|
CATH VERIPATH 7FR LIMA 50cm
|
Facility
|
OP
|
$575.00
|
|
| Hospital Charge Code |
270653086
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.86 |
| Max. Negotiated Rate |
$287.50 |
| Rate for Payer: Aetna Commercial |
$218.50
|
| Rate for Payer: Aetna Medicare Advantage |
$172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$146.62
|
| Rate for Payer: Cigna Commercial |
$287.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$126.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.24
|
|
|
CATH VERIPATH 7FR M/PURP 50cm
|
Facility
|
OP
|
$575.00
|
|
| Hospital Charge Code |
270653062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.86 |
| Max. Negotiated Rate |
$287.50 |
| Rate for Payer: Aetna Commercial |
$218.50
|
| Rate for Payer: Aetna Medicare Advantage |
$172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$146.62
|
| Rate for Payer: Cigna Commercial |
$287.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$126.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.24
|
|
|
CATH VERIPATH 7FR M/PURP 50cm
|
Facility
|
IP
|
$575.00
|
|
| Hospital Charge Code |
270653062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.25 |
| Max. Negotiated Rate |
$139.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$126.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
|
|
CATH VERIPATH 7FR RDC1 50cm
|
Facility
|
IP
|
$575.00
|
|
| Hospital Charge Code |
270653075
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.25 |
| Max. Negotiated Rate |
$139.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$126.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
|
|
CATH VERIPATH 7FR RDC1 50cm
|
Facility
|
OP
|
$575.00
|
|
| Hospital Charge Code |
270653075
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.86 |
| Max. Negotiated Rate |
$287.50 |
| Rate for Payer: Aetna Commercial |
$218.50
|
| Rate for Payer: Aetna Medicare Advantage |
$172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$146.62
|
| Rate for Payer: Cigna Commercial |
$287.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$126.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.24
|
|
|
CATH VERIPATH 7FR RDC 50cm
|
Facility
|
IP
|
$575.00
|
|
| Hospital Charge Code |
270653079
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.25 |
| Max. Negotiated Rate |
$139.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$126.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
|
|
CATH VERIPATH 7FR RDC 50cm
|
Facility
|
OP
|
$575.00
|
|
| Hospital Charge Code |
270653079
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.86 |
| Max. Negotiated Rate |
$287.50 |
| Rate for Payer: Aetna Commercial |
$218.50
|
| Rate for Payer: Aetna Medicare Advantage |
$172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$146.62
|
| Rate for Payer: Cigna Commercial |
$287.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$126.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.24
|
|
|
CATH VERIPATH 8FR H/STICK 50cm
|
Facility
|
IP
|
$575.00
|
|
| Hospital Charge Code |
270653092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.25 |
| Max. Negotiated Rate |
$139.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$126.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
|
|
CATH VERIPATH 8FR H/STICK 50cm
|
Facility
|
OP
|
$575.00
|
|
| Hospital Charge Code |
270653092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.86 |
| Max. Negotiated Rate |
$287.50 |
| Rate for Payer: Aetna Commercial |
$218.50
|
| Rate for Payer: Aetna Medicare Advantage |
$172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$146.62
|
| Rate for Payer: Cigna Commercial |
$287.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$126.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.24
|
|
|
CATH VERIPATH 8FR LIMA 50cm
|
Facility
|
OP
|
$575.00
|
|
| Hospital Charge Code |
270653088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.86 |
| Max. Negotiated Rate |
$287.50 |
| Rate for Payer: Aetna Commercial |
$218.50
|
| Rate for Payer: Aetna Medicare Advantage |
$172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$146.62
|
| Rate for Payer: Cigna Commercial |
$287.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$126.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.24
|
|
|
CATH VERIPATH 8FR LIMA 50cm
|
Facility
|
IP
|
$575.00
|
|
| Hospital Charge Code |
270653088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.25 |
| Max. Negotiated Rate |
$139.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$126.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
|
|
CATH VERIPATH 8FR M/PURP 50cm
|
Facility
|
OP
|
$575.00
|
|
| Hospital Charge Code |
270653069
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.86 |
| Max. Negotiated Rate |
$287.50 |
| Rate for Payer: Aetna Commercial |
$218.50
|
| Rate for Payer: Aetna Medicare Advantage |
$172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$146.62
|
| Rate for Payer: Cigna Commercial |
$287.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$126.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.24
|
|
|
CATH VERIPATH 8FR M/PURP 50cm
|
Facility
|
IP
|
$575.00
|
|
| Hospital Charge Code |
270653069
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.25 |
| Max. Negotiated Rate |
$139.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$126.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
|
|
CATH VERIPATH 8FR RDC1 50cm
|
Facility
|
IP
|
$575.00
|
|
| Hospital Charge Code |
270653077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.25 |
| Max. Negotiated Rate |
$139.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$126.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
|
|
CATH VERIPATH 8FR RDC1 50cm
|
Facility
|
OP
|
$575.00
|
|
| Hospital Charge Code |
270653077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.86 |
| Max. Negotiated Rate |
