|
CATH POWERMIDLINE PICC KT 4FR
|
Facility
|
OP
|
$865.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270684375N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.85 |
| Max. Negotiated Rate |
$432.50 |
| Rate for Payer: Aetna Commercial |
$328.70
|
| Rate for Payer: Aetna Medicare Advantage |
$259.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$220.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$220.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$173.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$220.57
|
| Rate for Payer: Cigna Commercial |
$432.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$209.33
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$190.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$129.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$22.92
|
|
|
CATH POWERMIDLINE PICC KT 4FR
|
Facility
|
IP
|
$865.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270684375N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.75 |
| Max. Negotiated Rate |
$209.33 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$173.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$209.33
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$190.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$129.75
|
|
|
CATH POWER PICC 4FR SNGL 135CM
|
Facility
|
IP
|
$518.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270675028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.78 |
| Max. Negotiated Rate |
$125.48 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$103.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.48
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$114.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.78
|
|
|
CATH POWER PICC 4FR SNGL 135CM
|
Facility
|
OP
|
$518.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270675028S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$259.25 |
| Rate for Payer: Aetna Commercial |
$197.03
|
| Rate for Payer: Aetna Medicare Advantage |
$155.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$132.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$132.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$103.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$132.22
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.48
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$114.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.78
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.74
|
|
|
CATH POWER PICC 4FR SNGL 135CM
|
Facility
|
IP
|
$518.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270675028S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.78 |
| Max. Negotiated Rate |
$125.48 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$103.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.48
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$114.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.78
|
|
|
CATH POWER PICC 4FR SNGL 135CM
|
Facility
|
IP
|
$518.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270675028N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.78 |
| Max. Negotiated Rate |
$125.48 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$103.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.48
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$114.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.78
|
|
|
CATH POWER PICC 4FR SNGL 135CM
|
Facility
|
OP
|
$518.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270675028N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$259.25 |
| Rate for Payer: Aetna Commercial |
$197.03
|
| Rate for Payer: Aetna Medicare Advantage |
$155.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$132.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$132.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$103.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$132.22
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.48
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$114.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.78
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.74
|
|
|
CATH POWER PICC 4FR SNGL 135CM
|
Facility
|
OP
|
$518.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270675028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$259.25 |
| Rate for Payer: Aetna Commercial |
$197.03
|
| Rate for Payer: Aetna Medicare Advantage |
$155.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$132.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$132.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$103.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$132.22
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.48
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$114.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.78
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.74
|
|
|
CATH POWER PICC 4FR SNGL 70CM
|
Facility
|
OP
|
$518.50
|
|
| Hospital Charge Code |
270677809
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$259.25 |
| Rate for Payer: Aetna Commercial |
$197.03
|
| Rate for Payer: Aetna Medicare Advantage |
$155.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$132.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$132.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$103.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$132.22
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.48
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$114.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.78
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.74
|
|
|
CATH POWER PICC 4FR SNGL 70CM
|
Facility
|
IP
|
$518.50
|
|
| Hospital Charge Code |
270677809
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.78 |
| Max. Negotiated Rate |
$125.48 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$103.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.48
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$114.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.78
|
|
|
CATH POWER PICC 5FR DUAL 135CM
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270644329S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$125.84 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$104.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.84
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$114.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.00
|
|
|
CATH POWER PICC 5FR DUAL 135CM
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270644329S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Aetna Commercial |
$197.60
|
| Rate for Payer: Aetna Medicare Advantage |
$156.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$132.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$132.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$104.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$132.60
|
| Rate for Payer: Cigna Commercial |
$260.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.84
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$114.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.78
|
|
|
CATH POWER PICC 5FR DUAL 135CM
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270644329N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$125.84 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$104.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.84
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$114.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.00
|
|
|
CATH POWER PICC 5FR DUAL 135CM
