetna Medicare Advantage |
$208.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$177.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$177.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$177.22
|
| Rate for Payer: Cigna Commercial |
$347.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$180.70
|
| Rate for Payer: Oxford Commercial |
$139.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$104.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$139.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.74
|
|
|
CATH PIGTAIL 6FR DUAL LUMEN
|
Facility
|
OP
|
$695.00
|
|
| Hospital Charge Code |
270653766
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.74 |
| Max. Negotiated Rate |
$347.50 |
| Rate for Payer: Aetna Commercial |
$264.10
|
| Rate for Payer: Aetna Medicare Advantage |
$208.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$177.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$177.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$177.22
|
| Rate for Payer: Cigna Commercial |
$347.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$180.70
|
| Rate for Payer: Oxford Commercial |
$139.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$104.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$139.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.74
|
|
|
CATH PIGTAIL 6FR DUAL LUMEN
|
Facility
|
IP
|
$695.00
|
|
| Hospital Charge Code |
270653766C
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$104.25 |
| Max. Negotiated Rate |
$104.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$104.25
|
|
|
CATH PIGTAIL 6FR DUAL LUMEN
|
Facility
|
OP
|
$695.00
|
|
| Hospital Charge Code |
270653766C
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.74 |
| Max. Negotiated Rate |
$347.50 |
| Rate for Payer: Aetna Commercial |
$264.10
|
| Rate for Payer: Aetna Medicare Advantage |
$208.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$177.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$177.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$177.22
|
| Rate for Payer: Cigna Commercial |
$347.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$180.70
|
| Rate for Payer: Oxford Commercial |
$139.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$104.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$139.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.74
|
|
|
CATH PIGTAIL 6FR DUAL LUMEN
|
Facility
|
IP
|
$595.00
|
|
| Hospital Charge Code |
270653766N
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$89.25 |
| Max. Negotiated Rate |
$89.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.25
|
|
|
CATH PIGTAIL 6FR DUAL LUMEN
|
Facility
|
OP
|
$595.00
|
|
| Hospital Charge Code |
270653766N
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Aetna Commercial |
$226.10
|
| Rate for Payer: Aetna Medicare Advantage |
$178.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$151.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$151.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$151.72
|
| Rate for Payer: Cigna Commercial |
$297.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$154.70
|
| Rate for Payer: Oxford Commercial |
$119.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$119.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.90
|
|
|
CATH PIGTAIL SOFT-VU 5FX90CM
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270678515C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.56
|
|
|
CATH PIGTAIL SOFT-VU 5FX90CM
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270678515C
|
|
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
|
|
|
CATH PLACE CARDIO BRACHYTX
|
Facility
|
IP
|
$12,500.00
|
|
|
Service Code
|
HCPCS 92974
|
| Hospital Charge Code |
411092974
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$1,875.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,875.00
|
|
|
CATH PLACE CARDIO BRACHYTX
|
Facility
|
OP
|
$12,500.00
|
|
|
Service Code
|
HCPCS 92974
|
| Hospital Charge Code |
411092974
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$355.00 |
| Max. Negotiated Rate |
$6,250.00 |
| Rate for Payer: Aetna Commercial |
$4,750.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,187.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,187.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,213.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,187.50
|
| Rate for Payer: Cigna Commercial |
$6,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,250.00
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,875.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$395.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$355.00
|
|
|
CATH PLACEMENT VEN 2ND LT
|
Facility
|
IP
|
$2,919.00
|
|
|
Service Code
|
HCPCS 36012LT
|
| Hospital Charge Code |
7412048
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$437.85 |
| Max. Negotiated Rate |
$437.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$437.85
|
|
|
CATH PLACEMENT VEN 2ND LT
|
Facility
|
OP
|
$2,919.00
|
|
|
Service Code
|
HCPCS 36012LT
|
| Hospital Charge Code |
7412048
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$82.90 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$1,109.22
|
| Rate for Payer: Aetna Medicare Advantage |
$875.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$744.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$744.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$744.35
|
| Rate for Payer: Cigna Commercial |
$1,459.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$758.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$437.85
|
| Rate for Payer: UnitedHealthcare Community & State |
$92.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$82.90
|
|
|
CATH PLACEMENT VEN 2ND RT
|
Facility
|
IP
|
$2,919.00
|
|
|
Service Code
|
HCPCS 36012RT
|
| Hospital Charge Code |
7412049
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$437.85 |
| Max. Negotiated Rate |
$437.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$437.85
|
|
|
CATH PLACEMENT VEN 2ND RT
|
Facility
|
OP
|
$2,919.00
|
|
|
Service Code
|
HCPCS 36012RT
|
| Hospital Charge Code |
7412049
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$82.90 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$1,109.22
|
| Rate for Payer: Aetna Medicare Advantage |
$875.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$744.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$744.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$744.35
|
| Rate for Payer: Cigna Commercial |
$1,459.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$758.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$437.85
|
| Rate for Payer: UnitedHealthcare Community & State |
$92.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$82.90
|
|
|
CATH POWERMIDLINE PICC KT 3FR
|
Facility
|
IP
|
$735.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270684374N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$177.87 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$147.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$177.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$110.25
|
|
|
CATH POWERMIDLINE PICC KT 3FR
|
Facility
|
OP
|
$735.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270684374N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.87 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: Aetna Commercial |
$279.30
|
| Rate for Payer: Aetna Medicare Advantage |
$220.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$187.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$187.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$187.43
|
| Rate for Payer: Cigna Commercial |
$367.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$177.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$110.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20.87
|
|