|
CATH XB LAD 3.5 6F
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636338S
|
|
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 XB LAD 3.5 6F
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636338N
|
|
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: Qualcare PPO/HMO/WC |
$8.40
|
|
|
CATH XB LAD 3.5 6F
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636338N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna Commercial |
$16.80
|
| 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: Qualcare PPO/HMO/WC |
$8.40
|
|
|
CATH XB LAD 3.5 7FR 77806100
|
Facility
|
OP
|
$277.70
|
|
| Hospital Charge Code |
270636384
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.66 |
| Max. Negotiated Rate |
$138.85 |
| Rate for Payer: Aetna Commercial |
$83.31
|
| 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: Qualcare PPO/HMO/WC |
$41.66
|
|
|
CATH XB LAD 3.5 7FR 77806100
|
Facility
|
IP
|
$277.70
|
|
| Hospital Charge Code |
270636384
|
|
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: Qualcare PPO/HMO/WC |
$41.66
|
|
|
CATH XB LAD 3.5 SH 6F 67006100
|
Facility
|
OP
|
$279.85
|
|
| Hospital Charge Code |
270636339C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.98 |
| Max. Negotiated Rate |
$139.93 |
| Rate for Payer: Aetna Commercial |
$83.95
|
| Rate for Payer: Aetna Medicare Advantage |
$83.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$71.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$71.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$55.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$71.36
|
| Rate for Payer: Cigna Commercial |
$139.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$67.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.98
|
|
|
CATH XB LAD 3.5 SH 6F 67006100
|
Facility
|
IP
|
$279.85
|
|
| Hospital Charge Code |
270636339C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.98 |
| Max. Negotiated Rate |
$67.72 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$55.97
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$67.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.98
|
|
|
CATH.XB.LAD 3.5 SH6FR 67006100
|
Facility
|
IP
|
$277.70
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636339
|
|
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: Qualcare PPO/HMO/WC |
$41.66
|
|
|
CATH.XB.LAD 3.5 SH6FR 67006100
|
Facility
|
OP
|
$277.70
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636339
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.66 |
| Max. Negotiated Rate |
$138.85 |
| Rate for Payer: Aetna Commercial |
$83.31
|
| 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: Qualcare PPO/HMO/WC |
$41.66
|
|
|
CATH XB LAD 4.0 6F
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636340S
|
|
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 XB LAD 4.0 6F
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636340S
|
|
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 XB LAD 4.0 6F
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636340
|
|
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 XB LAD 4.0 6F
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636340
|
|
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 XB LAD 4.0 7FR
|
Facility
|
IP
|
$277.70
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636385N
|
|
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: Qualcare PPO/HMO/WC |
$41.66
|
|
|
CATH XB LAD 4.0 7FR
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636385
|
|
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: Qualcare PPO/HMO/WC |
$33.00
|
|
|
CATH XB LAD 4.0 7FR
|
Facility
|
OP
|
$277.70
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636385N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.66 |
| Max. Negotiated Rate |
$138.85 |
| Rate for Payer: Aetna Commercial |
$83.31
|
| 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: Qualcare PPO/HMO/WC |
$41.66
|
|
|
CATH XB LAD 4.0 7FR
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636385
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna Commercial |
$66.00
|
| 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: Qualcare PPO/HMO/WC |
$33.00
|
|
|
CATH XBLAD 8FR 3 5cm 5888100
|
Facility
|
IP
|
$280.00
|
|
| Hospital Charge Code |
270637735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$67.76 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$56.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$67.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.00
|
|
|
CATH XBLAD 8FR 3 5cm 5888100
|
Facility
|
OP
|
$280.00
|
|
| Hospital Charge Code |
270637735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna Commercial |
$84.00
|
| Rate for Payer: Aetna Medicare Advantage |
$84.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$71.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$71.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$56.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$71.40
|
| Rate for Payer: Cigna Commercial |
$140.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$67.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.00
|
|
|
CATH XB LAD SH 7FR 77806300
|
Facility
|
OP
|
$277.70
|
|
| Hospital Charge Code |
270636386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.66 |
| Max. Negotiated Rate |
$138.85 |
| Rate for Payer: Aetna Commercial |
$83.31
|
| 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: Qualcare PPO/HMO/WC |
$41.66
|
|
|
CATH XB LAD SH 7FR 77806300
|
Facility
|
IP
|
$277.70
|
|
| Hospital Charge Code |
270636386
|
|
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: Qualcare PPO/HMO/WC |
$41.66
|
|
|
CATH XB RCA SH 6FR 67012700
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636343
|
|
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 XB RCA SH 6FR 67012700
|
Facility
|
IP
|
$277.70
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636343N
|
|
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: Qualcare PPO/HMO/WC |
$41.66
|
|
|
CATH XB RCA SH 6FR 67012700
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636343
|
|
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 XB RCA SH 6FR 67012700
|
Facility
|
OP
|
$277.70
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636343N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.66 |
| Max. Negotiated Rate |
$138.85 |
| Rate for Payer: Aetna Commercial |
$83.31
|
| 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: Qualcare PPO/HMO/WC |
$41.66
|
|