|
CORNEA TISSUE
|
Facility
|
IP
|
$15,500.00
|
|
| Hospital Charge Code |
270661141
|
|
Hospital Revenue Code
|
810
|
| Min. Negotiated Rate |
$2,325.00 |
| Max. Negotiated Rate |
$2,325.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,325.00
|
|
|
CORNEA TISSUE
|
Facility
|
OP
|
$15,500.00
|
|
| Hospital Charge Code |
270661154
|
|
Hospital Revenue Code
|
810
|
| Min. Negotiated Rate |
$373.55 |
| Max. Negotiated Rate |
$7,750.00 |
| Rate for Payer: Aetna Commercial |
$5,890.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,952.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,952.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,952.50
|
| Rate for Payer: Cigna Commercial |
$7,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,650.00
|
| Rate for Payer: Oxford Commercial |
$3,100.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,325.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,100.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$373.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$410.75
|
|
|
CORNEA TISSUE
|
Facility
|
OP
|
$15,500.00
|
|
| Hospital Charge Code |
270661141
|
|
Hospital Revenue Code
|
810
|
| Min. Negotiated Rate |
$373.55 |
| Max. Negotiated Rate |
$7,750.00 |
| Rate for Payer: Aetna Commercial |
$5,890.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,952.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,952.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,952.50
|
| Rate for Payer: Cigna Commercial |
$7,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,650.00
|
| Rate for Payer: Oxford Commercial |
$3,100.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,325.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,100.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$373.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$410.75
|
|
|
CORNEA TISSUE
|
Facility
|
OP
|
$19,000.00
|
|
| Hospital Charge Code |
270663595
|
|
Hospital Revenue Code
|
810
|
| Min. Negotiated Rate |
$457.90 |
| Max. Negotiated Rate |
$9,500.00 |
| Rate for Payer: Aetna Commercial |
$7,220.00
|
| Rate for Payer: Aetna Medicare Advantage |
$5,700.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,845.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,845.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,845.00
|
| Rate for Payer: Cigna Commercial |
$9,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,700.00
|
| Rate for Payer: Oxford Commercial |
$3,800.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,850.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,800.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$457.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$503.50
|
|
|
CORNEA TISSUE
|
Facility
|
OP
|
$16,000.00
|
|
|
Service Code
|
HCPCS V2785
|
| Hospital Charge Code |
270671570
|
|
Hospital Revenue Code
|
810
|
| Min. Negotiated Rate |
$385.60 |
| Max. Negotiated Rate |
$8,000.00 |
| Rate for Payer: Aetna Commercial |
$6,080.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,080.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,080.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,080.00
|
| Rate for Payer: Cigna Commercial |
$8,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,800.00
|
| Rate for Payer: Oxford Commercial |
$3,200.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,400.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,200.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$385.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$424.00
|
|
|
CORNER CHISEL TMT RAPID RELEAS
|
Facility
|
OP
|
$2,750.00
|
|
| Hospital Charge Code |
270704360
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.28 |
| Max. Negotiated Rate |
$1,375.00 |
| Rate for Payer: Aetna Commercial |
$1,045.00
|
| Rate for Payer: Aetna Medicare Advantage |
$825.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$701.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$701.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$701.25
|
| Rate for Payer: Cigna Commercial |
$1,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$825.00
|
| Rate for Payer: Oxford Commercial |
$550.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$412.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$550.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$66.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$72.88
|
|
|
CORNER CHISEL TMT RAPID RELEAS
|
Facility
|
IP
|
$2,750.00
|
|
| Hospital Charge Code |
270704360
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$412.50 |
| Max. Negotiated Rate |
$412.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$412.50
|
|
|
COROENT LARGE 9X9X28.8 DEGREES
|
Facility
|
IP
|
$26,660.00
|
|
| Hospital Charge Code |
270663771
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3,999.00 |
| Max. Negotiated Rate |
$3,999.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,999.00
|
|
|
COROENT LARGE 9X9X28.8 DEGREES
|
Facility
|
OP
|
$26,660.00
|
|
| Hospital Charge Code |
270663771
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$642.51 |
| Max. Negotiated Rate |
$13,330.00 |
| Rate for Payer: Aetna Commercial |
$10,130.80
|
| Rate for Payer: Aetna Medicare Advantage |
$7,998.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,798.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,798.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,798.30
|
| Rate for Payer: Cigna Commercial |
$13,330.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,998.00
|
| Rate for Payer: Oxford Commercial |
$5,332.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,999.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,332.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$642.51
