|
CATH DXT 5 F JR35 100CM
|
Facility
|
IP
|
$41.25
|
|
| Hospital Charge Code |
270683018
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.19 |
| Max. Negotiated Rate |
$6.19 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.19
|
|
|
CATH DXT 5 F JR35 100CM
|
Facility
|
OP
|
$41.25
|
|
| Hospital Charge Code |
270683018N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$20.62 |
| Rate for Payer: Aetna Commercial |
$15.68
|
| Rate for Payer: Aetna Medicare Advantage |
$12.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.52
|
| Rate for Payer: Cigna Commercial |
$20.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.19
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.17
|
|
|
CATH DXT 5 F JR35 100CM
|
Facility
|
IP
|
$41.25
|
|
| Hospital Charge Code |
270683018N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.19 |
| Max. Negotiated Rate |
$9.98 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.19
|
|
|
CATH DXT 5 F JR35 100CM
|
Facility
|
OP
|
$41.25
|
|
| Hospital Charge Code |
270683018
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$20.62 |
| Rate for Payer: Aetna Commercial |
$15.68
|
| Rate for Payer: Aetna Medicare Advantage |
$12.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.52
|
| Rate for Payer: Cigna Commercial |
$20.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.72
|
| Rate for Payer: Oxford Commercial |
$8.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.17
|
|
|
CATH DXT 5F JR40 100CM
|
Facility
|
IP
|
$41.25
|
|
| Hospital Charge Code |
270683021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.19 |
| Max. Negotiated Rate |
$6.19 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.19
|
|
|
CATH DXT 5F JR40 100CM
|
Facility
|
OP
|
$41.25
|
|
| Hospital Charge Code |
270683021N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$20.62 |
| Rate for Payer: Aetna Commercial |
$15.68
|
| Rate for Payer: Aetna Medicare Advantage |
$12.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.52
|
| Rate for Payer: Cigna Commercial |
$20.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.72
|
| Rate for Payer: Oxford Commercial |
$8.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.17
|
|
|
CATH DXT 5F JR40 100CM
|
Facility
|
IP
|
$41.25
|
|
| Hospital Charge Code |
270683021N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.19 |
| Max. Negotiated Rate |
$6.19 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.19
|
|
|
CATH DXT 5F JR40 100CM
|
Facility
|
OP
|
$41.25
|
|
| Hospital Charge Code |
270683021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$20.62 |
| Rate for Payer: Aetna Commercial |
$15.68
|
| Rate for Payer: Aetna Medicare Advantage |
$12.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.52
|
| Rate for Payer: Cigna Commercial |
$20.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.72
|
| Rate for Payer: Oxford Commercial |
$8.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.17
|
|
|
CATH DXT 5F PG145 110CM
|
Facility
|
OP
|
$41.25
|
|
| Hospital Charge Code |
270683023N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$20.62 |
| Rate for Payer: Aetna Commercial |
$15.68
|
| Rate for Payer: Aetna Medicare Advantage |
$12.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.52
|
| Rate for Payer: Cigna Commercial |
$20.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.72
|
| Rate for Payer: Oxford Commercial |
$8.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.17
|
|
|
CATH DXT 5F PG145 110CM
|
Facility
|
IP
|
$41.25
|
|
| Hospital Charge Code |
270683023N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.19 |
| Max. Negotiated Rate |
$6.19 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.19
|
|
|
CATH DXT 5F PG145 110CM
|
Facility
|
IP
|
$41.25
|
|
| Hospital Charge Code |
270683023
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.19 |
| Max. Negotiated Rate |
$6.19 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.19
|
|
|
CATH DXT 5F PG145 110CM
|
Facility
|
OP
|
$41.25
|
|
| Hospital Charge Code |
270683023
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$20.62 |
| Rate for Payer: Aetna Commercial |
$15.68
|
| Rate for Payer: Aetna Medicare Advantage |
$12.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.52
|
| Rate for Payer: Cigna Commercial |
$20.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.72
|
| Rate for Payer: Oxford Commercial |
$8.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.17
|
|
|
CATH DXT 6F JL35 100 CM
|
Facility
|
IP
|
$41.25
|
|
| Hospital Charge Code |
270683016N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.19 |
| Max. Negotiated Rate |
$6.19 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.19
|
|
|
CATH DXT 6F JL35 100 CM
|
Facility
|