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270644329N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Aetna Commercial |
$197.60
|
| Rate for Payer: Aetna Medicare Advantage |
$156.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$132.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$132.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$104.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$132.60
|
| Rate for Payer: Cigna Commercial |
$260.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.84
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$114.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.78
|
|
|
CATH POWER PICC 5FR DUAL 135CM
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270644329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Aetna Commercial |
$197.60
|
| Rate for Payer: Aetna Medicare Advantage |
$156.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$132.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$132.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$104.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$132.60
|
| Rate for Payer: Cigna Commercial |
$260.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.84
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$114.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.78
|
|
|
CATH POWER PICC 5FR DUAL 135CM
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270644329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$125.84 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$104.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.84
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$114.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.00
|
|
|
CATH POWER PICC 5FR DUAL 70CM
|
Facility
|
OP
|
$520.00
|
|
| Hospital Charge Code |
270662310
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Aetna Commercial |
$197.60
|
| Rate for Payer: Aetna Medicare Advantage |
$156.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$132.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$132.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$104.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$132.60
|
| Rate for Payer: Cigna Commercial |
$260.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.84
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$114.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.78
|
|
|
CATH POWER PICC 5FR DUAL 70CM
|
Facility
|
IP
|
$520.00
|
|
| Hospital Charge Code |
270662310
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$125.84 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$104.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.84
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$114.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.00
|
|
|
CATH POWER PICC SOLO D/LUM 5FR
|
Facility
|
OP
|
$1,169.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270649055N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.18 |
| Max. Negotiated Rate |
$584.75 |
| Rate for Payer: Aetna Commercial |
$444.41
|
| Rate for Payer: Aetna Medicare Advantage |
$350.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$298.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$298.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$233.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$298.22
|
| Rate for Payer: Cigna Commercial |
$584.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$283.02
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$257.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$175.43
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$30.99
|
|
|
CATH POWER PICC SOLO D/LUM 5FR
|
Facility
|
IP
|
$1,169.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270649055N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.43 |
| Max. Negotiated Rate |
$283.02 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$233.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$283.02
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$257.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$175.43
|
|
|
CATH POWER PICC SOLO D/LUM 5FR
|
Facility
|
OP
|
$1,169.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270649055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.18 |
| Max. Negotiated Rate |
$584.75 |
| Rate for Payer: Aetna Commercial |
$444.41
|
| Rate for Payer: Aetna Medicare Advantage |
$350.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$298.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$298.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$233.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$298.22
|
| Rate for Payer: Cigna Commercial |
$584.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$283.02
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$257.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$175.43
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$30.99
|
|
|
CATH POWER PICC SOLO D/LUM 5FR
|
Facility
|
IP
|
$1,169.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270649055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.43 |
| Max. Negotiated Rate |
$283.02 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$233.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$283.02
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$257.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$175.43
|
|
|
CATH POWER PICC SOLO S/LUM 4FR
|
Facility
|
IP
|
$1,111.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270649056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$166.65 |
| Max. Negotiated Rate |
$268.86 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$222.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$268.86
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$244.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$166.65
|
|
|
CATH POWER PICC SOLO S/LUM 4FR
|
Facility
|
OP
|
$1,111.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270649056S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$555.50 |
| Rate for Payer: Aetna Commercial |
$422.18
|
| Rate for Payer: Aetna Medicare Advantage |
$333.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$283.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$283.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$222.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$283.31
|
| Rate for Payer: Cigna Commercial |
$555.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$268.86
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$244.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$166.65
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.78
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.44
|
|
|
CATH POWER PICC SOLO S/LUM 4FR
|
Facility
|
OP
|
$1,111.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270649056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$555.50 |
| Rate for Payer: Aetna Commercial |
$422.18
|
| Rate for Payer: Aetna Medicare Advantage |
$333.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$283.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$283.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$222.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$283.31
|
| Rate for Payer: Cigna Commercial |
$555.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$268.86
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$244.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$166.65
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.78
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.44
|
|