|
CATH AL 1.5 6F 67003800
|
Facility
|
OP
|
$277.70
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636312
|
|
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 AL 1.5 7F 77803800
|
Facility
|
IP
|
$277.70
|
|
| Hospital Charge Code |
270636367
|
|
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 AL 1.5 7F 77803800
|
Facility
|
OP
|
$277.70
|
|
| Hospital Charge Code |
270636367
|
|
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 AL 1.5 SH 7F 67004000
|
Facility
|
IP
|
$277.70
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636313N
|
|
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 AL 1.5 SH 7F 67004000
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636313S
|
|
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 AL 1.5 SH 7F 67004000
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636313
|
|
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 AL 1.5 SH 7F 67004000
|
Facility
|
OP
|
$277.70
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636313N
|
|
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 AL 1.5 SH 7F 67004000
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636313
|
|
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 AL 1.5 SH 7F 67004000
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636313S
|
|
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 AL 1.5 SH 7F 77803900
|
Facility
|
IP
|
$277.70
|
|
| Hospital Charge Code |
270636368
|
|
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 AL 1.5 SH 7F 77803900
|
Facility
|
OP
|
$277.70
|
|
| Hospital Charge Code |
270636368
|
|
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 AL 1 6F
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636308
|
|
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 AL 1 6F
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636308
|
|
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 AL 1 SH 6F 67003700
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636309
|
|
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 AL 1 SH 6F 67003700
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636309
|
|
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 AL 1 SH 6F 67003700
|
Facility
|
OP
|
$277.70
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636309N
|
|
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 AL 1 SH 6F 67003700
|
Facility
|
IP
|
$277.70
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636309N
|
|
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 AL .75 6F 67003400
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636306N
|
|
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 AL .75 6F 67003400
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636306N
|
|
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 AL .75 6F 67003400
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636306
|
|
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 AL .75 6F 67003400
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636306
|
|
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 AL .75 7F 77803400
|
Facility
|
OP
|
$277.70
|
|
| Hospital Charge Code |
270636363
|
|
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 AL .75 7F 77803400
|
Facility
|
IP
|
$277.70
|
|
| Hospital Charge Code |
270636363
|
|
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 AL 75 7FR 77803400
|
Facility
|
IP
|
$279.85
|
|
| Hospital Charge Code |
270636363C
|
|
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 AL 75 7FR 77803400
|
Facility
|
OP
|
$279.85
|
|
| Hospital Charge Code |
270636363C
|
|
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
|
|