|
CATH PERF 6FR JL4 750120
|
Facility
|
IP
|
$37.90
|
|
| Hospital Charge Code |
270655490
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$5.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.68
|
|
|
CATH PERF 6FR JL4 750120
|
Facility
|
OP
|
$37.90
|
|
| Hospital Charge Code |
270655490S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$18.95 |
| Rate for Payer: Aetna Commercial |
$11.37
|
| Rate for Payer: Aetna Medicare Advantage |
$11.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.66
|
| Rate for Payer: Cigna Commercial |
$18.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.93
|
| Rate for Payer: Oxford Commercial |
$18.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$18.95
|
|
|
CATH PERF 6FR JL4 750120
|
Facility
|
OP
|
$37.90
|
|
| Hospital Charge Code |
270655490N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$18.95 |
| Rate for Payer: Aetna Commercial |
$11.37
|
| Rate for Payer: Aetna Medicare Advantage |
$11.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.66
|
| Rate for Payer: Cigna Commercial |
$18.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.93
|
| Rate for Payer: Oxford Commercial |
$18.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$18.95
|
|
|
CATH PERF 6FR JL4 750120
|
Facility
|
IP
|
$37.90
|
|
| Hospital Charge Code |
270655490N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$5.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.68
|
|
|
CATH PERF 6FR JL4 750120
|
Facility
|
OP
|
$37.90
|
|
| Hospital Charge Code |
270655490
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$18.95 |
| Rate for Payer: Aetna Commercial |
$11.37
|
| Rate for Payer: Aetna Medicare Advantage |
$11.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.66
|
| Rate for Payer: Cigna Commercial |
$18.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.93
|
| Rate for Payer: Oxford Commercial |
$18.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$18.95
|
|
|
CATH PERFLEX 6x4 80 PG4206040S
|
Facility
|
OP
|
$1,314.45
|
|
| Hospital Charge Code |
270630173
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.17 |
| Max. Negotiated Rate |
$657.23 |
| Rate for Payer: Aetna Commercial |
$394.33
|
| Rate for Payer: Aetna Medicare Advantage |
$394.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$335.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$335.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$262.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$335.18
|
| Rate for Payer: Cigna Commercial |
$657.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$318.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$197.17
|
|
|
CATH PERFLEX 6x4 80 PG4206040S
|
Facility
|
IP
|
$1,314.45
|
|
| Hospital Charge Code |
270630173
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.17 |
| Max. Negotiated Rate |
$318.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$262.89
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$318.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$197.17
|
|
|
CATH PERF LT4FR AL1
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
2709006890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$12.00
|
| Rate for Payer: Aetna Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.20
|
| Rate for Payer: Cigna Commercial |
$20.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.20
|
| Rate for Payer: Oxford Commercial |
$20.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$20.00
|
|
|
CATH PERF LT4FR AL1
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
2709006890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
CATH PERF LT4FR AL2
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
2709006891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$12.00
|
| Rate for Payer: Aetna Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.20
|
| Rate for Payer: Cigna Commercial |
$20.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.20
|
| Rate for Payer: Oxford Commercial |
$20.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$20.00
|
|
|
CATH PERF LT4FR AL2
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
2709006891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
CATH PERF LT CORN BYPASS 4FR
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
2709006895
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$12.00
|
| Rate for Payer: Aetna Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.20
|
| Rate for Payer: Cigna Commercial |
$20.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.20
|
| Rate for Payer: Oxford Commercial |
$20.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$20.00
|
|
|
CATH PERF LT CORN BYPASS 4FR
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
2709006895
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
CATH PERFORMA 4F 7706 10
|
Facility
|
IP
|
$37.35
|
|
| Hospital Charge Code |
270658256
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.60
|
|
|
CATH PERFORMA 4F 7706 10
|
Facility
|
OP
|
$37.35
|
|
| Hospital Charge Code |
270658256
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$18.68 |
| Rate for Payer: Aetna Commercial |
$11.21
|
| Rate for Payer: Aetna Medicare Advantage |
$11.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.52
|
| Rate for Payer: Cigna Commercial |
$18.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.86
|
| Rate for Payer: Oxford Commercial |
$18.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$18.68
|
|
|
CATH PERF RT4FR AR2
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
2709006894
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
CATH PERF RT4FR AR2
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
2709006894
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$12.00
|
| Rate for Payer: Aetna Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.20
|
| Rate for Payer: Cigna Commercial |
$20.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.20
|
| Rate for Payer: Oxford Commercial |
$20.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$20.00
|
|
|
CATH PERF RT4FR ARMOD
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
2709006893
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
CATH PERF RT4FR ARMOD
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
2709006893
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$12.00
|
| Rate for Payer: Aetna Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.20
|
| Rate for Payer: Cigna Commercial |
$20.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.20
|
| Rate for Payer: Oxford Commercial |
$20.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$20.00
|
|
|
CATH PERF RT4FR JR5.0
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
2709006888
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
CATH PERF RT4FR JR5.0
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
2709006888
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$12.00
|
| Rate for Payer: Aetna Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.20
|
| Rate for Payer: Cigna Commercial |
$20.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.20
|
| Rate for Payer: Oxford Commercial |
$20.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$20.00
|
|
|
CATH PERF RT4FR JR6.0
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
2709006889
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$12.00
|
| Rate for Payer: Aetna Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.20
|
| Rate for Payer: Cigna Commercial |
$20.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.20
|
| Rate for Payer: Oxford Commercial |
$20.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$20.00
|
|
|
CATH PERF RT4FR JR6.0
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
2709006889
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
CATH PERFUSION W/ASP TB RED43
|
Facility
|
IP
|
$11,950.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270700022S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,792.50 |
| Max. Negotiated Rate |
$2,891.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,390.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,891.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,792.50
|
|
|
CATH PERFUSION W/ASP TB RED43
|
Facility
|
OP
|
$11,950.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270700022S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,792.50 |
| Max. Negotiated Rate |
$5,975.00 |
| Rate for Payer: Aetna Commercial |
$3,585.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,585.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,047.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,047.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,390.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,047.25
|
| Rate for Payer: Cigna Commercial |
$5,975.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,891.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,792.50
|
|