|
CATH 5FR SRC 100cm 534574T
|
Facility
|
OP
|
$44.50
|
|
| Hospital Charge Code |
270644610S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$22.25 |
| Rate for Payer: Aetna Commercial |
$16.91
|
| 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) PPO |
$11.35
|
| Rate for Payer: Cigna Commercial |
$22.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.57
|
| Rate for Payer: Oxford Commercial |
$8.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.67
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.90
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.26
|
|
|
CATH 5FR SRC 100cm 534574T
|
Facility
|
IP
|
$44.50
|
|
| Hospital Charge Code |
270644610S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.67 |
| Max. Negotiated Rate |
$6.67 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.67
|
|
|
CATH 5FR SRC 100cm 534574T
|
Facility
|
OP
|
$44.50
|
|
| Hospital Charge Code |
270644610C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$22.25 |
| Rate for Payer: Aetna Commercial |
$16.91
|
| 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) PPO |
$11.35
|
| Rate for Payer: Cigna Commercial |
$22.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.57
|
| Rate for Payer: Oxford Commercial |
$8.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.67
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.90
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.26
|
|
|
CATH 5FR SRC 100cm 534574T
|
Facility
|
IP
|
$44.50
|
|
| Hospital Charge Code |
270644610C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.67 |
| Max. Negotiated Rate |
$6.67 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.67
|
|
|
CATH 6F AL I 533645
|
Facility
|
OP
|
$42.25
|
|
| Hospital Charge Code |
270604409
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$21.12 |
| Rate for Payer: Aetna Commercial |
$16.05
|
| Rate for Payer: Aetna Medicare Advantage |
$12.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.77
|
| Rate for Payer: Cigna Commercial |
$21.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.98
|
| Rate for Payer: Oxford Commercial |
$8.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.45
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.20
|
|
|
CATH 6F AL I 533645
|
Facility
|
IP
|
$42.25
|
|
| Hospital Charge Code |
270604409
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.34
|
|
|
CATH 6F INFINITI TL 534674T
|
Facility
|
IP
|
$44.50
|
|
| Hospital Charge Code |
270618311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.67 |
| Max. Negotiated Rate |
$6.67 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.67
|
|
|
CATH 6F INFINITI TL 534674T
|
Facility
|
OP
|
$44.50
|
|
| Hospital Charge Code |
270618311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$22.25 |
| Rate for Payer: Aetna Commercial |
$16.91
|
| 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) PPO |
$11.35
|
| Rate for Payer: Cigna Commercial |
$22.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.57
|
| Rate for Payer: Oxford Commercial |
$8.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.67
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.90
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.26
|
|
|
CATH 6F JR 5 0 100 533623
|
Facility
|
OP
|
$41.20
|
|
| Hospital Charge Code |
270616022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$20.60 |
| Rate for Payer: Aetna Commercial |
$15.66
|
| Rate for Payer: Aetna Medicare Advantage |
$12.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.51
|
| Rate for Payer: Cigna Commercial |
$20.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.71
|
| Rate for Payer: Oxford Commercial |
$8.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.24
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.17
|
|
|
CATH 6F JR 5 0 100 533623
|
Facility
|
IP
|
$41.20
|
|
| Hospital Charge Code |
270616022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$6.18 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.18
|
|
|
CATH 6F LCB
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270639849
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$91.20
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.82
|
|
|
CATH 6F LCB
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270639849
|
|
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 6 F MPA 1
|
Facility
|
IP
|
$54.95
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636331N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$13.30 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.99
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.24
|
|
|
CATH 6 F MPA 1
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636331S
|
|
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 6 F MPA 1
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$91.20
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.82
|
|
|
CATH 6 F MPA 1
|
Facility
|
OP
|
$54.95
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636331N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$27.48 |
| Rate for Payer: Aetna Commercial |
$20.88
|
| Rate for Payer: Aetna Medicare Advantage |
$16.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.01
|
| Rate for Payer: Cigna Commercial |
$27.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.24
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.56
|
|
|
CATH 6 F MPA 1
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636331
|
|
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 6 F MPA 1
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636331S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$91.20
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.82
|
|
|
CATH 6F MPA2 533642
|
Facility
|
IP
|
$42.25
|
|
| Hospital Charge Code |
270604410
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.34
|
|
|
CATH 6F MPA2 533642
|
Facility
|
OP
|
$42.25
|
|
| Hospital Charge Code |
270604410
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$21.12 |
| Rate for Payer: Aetna Commercial |
$16.05
|
| Rate for Payer: Aetna Medicare Advantage |
$12.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.77
|
| Rate for Payer: Cigna Commercial |
$21.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.98
|
| Rate for Payer: Oxford Commercial |
$8.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.45
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.20
|
|
|
CATH 6FR 90CM THROMBECTOMY
|
Facility
|
OP
|
$7,950.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
270648157N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.78 |
| Max. Negotiated Rate |
$3,975.00 |
| Rate for Payer: Aetna Commercial |
$3,021.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,385.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,027.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,027.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,590.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,027.25
|
| Rate for Payer: Cigna Commercial |
$3,975.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,923.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,192.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$251.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$225.78
|
|
|
CATH 6FR 90CM THROMBECTOMY
|
Facility
|
OP
|
$7,950.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
270648157C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.78 |
| Max. Negotiated Rate |
$3,975.00 |
| Rate for Payer: Aetna Commercial |
$3,021.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,385.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,027.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,027.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,590.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,027.25
|
| Rate for Payer: Cigna Commercial |
$3,975.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,923.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,192.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$251.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$225.78
|
|
|
CATH 6FR 90CM THROMBECTOMY
|
Facility
|
IP
|
$7,950.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
270648157C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,192.50 |
| Max. Negotiated Rate |
$1,923.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,590.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,923.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,192.50
|
|
|
CATH 6FR 90CM THROMBECTOMY
|
Facility
|
OP
|
$7,950.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
270648157A
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.78 |
| Max. Negotiated Rate |
$3,975.00 |
| Rate for Payer: Aetna Commercial |
$3,021.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,385.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,027.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,027.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,590.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,027.25
|
| Rate for Payer: Cigna Commercial |
$3,975.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,923.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,192.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$251.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$225.78
|
|
|
CATH 6FR 90CM THROMBECTOMY
|
Facility
|
OP
|
$7,950.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
270648157
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.78 |
| Max. Negotiated Rate |
$3,975.00 |
| Rate for Payer: Aetna Commercial |
$3,021.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,385.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,027.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,027.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,590.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,027.25
|
| Rate for Payer: Cigna Commercial |
$3,975.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,923.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,192.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$251.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$225.78
|
|