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$706.49
|
|
|
COROENT LARGE MP 9x9x23 4 DEG
|
Facility
|
IP
|
$26,660.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,999.00 |
| Max. Negotiated Rate |
$6,451.72 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,332.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,451.72
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,865.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,999.00
|
|
|
COROENT LARGE MP 9x9x23 4 DEG
|
Facility
|
OP
|
$26,660.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$642.51 |
| Max. Negotiated Rate |
$13,330.00 |
| Rate for Payer: Aetna Commercial |
$10,130.80
|
| Rate for Payer: Aetna Medicare Advantage |
$7,998.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,798.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,798.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,332.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,798.30
|
| Rate for Payer: Cigna Commercial |
$13,330.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,451.72
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,865.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,999.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$642.51
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$706.49
|
|
|
COROENT LARGE MP TI 10X9X23 MM
|
Facility
|
OP
|
$44,525.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270691452
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,073.05 |
| Max. Negotiated Rate |
$22,262.50 |
| Rate for Payer: Aetna Commercial |
$16,919.50
|
| Rate for Payer: Aetna Medicare Advantage |
$13,357.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11,353.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11,353.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8,905.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$11,353.88
|
| Rate for Payer: Cigna Commercial |
$22,262.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10,775.05
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$9,795.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,678.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,073.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,179.91
|
|
|
COROENT LARGE MP TI 10X9X23 MM
|
Facility
|
IP
|
$44,525.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270691452
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,678.75 |
| Max. Negotiated Rate |
$10,775.05 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8,905.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10,775.05
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$9,795.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,678.75
|
|
|
COROENT LC 14x1x25.8
|
Facility
|
OP
|
$24,955.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270676534
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$601.42 |
| Max. Negotiated Rate |
$12,477.50 |
| Rate for Payer: Aetna Commercial |
$9,482.90
|
| Rate for Payer: Aetna Medicare Advantage |
$7,486.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,363.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,363.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,991.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,363.52
|
| Rate for Payer: Cigna Commercial |
$12,477.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,039.11
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,490.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,743.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$601.42
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$661.31
|
|
|
COROENT LC 14x1x25.8
|
Facility
|
IP
|
$24,955.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270676534
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,743.25 |
| Max. Negotiated Rate |
$6,039.11 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,991.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,039.11
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,490.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,743.25
|
|
|
COROENT SI SCRW 4X13MM SELFTAP
|
Facility
|
OP
|
$2,775.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.88 |
| Max. Negotiated Rate |
$1,387.50 |
| Rate for Payer: Aetna Commercial |
$1,054.50
|
| Rate for Payer: Aetna Medicare Advantage |
$832.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$707.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$707.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$555.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$707.62
|
| Rate for Payer: Cigna Commercial |
$1,387.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$671.55
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$610.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$416.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$66.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$73.54
|
|
|
COROENT SI SCRW 4X13MM SELFTAP
|
Facility
|
IP
|
$2,775.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$416.25 |
| Max. Negotiated Rate |
$671.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$555.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$671.55
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$610.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$416.25
|
|
|
COROENT SM 5X11X14MM 5D LORD
|
Facility
|
IP
|
$9,075.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
270693073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,361.25 |
| Max. Negotiated Rate |
$2,196.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,815.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,196.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,996.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,361.25
|
|
|
COROENT SM 5X11X14MM 5D LORD
|
Facility
