|
CATH IMAGER II 5FR 65cm .038
|
Facility
|
IP
|
$279.10
|
|
| Hospital Charge Code |
270638265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.87 |
| Max. Negotiated Rate |
$41.87 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.87
|
|
|
CATH IMAGER II 5FR 65cm .038
|
Facility
|
OP
|
$55.82
|
|
| Hospital Charge Code |
270638265C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$27.91 |
| Rate for Payer: Aetna Commercial |
$21.21
|
| 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) PPO |
$14.23
|
| Rate for Payer: Cigna Commercial |
$27.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.75
|
| Rate for Payer: Oxford Commercial |
$11.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.16
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.48
|
|
|
CATH IMAGER II 5FR 90cm .038
|
Facility
|
IP
|
$279.10
|
|
| Hospital Charge Code |
270627432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.87 |
| Max. Negotiated Rate |
$41.87 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.87
|
|
|
CATH IMAGER II 5FR 90cm .038
|
Facility
|
OP
|
$279.10
|
|
| Hospital Charge Code |
270627432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$139.55 |
| Rate for Payer: Aetna Commercial |
$106.06
|
| Rate for Payer: Aetna Medicare Advantage |
$83.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$71.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$71.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$71.17
|
| Rate for Payer: Cigna Commercial |
$139.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$83.73
|
| Rate for Payer: Oxford Commercial |
$55.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.87
|
| Rate for Payer: UnitedHealthcare Commercial |
$55.82
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.40
|
|
|
CATH IMGER II FLSH 5FR C1 65cm
|
Facility
|
IP
|
$500.00
|
|
| Hospital Charge Code |
2709003625
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
|
|
CATH IMGER II FLSH 5FR C1 65cm
|
Facility
|
OP
|
$500.00
|
|
| Hospital Charge Code |
2709003625
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$190.00
|
| Rate for Payer: Aetna Medicare Advantage |
$150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$127.50
|
| Rate for Payer: Cigna Commercial |
$250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$150.00
|
| Rate for Payer: Oxford Commercial |
$100.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$100.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.25
|
|
|
CATH IMPRESS 46X1X17X40X38
|
Facility
|
IP
|
$67.50
|
|
| Hospital Charge Code |
270658002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$10.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.12
|
|
|
CATH IMPRESS 46X1X17X40X38
|
Facility
|
OP
|
$67.50
|
|
| Hospital Charge Code |
270658002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Aetna Commercial |
$25.65
|
| Rate for Payer: Aetna Medicare Advantage |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.21
|
| Rate for Payer: Cigna Commercial |
$33.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.25
|
| Rate for Payer: Oxford Commercial |
$13.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$13.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.79
|
|
|
CATH IMPRESS MOD HOOK 052 1.32
|
Facility
|
IP
|
$57.50
|
|
| Hospital Charge Code |
270658006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$8.62 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.62
|
|
|
CATH IMPRESS MOD HOOK 052 1.32
|
Facility
|
OP
|
$57.50
|
|
| Hospital Charge Code |
270658006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$28.75 |
| Rate for Payer: Aetna Commercial |
$21.85
|
| Rate for Payer: Aetna Medicare Advantage |
$17.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.66
|
| Rate for Payer: Cigna Commercial |
$28.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17.25
|
| Rate for Payer: Oxford Commercial |
$11.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.62
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.52
|
|
|
CATH IMPRESS MOD HOOK 052 1.32
|
Facility
|
IP
|
$67.50
|
|
| Hospital Charge Code |
270658006N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$10.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.12
|
|
|
CATH IMPRESS MOD HOOK 052 1.32
|
Facility
|
OP
|
$67.50
|
|
| Hospital Charge Code |
270658006N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Aetna Commercial |
$25.65
|
| Rate for Payer: Aetna Medicare Advantage |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.21
|
| Rate for Payer: Cigna Commercial |
$33.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.25
|
| Rate for Payer: Oxford Commercial |
$13.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$13.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.79
|
|
|
CATH IMPRESS MOD HOOK 052 1.32
|
Facility
|
IP
|
$57.50
|
|
| Hospital Charge Code |
270658006S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$8.62 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.62
|
|
|
CATH IMPRESS MOD HOOK 052 1.32
|
Facility
|
OP
|
$57.50
|
|
| Hospital Charge Code |
270658006S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$28.75 |
| Rate for Payer: Aetna Commercial |
$21.85
|
| Rate for Payer: Aetna Medicare Advantage |
$17.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.66
|
| Rate for Payer: Cigna Commercial |
$28.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17.25
|
| Rate for Payer: Oxford Commercial |
