|
CATH CXI SUPP 2.6 FR 65CM ANG
|
Facility
|
OP
|
$925.00
|
|
| Hospital Charge Code |
270673506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.27 |
| Max. Negotiated Rate |
$462.50 |
| Rate for Payer: Aetna Commercial |
$351.50
|
| Rate for Payer: Aetna Medicare Advantage |
$277.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$235.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$235.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$235.88
|
| Rate for Payer: Cigna Commercial |
$462.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$240.50
|
| Rate for Payer: Oxford Commercial |
$185.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$138.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$185.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$29.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.27
|
|
|
CATH CXI SUPP 2.6 FR 65CM ANG
|
Facility
|
IP
|
$925.00
|
|
| Hospital Charge Code |
270673506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.75 |
| Max. Negotiated Rate |
$138.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$138.75
|
|
|
CATH CXI SUPP 2.6 FR 66CM ANG
|
Facility
|
IP
|
$925.00
|
|
| Hospital Charge Code |
270673506S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.75 |
| Max. Negotiated Rate |
$138.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$138.75
|
|
|
CATH CXI SUPP 2.6 FR 66CM ANG
|
Facility
|
OP
|
$925.00
|
|
| Hospital Charge Code |
270673506S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.27 |
| Max. Negotiated Rate |
$462.50 |
| Rate for Payer: Aetna Commercial |
$351.50
|
| Rate for Payer: Aetna Medicare Advantage |
$277.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$235.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$235.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$235.88
|
| Rate for Payer: Cigna Commercial |
$462.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$240.50
|
| Rate for Payer: Oxford Commercial |
$185.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$138.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$185.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$29.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.27
|
|
|
CATH CXI SUPP 2.6 FR 90CM ANG
|
Facility
|
IP
|
$925.00
|
|
| Hospital Charge Code |
270673508S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.75 |
| Max. Negotiated Rate |
$138.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$138.75
|
|
|
CATH CXI SUPP 2.6 FR 90CM ANG
|
Facility
|
OP
|
$925.00
|
|
| Hospital Charge Code |
270673508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.27 |
| Max. Negotiated Rate |
$462.50 |
| Rate for Payer: Aetna Commercial |
$351.50
|
| Rate for Payer: Aetna Medicare Advantage |
$277.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$235.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$235.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$235.88
|
| Rate for Payer: Cigna Commercial |
$462.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$240.50
|
| Rate for Payer: Oxford Commercial |
$185.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$138.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$185.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$29.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.27
|
|
|
CATH CXI SUPP 2.6 FR 90CM ANG
|
Facility
|
IP
|
$925.00
|
|
| Hospital Charge Code |
270673508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.75 |
| Max. Negotiated Rate |
$138.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$138.75
|
|
|
CATH CXI SUPP 2.6 FR 90CM ANG
|
Facility
|
OP
|
$925.00
|
|
| Hospital Charge Code |
270673508S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.27 |
| Max. Negotiated Rate |
$462.50 |
| Rate for Payer: Aetna Commercial |
$351.50
|
| Rate for Payer: Aetna Medicare Advantage |
$277.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$235.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$235.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$235.88
|
| Rate for Payer: Cigna Commercial |
$462.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$240.50
|
| Rate for Payer: Oxford Commercial |
$185.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$138.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$185.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$29.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.27
|
|
|
CATH CXI SUPP 2.6 FR 90CM STR
|
Facility
|
OP
|
$925.00
|
|
| Hospital Charge Code |
270673510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.27 |
| Max. Negotiated Rate |
$462.50 |
| Rate for Payer: Aetna Commercial |
$351.50
|
| Rate for Payer: Aetna Medicare Advantage |
$277.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$235.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$235.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$235.88
|
| Rate for Payer: Cigna Commercial |
$462.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$240.50
|
| Rate for Payer: Oxford Commercial |
$185.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$138.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$185.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$29.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.27
|
|
|
CATH CXI SUPP 2.6 FR 90CM STR
|
Facility
|
IP
|
$925.00
|
|
| Hospital Charge Code |
270673510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.75 |
| Max. Negotiated Rate |
$138.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$138.75
|
|
|
CATH CXI SUPP 4 FR 135CM ANG
|
Facility
|
IP
|
$925.00
|
|
| Hospital Charge Code |
270662850
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.75 |
| Max. Negotiated Rate |
$138.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$138.75
|
|
|
CATH CXI SUPP 4 FR 135CM ANG
|
Facility
|
OP
|
$925.00
|
|
| Hospital Charge Code |
270662850
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.27 |
| Max. Negotiated Rate |
$462.50 |
| Rate for Payer: Aetna Commercial |
$351.50
|
| Rate for Payer: Aetna Medicare Advantage |
$277.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$235.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$235.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$235.88
|
| Rate for Payer: Cigna Commercial |
$462.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$240.50
|
| Rate for Payer: Oxford Commercial |
$185.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$138.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$185.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$29.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.27
|
|
|
CATH CXI SUPP 4 FR 150CM ANG
|
Facility
|
OP
|
$1,024.95
|
|
| Hospital Charge Code |
270673512
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.11 |
| Max. Negotiated Rate |
$512.48 |
| Rate for Payer: Aetna Commercial |
$389.48
|
| Rate for Payer: Aetna Medicare Advantage |