OP
|
$41.25
|
|
| Hospital Charge Code |
270683016N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$20.62 |
| Rate for Payer: Aetna Commercial |
$15.68
|
| Rate for Payer: Aetna Medicare Advantage |
$12.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.52
|
| Rate for Payer: Cigna Commercial |
$20.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.72
|
| Rate for Payer: Oxford Commercial |
$8.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.17
|
|
|
CATH DXT 6F JL35 100 CM
|
Facility
|
OP
|
$41.25
|
|
| Hospital Charge Code |
270683016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$20.62 |
| Rate for Payer: Aetna Commercial |
$15.68
|
| Rate for Payer: Aetna Medicare Advantage |
$12.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.52
|
| Rate for Payer: Cigna Commercial |
$20.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.72
|
| Rate for Payer: Oxford Commercial |
$8.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.17
|
|
|
CATH DXT 6F JL35 100 CM
|
Facility
|
IP
|
$41.25
|
|
| Hospital Charge Code |
270683016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.19 |
| Max. Negotiated Rate |
$6.19 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.19
|
|
|
CATH DXT 6F JL 4.0 100 CM
|
Facility
|
OP
|
$41.25
|
|
| Hospital Charge Code |
270682882
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$20.62 |
| Rate for Payer: Aetna Commercial |
$15.68
|
| Rate for Payer: Aetna Medicare Advantage |
$12.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.52
|
| Rate for Payer: Cigna Commercial |
$20.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.72
|
| Rate for Payer: Oxford Commercial |
$8.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.17
|
|
|
CATH DXT 6F JL 4.0 100 CM
|
Facility
|
IP
|
$41.25
|
|
| Hospital Charge Code |
270682882
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.19 |
| Max. Negotiated Rate |
$6.19 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.19
|
|
|
CATH DXT 6F JL 4.0 100CM
|
Facility
|
OP
|
$41.25
|
|
| Hospital Charge Code |
270682882S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$20.62 |
| Rate for Payer: Aetna Commercial |
$15.68
|
| Rate for Payer: Aetna Medicare Advantage |
$12.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.52
|
| Rate for Payer: Cigna Commercial |
$20.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.72
|
| Rate for Payer: Oxford Commercial |
$8.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.17
|
|
|
CATH DXT 6F JL 4.0 100CM
|
Facility
|
IP
|
$41.25
|
|
| Hospital Charge Code |
270682882S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.19 |
| Max. Negotiated Rate |
$6.19 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.19
|
|
|
CATH DXT 6F JR35 100 CM
|
Facility
|
IP
|
$41.25
|
|
| Hospital Charge Code |
270683020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.19 |
| Max. Negotiated Rate |
$6.19 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.19
|
|
|
CATH DXT 6F JR35 100 CM
|
Facility
|
OP
|
$41.25
|
|
| Hospital Charge Code |
270683020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$20.62 |
| Rate for Payer: Aetna Commercial |
$15.68
|
| Rate for Payer: Aetna Medicare Advantage |
$12.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.52
|
| Rate for Payer: Cigna Commercial |
$20.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.72
|
| Rate for Payer: Oxford Commercial |
$8.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.17
|
|
|
CATH DXT 6F JR35 100 CM
|
Facility
|
IP
|
$41.25
|
|
| Hospital Charge Code |
270683020N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.19 |
| Max. Negotiated Rate |
$6.19 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.19
|
|
|
CATH DXT 6F JR35 100 CM
|
Facility
|
OP
|
$41.25
|
|
| Hospital Charge Code |
270683020N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$20.62 |
| Rate for Payer: Aetna Commercial |
$15.68
|
| Rate for Payer: Aetna Medicare Advantage |
$12.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.52
|
| Rate for Payer: Cigna Commercial |
$20.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.72
|
| Rate for Payer: Oxford Commercial |
$8.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.17
|
|
|
CATH DXT 6F JR 4.0 100 CM
|
Facility
|
OP
|
$41.25
|
|
| Hospital Charge Code |
270682881
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$20.62 |
| Rate for Payer: Aetna Commercial |
$15.68
|
| Rate for Payer: Aetna Medicare Advantage |
$12.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.52
|
| Rate for Payer: Cigna Commercial |
$20.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.72
|
| Rate for Payer: Oxford Commercial |
$8.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.17
|
|