|
OP
|
$9,075.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
270693073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$218.71 |
| Max. Negotiated Rate |
$4,537.50 |
| Rate for Payer: Aetna Commercial |
$3,448.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,722.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,314.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,314.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,815.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,314.12
|
| Rate for Payer: Cigna Commercial |
$4,537.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,196.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,996.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,361.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$218.71
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$240.49
|
|
|
COROENT SM INTERLK 7X17X14MM7D
|
Facility
|
OP
|
$17,495.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
270692884
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$421.63 |
| Max. Negotiated Rate |
$8,747.50 |
| Rate for Payer: Aetna Commercial |
$6,648.10
|
| Rate for Payer: Aetna Medicare Advantage |
$5,248.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,461.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,461.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,499.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,461.23
|
| Rate for Payer: Cigna Commercial |
$8,747.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,233.79
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,848.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,624.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$421.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$463.62
|
|
|
COROENT SM INTERLK 7X17X14MM7D
|
Facility
|
IP
|
$17,495.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
270692884
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,624.25 |
| Max. Negotiated Rate |
$4,233.79 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,499.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,233.79
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,848.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,624.25
|
|
|
CORONARY ANGIO INJ
|
Facility
|
OP
|
$25,737.16
|
|
|
Service Code
|
HCPCS 93454
|
| Hospital Charge Code |
74110019
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$620.27 |
| Max. Negotiated Rate |
$13,902.76 |
| Rate for Payer: Aetna Commercial |
$10,476.08
|
| Rate for Payer: Aetna Medicare Advantage |
$12,478.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,902.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,902.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,851.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,194.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,902.76
|
| Rate for Payer: Cigna Commercial |
$7,720.31
|
| Rate for Payer: Cigna Medicare Advantage |
$3,851.50
|
| Rate for Payer: Clover Medicare Advantage |
$3,658.93
|
| Rate for Payer: EmblemHealth Commercial |
$11,554.50
|
| Rate for Payer: Humana Medicare Advantage |
$3,967.05
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,851.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,721.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$6,600.00
|
| Rate for Payer: Oxford Commercial |
$7,559.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,860.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$12,870.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$620.27
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,851.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,851.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$682.03
|
|
|
CORONARY ANGIO INJ
|
Facility
|
IP
|
$25,737.16
|
|
|
Service Code
|
HCPCS 93454
|
| Hospital Charge Code |
5100177
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,860.57 |
| Max. Negotiated Rate |
$3,860.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,860.57
|
|
|
CORONARY ANGIO INJ
|
Facility
|
OP
|
$25,737.16
|
|
|
Service Code
|
HCPCS 93454
|
| Hospital Charge Code |
5100177
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$620.27 |
| Max. Negotiated Rate |
$13,902.76 |
| Rate for Payer: Aetna Commercial |
$10,476.08
|
| Rate for Payer: Aetna Medicare Advantage |
$12,478.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,902.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,902.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,851.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,194.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,902.76
|
| Rate for Payer: Cigna Commercial |
$7,720.31
|
| Rate for Payer: Cigna Medicare Advantage |
$3,851.50
|
| Rate for Payer: Clover Medicare Advantage |
$3,658.93
|
| Rate for Payer: EmblemHealth Commercial |
$11,554.50
|
| Rate for Payer: Humana Medicare Advantage |
$3,967.05
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,851.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,721.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$6,600.00
|
| Rate for Payer: Oxford Commercial |
$7,559.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,860.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$12,870.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$620.27
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,851.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,851.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$682.03
|
|
|
CORONARY ANGIO INJ
|
Facility
|
IP
|
$25,737.16
|
|
|
Service Code
|
HCPCS 93454
|
| Hospital Charge Code |
74110019
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,860.57 |
| Max. Negotiated Rate |
$3,860.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,860.57
|
|