|
CONTOUR VL STENT
|
Facility
|
IP
|
$1,019.70
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
270652854S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$152.96 |
| Max. Negotiated Rate |
$246.77 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$203.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$246.77
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$224.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$152.96
|
|
|
CONTOUR VL STENT
|
Facility
|
OP
|
$1,019.70
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
270652854
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$509.85 |
| Rate for Payer: Aetna Commercial |
$387.49
|
| Rate for Payer: Aetna Medicare Advantage |
$305.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$260.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$260.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$203.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$260.02
|
| Rate for Payer: Cigna Commercial |
$509.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$246.77
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$224.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$152.96
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.02
|
|
|
CONTOUR VL STENT
|
Facility
|
IP
|
$1,019.70
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
270652854
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$152.96 |
| Max. Negotiated Rate |
$246.77 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$203.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$246.77
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$224.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$152.96
|
|
|
CONTRA 2 UPN SELECTIV 5FR 65CM
|
Facility
|
OP
|
$53.65
|
|
| Hospital Charge Code |
270663946
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$26.82 |
| Rate for Payer: Aetna Commercial |
$20.39
|
| Rate for Payer: Aetna Medicare Advantage |
$16.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.68
|
| Rate for Payer: Cigna Commercial |
$26.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.09
|
| Rate for Payer: Oxford Commercial |
$10.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$10.73
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.42
|
|
|
CONTRA 2 UPN SELECTIV 5FR 65CM
|
Facility
|
IP
|
$53.65
|
|
| Hospital Charge Code |
270663946
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.05 |
| Max. Negotiated Rate |
$8.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.05
|
|
|
CONTRAST BATH EA 15 MIN CQ
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
HCPCS 97034GP
|
| Hospital Charge Code |
409197034Q
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.90 |
| Max. Negotiated Rate |
$15.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.90
|
|
|
CONTRAST BATH EA 15 MIN CQ
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
HCPCS 97034GP
|
| Hospital Charge Code |
409197034Q
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Aetna Commercial |
$40.28
|
| Rate for Payer: Aetna Medicare Advantage |
$31.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$27.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$27.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$116.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$27.03
|
| Rate for Payer: Cigna Commercial |
$53.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$31.80
|
| Rate for Payer: Oxford Commercial |
$604.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,060.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.81
|
|
|
CONTRAST CONTROLLER 90400039
|
Facility
|
OP
|
$14.95
|
|
| Hospital Charge Code |
270632554
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$7.47 |
| Rate for Payer: Aetna Commercial |
$5.68
|
| Rate for Payer: Aetna Medicare Advantage |
$4.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.81
|
| Rate for Payer: Cigna Commercial |
$7.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.49
|
| Rate for Payer: Oxford Commercial |
$2.99
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.24
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.99
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.40
|
|
|
CONTRAST CONTROLLER 90400039
|
Facility
|
IP
|
$14.95
|
|
| Hospital Charge Code |
270632554
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$2.24 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.24
|
|
|
CONTRAST ECHO DEFINTY INJ UNIT
|
Facility
|
OP
|
$386.75
|
|
| Hospital Charge Code |
74115069
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$193.38 |
| Rate for Payer: Aetna Commercial |
$146.97
|
| Rate for Payer: Aetna Medicare Advantage |
$116.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$98.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$98.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$98.62
|
| Rate for Payer: Cigna Commercial |
$193.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$93.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.01
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.25
|
|
|
CONTRAST ECHO DEFINTY INJ UNIT
|
Facility
|
IP
|
$386.75
|
|
| Hospital Charge Code |
74115069
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.01 |
| Max. Negotiated Rate |
$93.59 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$93.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.01
|
|
|
CONTRAST ECHO DEFINTY INJ UNIT
|
Facility
|
IP
|
$386.75
|
|
| Hospital Charge Code |
74117069
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.01 |
| Max. Negotiated Rate |
$93.59 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$93.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.01
|
|
|
CONTRAST ECHO DEFINTY INJ UNIT
|
Facility
|
IP
|
$386.75
|
|
| Hospital Charge Code |
74116069
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.01 |
| Max. Negotiated Rate |
$93.59 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$93.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.01
|
|
|
CONTRAST ECHO DEFINTY INJ UNIT
|
Facility
|
IP
|
$559.10
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
5300170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.86 |
| Max. Negotiated Rate |
$135.30 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$135.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$83.86
|
|
|
CONTRAST ECHO DEFINTY INJ UNIT
|
Facility
|
OP
|
$386.75
|
|
| Hospital Charge Code |
74116069
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$193.38 |
| Rate for Payer: Aetna Commercial |
$146.97
|
| Rate for Payer: Aetna Medicare Advantage |
$116.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$98.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$98.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$98.62
|
