|
CATH 6FR SH JR 4.0
|
Facility
|
IP
|
$217.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636300S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$32.62 |
| Max. Negotiated Rate |
$52.63 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$43.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$52.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.62
|
|
|
CATH 6FR SH JR 4.0 67008300
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636300
|
|
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 6FR SH JR 4.0 67008300
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636300
|
|
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 6FR XBE 2.0
|
Facility
|
OP
|
$230.00
|
|
| Hospital Charge Code |
270639613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.90 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna Commercial |
$69.00
|
| Rate for Payer: Aetna Medicare Advantage |
$69.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$58.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$58.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$58.65
|
| Rate for Payer: Cigna Commercial |
$115.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.90
|
| Rate for Payer: Oxford Commercial |
$115.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$34.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$115.00
|
|
|
CATH 6FR XBE 2.0
|
Facility
|
IP
|
$230.00
|
|
| Hospital Charge Code |
270639613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$34.50
|
|
|
CATH 6FR XBR 1.0
|
Facility
|
IP
|
$255.00
|
|
| Hospital Charge Code |
270639612
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.25 |
| Max. Negotiated Rate |
$38.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.25
|
|
|
CATH 6FR XBR 1.0
|
Facility
|
OP
|
$255.00
|
|
| Hospital Charge Code |
270639612
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Medicare Advantage |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$65.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$65.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$65.03
|
| Rate for Payer: Cigna Commercial |
$127.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.15
|
| Rate for Payer: Oxford Commercial |
$127.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$127.50
|
|
|
CATH 6FR XB RCA .07
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636342
|
|
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 6FR XB RCA .07
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636342
|
|
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 6F SH AL 1.0 67003700
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636309S
|
|
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 6F SH AL 1.0 67003700
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636309S
|
|
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 7FR AL 1.0
|
Facility
|
IP
|
$220.00
|
|
| Hospital Charge Code |
270663276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.00
|
|
|
CATH 7FR AL 1.0
|
Facility
|
OP
|
$220.00
|
|
| Hospital Charge Code |
270663276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.60 |
| 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) PPO |
$56.10
|
| Rate for Payer: Cigna Commercial |
$110.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$28.60
|
| Rate for Payer: Oxford Commercial |
$110.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$110.00
|
|
|
CATH 7FR ALLII
|
Facility
|
IP
|
$45.00
|
|
| Hospital Charge Code |
270618288
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$6.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.75
|
|
|
CATH 7FR ALLII
|
Facility
|
OP
|
$45.00
|
|
| Hospital Charge Code |
270618288
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna Commercial |
$13.50
|
| Rate for Payer: Aetna Medicare Advantage |
$13.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$11.47
|
| Rate for Payer: Cigna Commercial |
$22.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.85
|
| Rate for Payer: Oxford Commercial |
$22.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$22.50
|
|
|
CATH 7FR JL 4.0
|
Facility
|
OP
|
$45.25
|
|
| Hospital Charge Code |
270613030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$22.62 |
| Rate for Payer: Aetna Commercial |
$13.57
|
| Rate for Payer: Aetna Medicare Advantage |
$13.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$11.54
|
| Rate for Payer: Cigna Commercial |
$22.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.88
|
| Rate for Payer: Oxford Commercial |
$22.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.79
|
| Rate for Payer: UnitedHealthcare Commercial |
$22.62
|
|
|
CATH 7FR JL 4.0
|
Facility
|
IP
|
$45.25
|
|
| Hospital Charge Code |
270613030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$6.79 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.79
|
|
|
CATH 7FR JL 4.5 ST
|
Facility
|
OP
|
$220.00
|
|
| Hospital Charge Code |
270663273
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.60 |
| 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) PPO |
$56.10
|
| Rate for Payer: Cigna Commercial |
$110.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$28.60
|
| Rate for Payer: Oxford Commercial |
$110.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$110.00
|
|
|
CATH 7FR JL 4.5 ST
|
Facility
|
IP
|
$220.00
|
|
| Hospital Charge Code |
270663273
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.00
|
|
|
CATH 7FR JL 5.0 ST
|
Facility
|
IP
|
$220.00
|
|
| Hospital Charge Code |
270663274
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.00
|
|
|
CATH 7FR JL 5.0 ST
|
Facility
|
OP
|
$220.00
|
|
| Hospital Charge Code |
270663274
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.60 |
| 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) PPO |
$56.10
|
| Rate for Payer: Cigna Commercial |
$110.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$28.60
|
| Rate for Payer: Oxford Commercial |
$110.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$110.00
|
|
|
CATH 7FR JL 6.0
|
Facility
|
OP
|
$220.00
|
|
| Hospital Charge Code |
270663275
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.60 |
| 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) PPO |
$56.10
|
| Rate for Payer: Cigna Commercial |
$110.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$28.60
|
| Rate for Payer: Oxford Commercial |
$110.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$110.00
|
|
|
CATH 7FR JL 6.0
|
Facility
|
IP
|
$220.00
|
|
| Hospital Charge Code |
270663275
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.00
|
|
|
CATH 7FR JR 3.5
|
Facility
|
OP
|
$42.50
|
|
| Hospital Charge Code |
270618292
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Aetna Commercial |
$12.75
|
| Rate for Payer: Aetna Medicare Advantage |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.84
|
| Rate for Payer: Cigna Commercial |
$21.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.53
|
| Rate for Payer: Oxford Commercial |
$21.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$21.25
|
|
|
CATH 7FR JR 3.5
|
Facility
|
IP
|
$42.50
|
|
| Hospital Charge Code |
270618292
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$6.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.38
|
|