$307.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$261.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$261.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$204.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$261.36
|
| Rate for Payer: Cigna Commercial |
$512.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$248.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.74
|
| Rate for Payer: UnitedHealthcare Community & State |
$32.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.11
|
|
|
CATH CXI SUPP 4 FR 150CM ANG
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270673512S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.27 |
| Max. Negotiated Rate |
$462.50 |
| Rate for Payer: Aetna Commercial |
$351.50
|
| Rate for Payer: Aetna Medicare Advantage |
$277.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$235.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$235.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$185.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$235.88
|
| Rate for Payer: Cigna Commercial |
$462.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$223.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$138.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$29.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.27
|
|
|
CATH CXI SUPP 4 FR 150CM ANG
|
Facility
|
IP
|
$1,024.95
|
|
| Hospital Charge Code |
270673512
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.74 |
| Max. Negotiated Rate |
$248.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$204.99
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$248.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.74
|
|
|
CATH CXI SUPP 4 FR 150CM ANG
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270673512S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.75 |
| Max. Negotiated Rate |
$223.85 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$185.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$223.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$138.75
|
|
|
CATH DAVIS 5FR
|
Facility
|
OP
|
$74.30
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270677004A
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$37.15 |
| Rate for Payer: Aetna Commercial |
$28.23
|
| Rate for Payer: Aetna Medicare Advantage |
$22.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.95
|
| Rate for Payer: Cigna Commercial |
$37.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.32
|
| Rate for Payer: Oxford Commercial |
$14.86
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$14.86
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.11
|
|
|
CATH DAVIS 5FR
|
Facility
|
IP
|
$74.30
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270677004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.14 |
| Max. Negotiated Rate |
$11.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.14
|
|
|
CATH DAVIS 5FR
|
Facility
|
IP
|
$74.30
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270677004A
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.14 |
| Max. Negotiated Rate |
$11.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.14
|
|
|
CATH DAVIS 5FR
|
Facility
|
OP
|
$74.30
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270677004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$37.15 |
| Rate for Payer: Aetna Commercial |
$28.23
|
| Rate for Payer: Aetna Medicare Advantage |
$22.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.95
|
| Rate for Payer: Cigna Commercial |
$37.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.32
|
| Rate for Payer: Oxford Commercial |
$14.86
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$14.86
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.11
|
|
|
CATH DEVICE CTO CROSS FLEX 150
|
Facility
|
OP
|
$10,975.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270661755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$311.69 |
| Max. Negotiated Rate |
$5,487.50 |
| Rate for Payer: Aetna Commercial |
$4,170.50
|
| Rate for Payer: Aetna Medicare Advantage |
$3,292.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,798.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,798.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,195.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,798.62
|
| Rate for Payer: Cigna Commercial |
$5,487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,655.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,646.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$346.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$311.69
|
|
|
CATH DEVICE CTO CROSS FLEX 150
|
Facility
|
IP
|
$10,975.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270661755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$2,655.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,195.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,655.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,646.25
|
|
|
CATH DIAMONDBK 1.25MICRO145CM
|
Facility
|
OP
|
$18,475.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
270693011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.69 |
| Max. Negotiated Rate |
$9,237.50 |
| Rate for Payer: Aetna Commercial |
$7,020.50
|
| Rate for Payer: Aetna Medicare Advantage |
$5,542.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,711.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,711.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,695.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,711.12
|
| Rate for Payer: Cigna Commercial |
$9,237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,470.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,771.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$583.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$524.69
|
|
|
CATH DIAMONDBK 1.25MICRO145CM
|
Facility
|
IP
|
$18,475.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
270693011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,771.25 |
| Max. Negotiated Rate |
$4,470.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,695.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,470.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,771.25
|
|
|
CATH DIL GUIDE FUBUKI 6FR 80CM
|
Facility
|
OP
|
$2,745.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270699484S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.96 |
| Max. Negotiated Rate |
$1,372.50 |
| Rate for Payer: Aetna Commercial |
$1,043.10
|
| Rate for Payer: Aetna Medicare Advantage |
$823.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$699.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$699.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$549.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$699.98
|
| Rate for Payer: Cigna Commercial |
$1,372.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$664.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$411.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$86.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$77.96
|
|