| Rate for Payer: Cigna Commercial |
$193.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$93.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.01
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.25
|
|
|
CONTRAST ECHO DEFINTY INJ UNIT
|
Facility
|
OP
|
$386.75
|
|
| Hospital Charge Code |
74117069
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$193.38 |
| Rate for Payer: Aetna Commercial |
$146.97
|
| Rate for Payer: Aetna Medicare Advantage |
$116.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$98.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$98.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$98.62
|
| Rate for Payer: Cigna Commercial |
$193.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$93.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.01
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.25
|
|
|
CONTRAST ECHO DEFINTY INJ UNIT
|
Facility
|
IP
|
$386.75
|
|
| Hospital Charge Code |
270636925
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.01 |
| Max. Negotiated Rate |
$93.59 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$93.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.01
|
|
|
CONTRAST ECHO DEFINTY INJ UNIT
|
Facility
|
OP
|
$386.75
|
|
| Hospital Charge Code |
270636925
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$193.38 |
| Rate for Payer: Aetna Commercial |
$146.97
|
| Rate for Payer: Aetna Medicare Advantage |
$116.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$98.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$98.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$98.62
|
| Rate for Payer: Cigna Commercial |
$193.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$93.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.01
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.25
|
|
|
CONTRAST ECHO DEFINTY INJ UNIT
|
Facility
|
OP
|
$559.10
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
5300170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.47 |
| Max. Negotiated Rate |
$279.55 |
| Rate for Payer: Aetna Commercial |
$212.46
|
| Rate for Payer: Aetna Medicare Advantage |
$167.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$142.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$142.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$142.57
|
| Rate for Payer: Cigna Commercial |
$279.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$135.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$83.86
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.82
|
|
|
CONTRAST ECHO DEFINTY INJ UNIT
|
Facility
|
IP
|
$386.75
|
|
| Hospital Charge Code |
94053160
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.01 |
| Max. Negotiated Rate |
$93.59 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$93.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.01
|
|
|
CONTRAST ECHO DEFINTY INJ UNIT
|
Facility
|
OP
|
$386.75
|
|
| Hospital Charge Code |
94053160
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$193.38 |
| Rate for Payer: Aetna Commercial |
$146.97
|
| Rate for Payer: Aetna Medicare Advantage |
$116.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$98.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$98.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$98.62
|
| Rate for Payer: Cigna Commercial |
$193.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$93.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.01
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.25
|
|
|
CONTRAST EXAM THORACIC AORTA
|
Facility
|
IP
|
$21,323.35
|
|
|
Service Code
|
HCPCS 75605
|
| Hospital Charge Code |
366875605
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,198.50 |
| Max. Negotiated Rate |
$3,198.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,198.50
|
|
|
CONTRAST EXAM THORACIC AORTA
|
Facility
|
OP
|
$21,323.35
|
|
|
Service Code
|
HCPCS 75605
|
| Hospital Charge Code |
366875605
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$277.49 |
| Max. Negotiated Rate |
$23,862.86 |
| Rate for Payer: Aetna Commercial |
$17,981.27
|
| Rate for Payer: Aetna Medicare Advantage |
$21,418.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,862.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,862.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,610.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$277.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23,862.86
|
| Rate for Payer: Cigna Commercial |
$13,251.23
|
| Rate for Payer: Cigna Medicare Advantage |
$4,627.53
|
| Rate for Payer: Clover Medicare Advantage |
$6,280.22
|
| Rate for Payer: EmblemHealth Commercial |
$19,832.28
|
| Rate for Payer: Humana Medicare Advantage |
$6,809.08
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,610.76
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,397.01
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,198.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$513.89
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,610.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,610.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$565.07
|
|
|
CONTRAST EXAM THORACIC AORTA
|
Facility
|
IP
|
$21,323.35
|
|
|
Service Code
|
HCPCS 75605
|
| Hospital Charge Code |
411075605
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,198.50 |
| Max. Negotiated Rate |
$3,198.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,198.50
|
|
|
CONTRAST EXAM THORACIC AORTA
|
Facility
|
OP
|
$21,323.35
|
|
|
Service Code
|
HCPCS 75605
|
| Hospital Charge Code |
411075605
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$277.49 |
| Max. Negotiated Rate |
$23,862.86 |
| Rate for Payer: Aetna Commercial |
$17,981.27
|
| Rate for Payer: Aetna Medicare Advantage |
$21,418.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,862.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,862.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,610.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$277.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23,862.86
|
| Rate for Payer: Cigna Commercial |
$13,251.23
|
| Rate for Payer: Cigna Medicare Advantage |
$4,627.53
|
| Rate for Payer: Clover Medicare Advantage |
$6,280.22
|
| Rate for Payer: EmblemHealth Commercial |
$19,832.28
|
| Rate for Payer: Humana Medicare Advantage |
$6,809.08
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,610.76
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,397.01
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,198.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$513.89
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,610.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,610.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$565.07
|
|
