|
CATH MICRO EXCEL SL 10STR 2TIP
|
Facility
|
IP
|
$4,726.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
278689725S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$708.94 |
| Max. Negotiated Rate |
$1,143.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$945.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,143.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$708.94
|
|
|
CATH MIK 5FR
|
Facility
|
IP
|
$200.85
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270677003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.13 |
| Max. Negotiated Rate |
$30.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.13
|
|
|
CATH MIK 5FR
|
Facility
|
OP
|
$200.85
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270677003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.11 |
| Max. Negotiated Rate |
$100.42 |
| Rate for Payer: Aetna Commercial |
$60.26
|
| Rate for Payer: Aetna Medicare Advantage |
$60.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$51.22
|
| Rate for Payer: Cigna Commercial |
$100.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$26.11
|
| Rate for Payer: Oxford Commercial |
$100.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$100.42
|
|
|
CATH MIKAELSON CVD 5F 559413**
|
Facility
|
IP
|
$46.00
|
|
| Hospital Charge Code |
270559413
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$6.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.90
|
|
|
CATH MIKAELSON CVD 5F 559413**
|
Facility
|
OP
|
$46.00
|
|
| Hospital Charge Code |
270559413
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna Commercial |
$13.80
|
| Rate for Payer: Aetna Medicare Advantage |
$13.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$11.73
|
| Rate for Payer: Cigna Commercial |
$23.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.98
|
| Rate for Payer: Oxford Commercial |
$23.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$23.00
|
|
|
CATH MM COBRA 1 5F 541213
|
Facility
|
OP
|
$52.00
|
|
| Hospital Charge Code |
270623749
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Aetna Commercial |
$15.60
|
| Rate for Payer: Aetna Medicare Advantage |
$15.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.26
|
| Rate for Payer: Cigna Commercial |
$26.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.76
|
| Rate for Payer: Oxford Commercial |
$26.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$26.00
|
|
|
CATH MM COBRA 1 5F 541213
|
Facility
|
IP
|
$52.00
|
|
| Hospital Charge Code |
270623749
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.80
|
|
|
CATH MM MIKAELSON CV 5F 559413
|
Facility
|
IP
|
$52.85
|
|
| Hospital Charge Code |
270623744
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$7.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.93
|
|
|
CATH MM MIKAELSON CV 5F 559413
|
Facility
|
OP
|
$52.85
|
|
| Hospital Charge Code |
270623744
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.87 |
| Max. Negotiated Rate |
$26.43 |
| Rate for Payer: Aetna Commercial |
$15.86
|
| Rate for Payer: Aetna Medicare Advantage |
$15.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.48
|
| Rate for Payer: Cigna Commercial |
$26.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.87
|
| Rate for Payer: Oxford Commercial |
$26.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.93
|
| Rate for Payer: UnitedHealthcare Commercial |
$26.43
|
|
|
CATH MM NEWTON 2 5F 5563-23
|
Facility
|
OP
|
$52.00
|
|
| Hospital Charge Code |
270623742
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Aetna Commercial |
$15.60
|
| Rate for Payer: Aetna Medicare Advantage |
$15.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.26
|
| Rate for Payer: Cigna Commercial |
$26.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.76
|
| Rate for Payer: Oxford Commercial |
$26.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$26.00
|
|
|
CATH MM NEWTON 2 5F 5563-23
|
Facility
|
IP
|
$52.00
|
|
| Hospital Charge Code |
270623742
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.80
|
|
|
CATH MM PERFORMA DVS 5F 559533
|
Facility
|
IP
|
$52.00
|
|
| Hospital Charge Code |
270623746
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.80
|
|
|
CATH MM PERFORMA DVS 5F 559533
|
Facility
|
OP
|
$52.00
|
|
| Hospital Charge Code |
270623746
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Aetna Commercial |
$15.60
|
| Rate for Payer: Aetna Medicare Advantage |
$15.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.26
|
| Rate for Payer: Cigna Commercial |
$26.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.76
|
| Rate for Payer: Oxford Commercial |
$26.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$26.00
|
|
|
CATH MM PIGTAIL 5F 553991
|
Facility
|
IP
|
$52.00
|
|
| Hospital Charge Code |
270623748
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.80
|
|
|
CATH MM PIGTAIL 5F 553991
|
Facility
|
OP
|
$52.00
|
|
| Hospital Charge Code |
270623748
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Aetna Commercial |
$15.60
|
| Rate for Payer: Aetna Medicare Advantage |
$15.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.26
|
| Rate for Payer: Cigna Commercial |
$26.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.76
|
| Rate for Payer: Oxford Commercial |
$26.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$26.00
|
|
|
CATH MM PIGTAIL 5F 760220M65
|
Facility
|
IP
|
$52.00
|
|
| Hospital Charge Code |
270623743
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.80
|
|
|
CATH MM PIGTAIL 5F 760220M65
|
Facility
|
OP
|
$52.00
|
|
| Hospital Charge Code |
270623743
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Aetna Commercial |
$15.60
|
| Rate for Payer: Aetna Medicare Advantage |
$15.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.26
|
| Rate for Payer: Cigna Commercial |
$26.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.76
|
| Rate for Payer: Oxford Commercial |
$26.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$26.00
|
|
|
CATH MM PIGTAIL CVD 5F 760223
|
Facility
|
OP
|
$52.00
|
|
| Hospital Charge Code |
270623747
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Aetna Commercial |
$15.60
|
| Rate for Payer: Aetna Medicare Advantage |
$15.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.26
|
| Rate for Payer: Cigna Commercial |
$26.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.76
|
| Rate for Payer: Oxford Commercial |
$26.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$26.00
|
|
|
CATH MM PIGTAIL CVD 5F 760223
|
Facility
|
IP
|
$52.00
|
|
| Hospital Charge Code |
270623747
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.80
|
|
|
CATH MM SIMMONS 2 5F 556423
|
Facility
|
OP
|
$52.00
|
|
| Hospital Charge Code |
270623745
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Aetna Commercial |
$15.60
|
| Rate for Payer: Aetna Medicare Advantage |
$15.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.26
|
| Rate for Payer: Cigna Commercial |
$26.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.76
|
| Rate for Payer: Oxford Commercial |
$26.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$26.00
|
|
|
CATH MM SIMMONS 2 5F 556423
|
Facility
|
IP
|
$52.00
|
|
| Hospital Charge Code |
270623745
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.80
|
|
|
CATH MM SIMMONS 5F 5594-B3
|
Facility
|
OP
|
$52.00
|
|
| Hospital Charge Code |
270623757
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Aetna Commercial |
$15.60
|
| Rate for Payer: Aetna Medicare Advantage |
$15.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.26
|
| Rate for Payer: Cigna Commercial |
$26.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.76
|
| Rate for Payer: Oxford Commercial |
$26.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$26.00
|
|
|
CATH MM SIMMONS 5F 5594-B3
|
Facility
|
IP
|
$52.00
|
|
| Hospital Charge Code |
270623757
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.80
|
|
|
CATH MPA2 5FR 100cm 534542T
|
Facility
|
IP
|
$44.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270644598C
|
|
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: Qualcare PPO/HMO/WC |
$6.67
|
|
|
CATH MPA2 5FR 100cm 534542T
|
Facility
|
OP
|
$44.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270644598C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.67 |
| Max. Negotiated Rate |
$22.25 |
| Rate for Payer: Aetna Commercial |
$13.35
|
| 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: Qualcare PPO/HMO/WC |
$6.67
|
|