|
CATH LAD 3.5 7FR 77806000
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636383
|
|
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: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$52.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.00
|
|
|
CATH LAD 3.5 7FR 77806000
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.78 |
| 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: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$52.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.78
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.36
|
|
|
CATH LAD 3.5 7FR 77806000
|
Facility
|
OP
|
$277.70
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636383N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.69 |
| Max. Negotiated Rate |
$138.85 |
| Rate for Payer: Aetna Commercial |
$105.53
|
| 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: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$61.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.66
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.69
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.36
|
|
|
CATH LAD 3.5 7FR 77806000
|
Facility
|
IP
|
$277.70
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270636383N
|
|
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: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$61.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.66
|
|
|
CATH LAPROSCOPIC 18g 11
|
Facility
|
IP
|
$145.00
|
|
| Hospital Charge Code |
270658591
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.75 |
| Max. Negotiated Rate |
$21.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.75
|
|
|
CATH LAPROSCOPIC 18g 11
|
Facility
|
OP
|
$145.00
|
|
| Hospital Charge Code |
270658591
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$72.50 |
| Rate for Payer: Aetna Commercial |
$55.10
|
| Rate for Payer: Aetna Medicare Advantage |
$43.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$36.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$36.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$36.98
|
| Rate for Payer: Cigna Commercial |
$72.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$43.50
|
| Rate for Payer: Oxford Commercial |
$29.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$29.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.84
|
|
|
CATH LAPRSC CHOLNGRPY SET ****
|
Facility
|
IP
|
$309.00
|
|
| Hospital Charge Code |
1604610
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.35 |
| Max. Negotiated Rate |
$46.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.35
|
|
|
CATH LAPRSC CHOLNGRPY SET ****
|
Facility
|
OP
|
$309.00
|
|
| Hospital Charge Code |
1604610
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.45 |
| Max. Negotiated Rate |
$154.50 |
| Rate for Payer: Aetna Commercial |
$117.42
|
| Rate for Payer: Aetna Medicare Advantage |
$92.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$78.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$78.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$78.80
|
| Rate for Payer: Cigna Commercial |
$154.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$92.70
|
| Rate for Payer: Oxford Commercial |
$61.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$61.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.45
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.19
|
|
|
CATH LASER GUIDE 2.0x7FR TURBO
|
Facility
|
OP
|
$12,500.00
|
|
| Hospital Charge Code |
270646807
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$301.25 |
| Max. Negotiated Rate |
$6,250.00 |
| Rate for Payer: Aetna Commercial |
$4,750.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,187.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,187.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,187.50
|
| Rate for Payer: Cigna Commercial |
$6,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,750.00
|
| Rate for Payer: Oxford Commercial |
$2,500.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,875.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,500.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$301.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$331.25
|
|
|
CATH LASER GUIDE 2.0x7FR TURBO
|
Facility
|
IP
|
$12,500.00
|
|
| Hospital Charge Code |
270646807
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$1,875.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,875.00
|
|
|
CATH LAUNCHER 7FR EBU 3.5
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270645940
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$85.50
|
| Rate for Payer: Aetna Medicare Advantage |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.38
|
| Rate for Payer: Cigna Commercial |
$112.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.45
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$49.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.42
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.96
|
|
|
CATH LAUNCHER 7FR EBU 3.5
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270645940
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$54.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.45
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$49.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
CATH LAUNCHER IMA 6FR 55cm
|
Facility
|
IP
|
$245.00
|
|
| Hospital Charge Code |
270645686C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$59.29 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$49.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.29
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$53.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
|
|
CATH LAUNCHER IMA 6FR 55cm
|
Facility
|
OP
|
$245.00
|
|
| Hospital Charge Code |
270645686C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$122.50 |
| Rate for Payer: Aetna Commercial |
$93.10
|
| Rate for Payer: Aetna Medicare Advantage |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$62.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$62.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$49.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$62.48
|
| Rate for Payer: Cigna Commercial |
$122.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.29
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$53.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.49
|
|
|
CATH LAUNCHER IMA 6FR 55cm
|
Facility
|
IP
|
$245.00
|
|
| Hospital Charge Code |
270645686
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$59.29 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$49.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.29
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$53.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
|
|
CATH LAUNCHER IMA 6FR 55cm
|
Facility
|
OP
|
$245.00
|
|
| Hospital Charge Code |
270645686
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$122.50 |
| Rate for Payer: Aetna Commercial |
$93.10
|
| Rate for Payer: Aetna Medicare Advantage |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$62.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$62.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$49.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$62.48
|
| Rate for Payer: Cigna Commercial |
$122.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.29
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$53.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.49
|
|
|
CATH LAUNCHER PK1 6FR 47cm
|
Facility
|
OP
|
$245.00
|
|
| Hospital Charge Code |
270645462C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$122.50 |
| Rate for Payer: Aetna Commercial |
$93.10
|
| Rate for Payer: Aetna Medicare Advantage |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$62.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$62.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$49.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$62.48
|
| Rate for Payer: Cigna Commercial |
$122.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.29
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$53.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.49
|
|
|
CATH LAUNCHER PK1 6FR 47cm
|
Facility
|
IP
|
$245.00
|
|
| Hospital Charge Code |
270645462C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$59.29 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$49.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.29
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$53.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
|
|
CATH LAUNCHER PK1 7FR 47cm
|
Facility
|
OP
|
$245.00
|
|
| Hospital Charge Code |
270645473C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$122.50 |
| Rate for Payer: Aetna Commercial |
$93.10
|
| Rate for Payer: Aetna Medicare Advantage |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$62.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$62.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$49.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$62.48
|
| Rate for Payer: Cigna Commercial |
$122.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.29
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$53.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.49
|
|
|
CATH LAUNCHER PK1 7FR 47cm
|
Facility
|
IP
|
$245.00
|
|
| Hospital Charge Code |
270645473C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$59.29 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$49.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.29
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$53.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
|
|
CATH LAUNCHER RDC 6FR 55cm
|
Facility
|
IP
|
$245.00
|
|
| Hospital Charge Code |
270645468C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$59.29 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$49.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.29
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$53.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
|
|
CATH LAUNCHER RDC 6FR 55cm
|
Facility
|
OP
|
$245.00
|
|
| Hospital Charge Code |
270645468C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$122.50 |
| Rate for Payer: Aetna Commercial |
$93.10
|
| Rate for Payer: Aetna Medicare Advantage |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$62.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$62.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$49.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$62.48
|
| Rate for Payer: Cigna Commercial |
$122.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.29
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$53.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.49
|
|
|
CATH LAUNCHER RDC 7FR 55cm
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270645469C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$54.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.45
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$49.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
CATH LAUNCHER RDC 7FR 55cm
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270645469C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$85.50
|
| Rate for Payer: Aetna Medicare Advantage |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.38
|
| Rate for Payer: Cigna Commercial |
$112.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.45
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$49.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.42
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.96
|
|
|
CATH LIFEPORT DT 8.4FR LPS7513
|
Facility
|
OP
|
$1,165.65
|
|
| Hospital Charge Code |
270636940
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.09 |
| Max. Negotiated Rate |
$582.83 |
| Rate for Payer: Aetna Commercial |
$442.95
|
| Rate for Payer: Aetna Medicare Advantage |
$349.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$297.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$297.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$233.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$297.24
|
| Rate for Payer: Cigna Commercial |
$582.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$282.09
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$256.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$174.85
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$30.89
|
|