|
CATH HOLTER PERITON 82-1684
|
Facility
|
IP
|
$851.25
|
|
| Hospital Charge Code |
270605137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.69 |
| Max. Negotiated Rate |
$127.69 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$127.69
|
|
|
CATH HOLTER PERITON 82-1684
|
Facility
|
OP
|
$851.25
|
|
| Hospital Charge Code |
270605137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.66 |
| Max. Negotiated Rate |
$425.62 |
| Rate for Payer: Aetna Commercial |
$255.38
|
| Rate for Payer: Aetna Medicare Advantage |
$255.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$217.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$217.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$217.07
|
| Rate for Payer: Cigna Commercial |
$425.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$110.66
|
| Rate for Payer: Oxford Commercial |
$425.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$127.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$425.62
|
|
|
CATH HOLTER VEN 10CM 82-1666
|
Facility
|
OP
|
$564.85
|
|
| Hospital Charge Code |
270605138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.43 |
| Max. Negotiated Rate |
$282.43 |
| Rate for Payer: Aetna Commercial |
$169.46
|
| Rate for Payer: Aetna Medicare Advantage |
$169.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$144.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$144.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$144.04
|
| Rate for Payer: Cigna Commercial |
$282.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$73.43
|
| Rate for Payer: Oxford Commercial |
$282.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$282.43
|
|
|
CATH HOLTER VEN 10CM 82-1666
|
Facility
|
IP
|
$564.85
|
|
| Hospital Charge Code |
270605138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.73 |
| Max. Negotiated Rate |
$84.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.73
|
|
|
CATH HOLTER VEN 15CM 82-1650
|
Facility
|
OP
|
$564.85
|
|
| Hospital Charge Code |
270605135
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.43 |
| Max. Negotiated Rate |
$282.43 |
| Rate for Payer: Aetna Commercial |
$169.46
|
| Rate for Payer: Aetna Medicare Advantage |
$169.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$144.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$144.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$144.04
|
| Rate for Payer: Cigna Commercial |
$282.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$73.43
|
| Rate for Payer: Oxford Commercial |
$282.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$282.43
|
|
|
CATH HOLTER VEN 15CM 82-1650
|
Facility
|
IP
|
$564.85
|
|
| Hospital Charge Code |
270605135
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.73 |
| Max. Negotiated Rate |
$84.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.73
|
|
|
CATH HOLTER VEN 4CM 82-1654
|
Facility
|
OP
|
$564.85
|
|
| Hospital Charge Code |
270605134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.43 |
| Max. Negotiated Rate |
$282.43 |
| Rate for Payer: Aetna Commercial |
$169.46
|
| Rate for Payer: Aetna Medicare Advantage |
$169.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$144.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$144.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$144.04
|
| Rate for Payer: Cigna Commercial |
$282.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$73.43
|
| Rate for Payer: Oxford Commercial |
$282.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$282.43
|
|
|
CATH HOLTER VEN 4CM 82-1654
|
Facility
|
IP
|
$564.85
|
|
| Hospital Charge Code |
270605134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.73 |
| Max. Negotiated Rate |
$84.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.73
|
|
|
CATH HOLTER VEN 7CM 82-1660
|
Facility
|
IP
|
$564.85
|
|
| Hospital Charge Code |
270605133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.73 |
| Max. Negotiated Rate |
$84.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.73
|
|
|
CATH HOLTER VEN 7CM 82-1660
|
Facility
|
OP
|
$564.85
|
|
| Hospital Charge Code |
270605133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.43 |
| Max. Negotiated Rate |
$282.43 |
| Rate for Payer: Aetna Commercial |
$169.46
|
| Rate for Payer: Aetna Medicare Advantage |
$169.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$144.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$144.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$144.04
|
| Rate for Payer: Cigna Commercial |
$282.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$73.43
|
| Rate for Payer: Oxford Commercial |
$282.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$282.43
|
|
|
CATH HOLTER VEN 9CM 82-1664
|
Facility
|
OP
|
$838.25
|
|
| Hospital Charge Code |
270605136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.97 |
| Max. Negotiated Rate |
$419.12 |
| Rate for Payer: Aetna Commercial |
$251.47
|
| Rate for Payer: Aetna Medicare Advantage |
$251.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$213.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$213.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$213.75