$11.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.62
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.52
|
|
|
CATH IMPSS MOD HOOK 040/1.02MM
|
Facility
|
IP
|
$27.00
|
|
| Hospital Charge Code |
270657618
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.05
|
|
|
CATH IMPSS MOD HOOK 040/1.02MM
|
Facility
|
OP
|
$27.00
|
|
| Hospital Charge Code |
270657618
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna Commercial |
$10.26
|
| Rate for Payer: Aetna Medicare Advantage |
$8.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6.88
|
| Rate for Payer: Cigna Commercial |
$13.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.10
|
| Rate for Payer: Oxford Commercial |
$5.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.65
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.72
|
|
|
CATH IM SH 6FR 670-191-00
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$58.08 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$48.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$58.08
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$52.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.00
|
|
|
CATH IM SH 6FR 670-191-00
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$91.20
|
| Rate for Payer: Aetna Medicare Advantage |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$48.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.20
|
| Rate for Payer: Cigna Commercial |
$120.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$58.08
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$52.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.78
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.36
|
|
|
CATH IM SH 6FR 670-191-00
|
Facility
|
IP
|
$277.70
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636315N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.66 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$55.54
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$67.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$61.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.66
|
|
|
CATH IM SH 6FR 670-191-00
|
Facility
|
OP
|
$277.70
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636315N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.69 |
| Max. Negotiated Rate |
$138.85 |
| Rate for Payer: Aetna Commercial |
$105.53
|
| Rate for Payer: Aetna Medicare Advantage |
$83.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$70.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$70.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$55.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$70.81
|
| Rate for Payer: Cigna Commercial |
$138.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$67.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$61.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.66
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.69
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.36
|
|
|
CATH IM SH 7FR 670-0020-00
|
Facility
|
OP
|
$277.70
|
|
| Hospital Charge Code |
270636372
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.69 |
| Max. Negotiated Rate |
$138.85 |
| Rate for Payer: Aetna Commercial |
$105.53
|
| Rate for Payer: Aetna Medicare Advantage |
$83.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$70.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$70.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$55.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$70.81
|
| Rate for Payer: Cigna Commercial |
$138.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$67.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$61.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.66
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.69
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.36
|
|
|
CATH IM SH 7FR 670-0020-00
|
Facility
|
IP
|
$277.70
|
|
| Hospital Charge Code |
270636372
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.66 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$55.54
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$67.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$61.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.66
|
|
|
CATH IN ART INIT 3RD LEFT
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
HCPCS 36247
|
| Hospital Charge Code |
1600000865
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11.66 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$183.92
|
| Rate for Payer: Aetna Medicare Advantage |
$145.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$123.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$123.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$123.42
|
| Rate for Payer: Cigna Commercial |
$242.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.20
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$72.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.66
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.83
|
|
|
CATH IN ART INIT 3RD LEFT
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
HCPCS 36247
|
| Hospital Charge Code |
1600000865
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$72.60 |
| Max. Negotiated Rate |
$72.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$72.60
|
|
|
CATH INFINITI 6FR IM 100CM
|
Facility
|
IP
|
$55.63
|
|
| Hospital Charge Code |
270689908
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$8.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.34
|
|