$287.50 |
| Rate for Payer: Aetna Commercial |
$218.50
|
| Rate for Payer: Aetna Medicare Advantage |
$172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$146.62
|
| Rate for Payer: Cigna Commercial |
$287.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$126.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.24
|
|
|
CATH VERIPATH 8FR RDC 50cm
|
Facility
|
IP
|
$575.00
|
|
| Hospital Charge Code |
270653084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.25 |
| Max. Negotiated Rate |
$139.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$126.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
|
|
CATH VERIPATH 8FR RDC 50cm
|
Facility
|
OP
|
$575.00
|
|
| Hospital Charge Code |
270653084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.86 |
| Max. Negotiated Rate |
$287.50 |
| Rate for Payer: Aetna Commercial |
$218.50
|
| Rate for Payer: Aetna Medicare Advantage |
$172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$146.62
|
| Rate for Payer: Cigna Commercial |
$287.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$126.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.24
|
|
|
CATH VERSA KATH EPIP 21G
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
HCPCS A4300
|
| Hospital Charge Code |
270638921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$54.75 |
| Max. Negotiated Rate |
$88.33 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$73.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$88.33
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$80.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.75
|
|
|
CATH VERSA KATH EPIP 21G
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
HCPCS A4300
|
| Hospital Charge Code |
270638921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$182.50 |
| Rate for Payer: Aetna Commercial |
$138.70
|
| Rate for Payer: Aetna Medicare Advantage |
$109.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$93.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$93.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$73.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$93.08
|
| Rate for Payer: Cigna Commercial |
$182.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$88.33
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$80.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.67
|
|
|
CATH VESSEL SIZING 5FR 65cm
|
Facility
|
OP
|
$452.55
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270624529
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$226.28 |
| Rate for Payer: Aetna Commercial |
$171.97
|
| Rate for Payer: Aetna Medicare Advantage |
$135.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$115.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$115.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$90.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$115.40
|
| Rate for Payer: Cigna Commercial |
$226.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$109.52
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$99.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.99
|
|
|
CATH VESSEL SIZING 5FR 65cm
|
Facility
|
IP
|
$452.55
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270624529
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.88 |
| Max. Negotiated Rate |
$109.52 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$90.51
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$109.52
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$99.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.88
|
|
|
CATH VIA 14+4x40 135 100818940
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270643584C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.75 |
| Max. Negotiated Rate |
$248.05 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$205.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$248.05
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$225.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.75
|
|
|
CATH VIA 14+4x40 135 100818940
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270643584C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$512.50 |
| Rate for Payer: Aetna Commercial |
$389.50
|
| Rate for Payer: Aetna Medicare Advantage |
$307.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$261.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$261.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$205.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$261.38
|
| Rate for Payer: Cigna Commercial |
$512.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$248.05
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$225.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.16
|
|
|
CATH VIA 14+6X20 135 100819720
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270635817C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$512.50 |
| Rate for Payer: Aetna Commercial |
$389.50
|
| Rate for Payer: Aetna Medicare Advantage |
$307.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$261.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$261.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$205.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$261.38
|
| Rate for Payer: Cigna Commercial |
$512.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$248.05
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$225.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.16
|
|
|
CATH VIA 14+6X20 135 100819720
|
Facility
|
IP
|
$1,425.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270635817N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$213.75 |
| Max. Negotiated Rate |
$344.85 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$285.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$344.85
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$313.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$213.75
|
|