|
CATH JL 3.5SH 6FR 670-003-00
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636293
|
|
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 JL 4.0 6F
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636294
|
|
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 JL 4.0 6F
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636294S
|
|
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 JL 4.0 6F
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636294N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$13.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.55
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$12.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.40
|
|
|
CATH JL 4.0 6F
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636294S
|
|
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 JL 4.0 6F
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636294N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna Commercial |
$21.28
|
| Rate for Payer: Aetna Medicare Advantage |
$16.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.28
|
| Rate for Payer: Cigna Commercial |
$28.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.55
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$12.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.48
|
|
|
CATH JL 4.0 6F
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636294
|
|
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 JL 4.0 7F
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636350
|
|
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 JL 4.0 7F
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636350
|
|
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 JL 4.0 SH 7FR 778-005-00
|
Facility
|
OP
|
$56.00
|
|
| Hospital Charge Code |
270636351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna Commercial |
$21.28
|
| Rate for Payer: Aetna Medicare Advantage |
$16.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.28
|
| Rate for Payer: Cigna Commercial |
$28.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.55
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$12.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.48
|
|
|
CATH JL 4.0 SH 7FR 778-005-00
|
Facility
|
IP
|
$56.00
|
|
| Hospital Charge Code |
270636351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$13.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.55
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$12.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.40
|
|
|
CATH JL 4.5 6FR 67000600
|
Facility
|
OP
|
$277.70
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636716N
|
|
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 JL 4.5 6FR 67000600
|
Facility
|
IP
|
$277.70
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636716N
|
|
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 JL 4.5 6FR 67000600
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636716
|
|
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 JL 4.5 6FR 67000600
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636716
|
|
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 JL 4.5 7FR 670-008-00
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636352
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$53.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$44.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$53.24
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$48.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.00
|
|
|
CATH JL 4.5 7FR 670-008-00
|
Facility
|
IP
|
$277.70
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636352N
|
|
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 JL 4.5 7FR 670-008-00
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636352
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna Commercial |
$83.60
|
| Rate for Payer: Aetna Medicare Advantage |
$66.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$56.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$56.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$44.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$56.10
|
| Rate for Payer: Cigna Commercial |
$110.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$53.24
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$48.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.83
|
|
|
CATH JL 4.5 7FR 670-008-00
|
Facility
|
OP
|
$277.70
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636352N
|
|
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 JL4 5FR 100cm
|
Facility
|
OP
|
$44.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270644605C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$22.25 |
| Rate for Payer: Aetna Commercial |
$16.91
|
| Rate for Payer: Aetna Medicare Advantage |
$13.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$11.35
|
| Rate for Payer: Cigna Commercial |
$22.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.77
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$9.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.67
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.18
|
|
|
CATH JL4 5FR 100cm
|
Facility
|
IP
|
$44.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270644605C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.67 |
| Max. Negotiated Rate |
$10.77 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.77
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$9.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.67
|
|
|
CATH JL 5.0 7FR 778-008-00
|
Facility
|
IP
|
$277.70
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636353N
|
|
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 JL 5.0 7FR 778-008-00
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$53.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$44.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$53.24
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$48.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.00
|
|
|
CATH JL 5.0 7FR 778-008-00
|
Facility
|
OP
|
$277.70
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636353N
|
|
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 JL 5.0 7FR 778-008-00
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna Commercial |
$83.60
|
| Rate for Payer: Aetna Medicare Advantage |
$66.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$56.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$56.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$44.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$56.10
|
| Rate for Payer: Cigna Commercial |
$110.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$53.24
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$48.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.83
|
|
