|
CATH CXI SUPP 2.3FR 135CM ANG2
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
270673503
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.69 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Aetna Commercial |
$370.50
|
| Rate for Payer: Aetna Medicare Advantage |
$292.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$248.62
|
| Rate for Payer: Cigna Commercial |
$487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$253.50
|
| Rate for Payer: Oxford Commercial |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$195.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$30.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.69
|
|
|
CATH CXI SUPP 2.3 FR 150CM ANG
|
Facility
|
IP
|
$1,024.95
|
|
| Hospital Charge Code |
270673504
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.74 |
| Max. Negotiated Rate |
$153.74 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.74
|
|
|
CATH CXI SUPP 2.3 FR 150CM ANG
|
Facility
|
OP
|
$1,024.95
|
|
| Hospital Charge Code |
270673504
|
|
Hospital Revenue Code
|
272
|
| 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) PPO |
$261.36
|
| Rate for Payer: Cigna Commercial |
$512.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$266.49
|
| Rate for Payer: Oxford Commercial |
$204.99
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.74
|
| Rate for Payer: UnitedHealthcare Commercial |
$204.99
|
| Rate for Payer: UnitedHealthcare Community & State |
$32.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.11
|
|
|
CATH CXI SUPP 2.3FR 150CM ANG
|
Facility
|
IP
|
$975.00
|
|
| Hospital Charge Code |
270673504S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
|
|
CATH CXI SUPP 2.3FR 150CM ANG
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
270673504S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.69 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Aetna Commercial |
$370.50
|
| Rate for Payer: Aetna Medicare Advantage |
$292.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$248.62
|
| Rate for Payer: Cigna Commercial |
$487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$253.50
|
| Rate for Payer: Oxford Commercial |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$195.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$30.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.69
|
|
|
CATH CXI SUPP 2.3FR 150CM ANG2
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
270673505
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.69 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Aetna Commercial |
$370.50
|
| Rate for Payer: Aetna Medicare Advantage |
$292.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$248.62
|
| Rate for Payer: Cigna Commercial |
$487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$253.50
|
| Rate for Payer: Oxford Commercial |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$195.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$30.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.69
|
|
|
CATH CXI SUPP 2.3FR 150CM ANG2
|
Facility
|
IP
|
$975.00
|
|
| Hospital Charge Code |
270673505
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
|
|
CATH CXI SUPP 2.3 FR 65CM ANG
|
Facility
|
IP
|
$925.00
|
|
| Hospital Charge Code |
270673492
|
|
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 2.3 FR 65CM ANG
|
Facility
|
OP
|
$925.00
|
|
| Hospital Charge Code |
270673492
|
|
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 2.3 FR 65CM ANG2
|
Facility
|
IP
|
$975.00
|
|
| Hospital Charge Code |
270673496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
|
|
CATH CXI SUPP 2.3 FR 65CM ANG2
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
270673496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.69 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Aetna Commercial |
$370.50
|
| Rate for Payer: Aetna Medicare Advantage |
$292.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$248.62
|
| Rate for Payer: Cigna Commercial |
$487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$253.50
|
| Rate for Payer: Oxford Commercial |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$195.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$30.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.69
|
|
|
CATH CXI SUPP 2.3 FR 65CM STR
|
Facility
|
IP
|
$1,020.00
|
|
| Hospital Charge Code |
270673497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.00
|
|
|
CATH CXI SUPP 2.3 FR 65CM STR
|
Facility
|
OP
|
$1,020.00
|
|
| Hospital Charge Code |
270673497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.97 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna Commercial |
$387.60
|
| Rate for Payer: Aetna Medicare Advantage |
$306.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$260.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$260.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$260.10
|
| Rate for Payer: Cigna Commercial |
$510.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$265.20
|
| Rate for Payer: Oxford Commercial |
$204.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$204.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$32.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.97
|
|
|
CATH CXI SUPP 2.3 FR 90CM ANG
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
270671144
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.69 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Aetna Commercial |
$370.50
|
| Rate for Payer: Aetna Medicare Advantage |
$292.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$248.62
|
| Rate for Payer: Cigna Commercial |
$487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$253.50
|
| Rate for Payer: Oxford Commercial |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$195.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$30.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.69
|
|
|
CATH CXI SUPP 2.3 FR 90CM ANG
|
Facility
|
IP
|
$975.00
|
|
| Hospital Charge Code |
270671144
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
|
|
CATH CXI SUPP 2.3 FR 90CM ANG2
|
Facility
|
IP
|
$975.00
|
|
| Hospital Charge Code |
270673499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
|
|
CATH CXI SUPP 2.3 FR 90CM ANG2
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
270673499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.69 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Aetna Commercial |
$370.50
|
| Rate for Payer: Aetna Medicare Advantage |
$292.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$248.62
|
| Rate for Payer: Cigna Commercial |
$487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$253.50
|
| Rate for Payer: Oxford Commercial |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$195.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$30.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.69
|
|
|
CATH CXI SUPP 2.3 FR 90CM STR
|
Facility
|
IP
|
$925.00
|
|
| Hospital Charge Code |
270673501
|
|
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 2.3 FR 90CM STR
|
Facility
|
OP
|
$925.00
|
|
| Hospital Charge Code |
270673501
|
|
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 150CM ANG
|
Facility
|
OP
|
$925.00
|
|
| Hospital Charge Code |
270673511S
|
|
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 150CM ANG
|
Facility
|
IP
|
$925.00
|
|
| Hospital Charge Code |
270673511S
|
|
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 150CM ANG
|
Facility
|
OP
|
$925.00
|
|
| Hospital Charge Code |
270673511
|
|
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 150CM ANG
|
Facility
|
IP
|
$925.00
|
|
| Hospital Charge Code |
270673511
|
|
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 60CM STR
|
Facility
|
IP
|
$975.00
|
|
| Hospital Charge Code |
270673507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
|
|
CATH CXI SUPP 2.6 FR 60CM STR
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
270673507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.69 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Aetna Commercial |
$370.50
|
| Rate for Payer: Aetna Medicare Advantage |
$292.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$248.62
|
| Rate for Payer: Cigna Commercial |
$487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$253.50
|
| Rate for Payer: Oxford Commercial |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$195.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$30.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.69
|
|