|
| Rate for Payer: Cigna Commercial |
$419.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$108.97
|
| Rate for Payer: Oxford Commercial |
$419.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.74
|
| Rate for Payer: UnitedHealthcare Commercial |
$419.12
|
|
|
CATH HOLTER VEN 9CM 82-1664
|
Facility
|
IP
|
$838.25
|
|
| Hospital Charge Code |
270605136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.74 |
| Max. Negotiated Rate |
$125.74 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.74
|
|
|
CATH HS 6F
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636316
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.00
|
|
|
CATH HS 6F
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636316
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| 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) PPO |
$61.20
|
| Rate for Payer: Cigna Commercial |
$120.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$31.20
|
| Rate for Payer: Oxford Commercial |
$120.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$120.00
|
|
|
CATH HS 7FR 778-278-00
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636373
|
|
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: Qualcare PPO/HMO/WC |
$36.00
|
|
|
CATH HS 7FR 778-278-00
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636373
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| 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: Qualcare PPO/HMO/WC |
$36.00
|
|
|
CATH HS SH 6F
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636317
|
|
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: Qualcare PPO/HMO/WC |
$36.00
|
|
|
CATH HS SH 6F
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| 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: Qualcare PPO/HMO/WC |
$36.00
|
|
|
CATH HS SH 7F 778-279-00
|
Facility
|
OP
|
$54.95
|
|
| Hospital Charge Code |
270636374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$27.48 |
| Rate for Payer: Aetna Commercial |
$16.48
|
| Rate for Payer: Aetna Medicare Advantage |
$16.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.01
|
| Rate for Payer: Cigna Commercial |
$27.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.24
|
|
|
CATH HS SH 7F 778-279-00
|
Facility
|
IP
|
$54.95
|
|
| Hospital Charge Code |
270636374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$13.30 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.99
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.24
|
|
|
CATH HYDRO 10FR 3CC
|
Facility
|
IP
|
$32.76
|
|
| Hospital Charge Code |
270302515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$4.91 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.91
|
|
|
CATH HYDRO 10FR 3CC
|
Facility
|
OP
|
$32.76
|
|
| Hospital Charge Code |
270302515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.26 |
| Max. Negotiated Rate |
$16.38 |
| Rate for Payer: Aetna Commercial |
$9.83
|
| Rate for Payer: Aetna Medicare Advantage |
$9.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.35
|
| Rate for Payer: Cigna Commercial |
$16.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.26
|
| Rate for Payer: Oxford Commercial |
$16.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.91
|
| Rate for Payer: UnitedHealthcare Commercial |
$16.38
|
|
|
CATH HYDRO BERN IMPRESS 5FX100
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270657628S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.25 |
| Max. Negotiated Rate |
$117.50 |
| Rate for Payer: Aetna Commercial |
$70.50
|
| Rate for Payer: Aetna Medicare Advantage |
$70.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$59.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$59.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$47.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$59.92
|
| Rate for Payer: Cigna Commercial |
$117.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$56.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.25
|
|
|
CATH HYDRO BERN IMPRESS 5FX100
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270657628S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.25 |
| Max. Negotiated Rate |
$56.87 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$47.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$56.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.25
|
|
|
CATH IABP 0.34CC
|
Facility
|
OP
|
$3,246.45
|
|
| Hospital Charge Code |
270600703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$422.04 |
| Max. Negotiated Rate |
$1,623.22 |
| Rate for Payer: Aetna Commercial |
$973.93
|
| Rate for Payer: Aetna Medicare Advantage |
$973.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$827.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$827.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$827.84
|
| Rate for Payer: Cigna Commercial |
$1,623.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$422.04
|
| Rate for Payer: Oxford Commercial |
$1,623.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$486.97
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,623.22
|
|