|
GRAFT STENT ILIAC 14X14120
|
Facility
|
IP
|
$28,495.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270690574
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,274.25 |
| Max. Negotiated Rate |
$6,895.79 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,699.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,895.79
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$6,268.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,274.25
|
|
|
GRAFT STENT ILIAC 14X16X160MM
|
Facility
|
IP
|
$28,495.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270690576
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,274.25 |
| Max. Negotiated Rate |
$6,895.79 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,699.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,895.79
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$6,268.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,274.25
|
|
|
GRAFT STENT ILIAC 14X16X160MM
|
Facility
|
OP
|
$28,495.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270690576
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$686.73 |
| Max. Negotiated Rate |
$14,247.50 |
| Rate for Payer: Aetna Commercial |
$10,828.10
|
| Rate for Payer: Aetna Medicare Advantage |
$8,548.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,266.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,266.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,699.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,266.23
|
| Rate for Payer: Cigna Commercial |
$14,247.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,895.79
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$6,268.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,274.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$686.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$755.12
|
|
|
GRAFT STENT ILIAC LIMB14X10X16
|
Facility
|
IP
|
$28,495.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270690575
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,274.25 |
| Max. Negotiated Rate |
$6,895.79 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,699.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,895.79
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$6,268.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,274.25
|
|
|
GRAFT STENT ILIAC LIMB14X10X16
|
Facility
|
OP
|
$28,495.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270690575
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$686.73 |
| Max. Negotiated Rate |
$14,247.50 |
| Rate for Payer: Aetna Commercial |
$10,828.10
|
| Rate for Payer: Aetna Medicare Advantage |
$8,548.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,266.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,266.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,699.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,266.23
|
| Rate for Payer: Cigna Commercial |
$14,247.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,895.79
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$6,268.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,274.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$686.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$755.12
|
|
|
GRAFT STENT MAIN BODY 40x120
|
Facility
|
OP
|
$65,795.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
270686385
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,585.66 |
| Max. Negotiated Rate |
$32,897.50 |
| Rate for Payer: Aetna Commercial |
$25,002.10
|
| Rate for Payer: Aetna Medicare Advantage |
$19,738.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$16,777.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$16,777.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13,159.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$16,777.72
|
| Rate for Payer: Cigna Commercial |
$32,897.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15,922.39
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$14,474.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9,869.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,585.66
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,743.57
|
|
|
GRAFT STENT MAIN BODY 40x120
|
Facility
|
IP
|
$65,795.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
270686385
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,869.25 |
| Max. Negotiated Rate |
$15,922.39 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13,159.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15,922.39
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$14,474.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9,869.25
|
|
|
GRAFT STENT MAIN BODY 40x120
|
Facility
|
OP
|
$65,795.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
270686385C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,585.66 |
| Max. Negotiated Rate |
$32,897.50 |
| Rate for Payer: Aetna Commercial |
$25,002.10
|
| Rate for Payer: Aetna Medicare Advantage |
$19,738.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$16,777.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$16,777.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13,159.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$16,777.72
|
| Rate for Payer: Cigna Commercial |
$32,897.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15,922.39
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$14,474.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9,869.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,585.66
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,743.57
|
|
|
GRAFT STENT MAIN BODY 40x120
|
Facility
|
IP
|
$65,795.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
270686385C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,869.25 |
| Max. Negotiated Rate |
$15,922.39 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13,159.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15,922.39
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$14,474.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9,869.25
|
|
|
GRAFT STRETCH 4-6mm 45cm
|
Facility
|
OP
|
$3,110.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
270601149
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.95 |
| Max. Negotiated Rate |
$1,555.00 |
| Rate for Payer: Aetna Commercial |
$1,181.80
|
| Rate for Payer: Aetna Medicare Advantage |
$933.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$793.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$793.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$622.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$793.05
|
| Rate for Payer: Cigna Commercial |
$1,555.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$752.62
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$684.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$466.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$74.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$82.42
|
|
|
GRAFT STRETCH 4-6mm 45cm
|
Facility
|
IP
|
$3,110.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
270601149
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$466.50 |
| Max. Negotiated Rate |
$752.62 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$622.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$752.62
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$684.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$466.50
|
|
|
GRAFT STRETCH 4-7MM 40CM
|
Facility
|
OP
|
$2,885.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
270691573
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.53 |
| Max. Negotiated Rate |
$1,442.50 |
| Rate for Payer: Aetna Commercial |
$1,096.30
|
| Rate for Payer: Aetna Medicare Advantage |
$865.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$735.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$735.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$577.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$735.67
|
| Rate for Payer: Cigna Commercial |
$1,442.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$698.17
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$634.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$432.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$69.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$76.45
|
|
|
GRAFT STRETCH 4-7MM 40CM
|
Facility
|
IP
|
$2,885.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
270691573
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$432.75 |
| Max. Negotiated Rate |
$698.17 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$577.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$698.17
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$634.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$432.75
|
|
|
GRAFT STRETCH 4-7mm 45cm
|
Facility
|
OP
|
$3,110.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
270605300
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.95 |
| Max. Negotiated Rate |
$1,555.00 |
| Rate for Payer: Aetna Commercial |
$1,181.80
|
| Rate for Payer: Aetna Medicare Advantage |
$933.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$793.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$793.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$622.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$793.05
|
| Rate for Payer: Cigna Commercial |
$1,555.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$752.62
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$684.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$466.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$74.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$82.42
|
|
|
GRAFT STRETCH 4-7mm 45cm
|
Facility
|
IP
|
$3,110.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
270605300
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$466.50 |
| Max. Negotiated Rate |
$752.62 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$622.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$752.62
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$684.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$466.50
|
|
|
GRAFT STRETCH 6mm 40cm
|
Facility
|
IP
|
$2,655.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
270601128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$398.25 |
| Max. Negotiated Rate |
$642.51 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$531.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$642.51
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$584.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$398.25
|
|
|
GRAFT STRETCH 6mm 40cm
|
Facility
|
OP
|
$2,655.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
270601128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.99 |
| Max. Negotiated Rate |
$1,327.50 |
| Rate for Payer: Aetna Commercial |
$1,008.90
|
| Rate for Payer: Aetna Medicare Advantage |
$796.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$677.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$677.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$531.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$677.02
|
| Rate for Payer: Cigna Commercial |
$1,327.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$642.51
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$584.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$398.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$63.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$70.36
|
|
|
GRAFT STRETCH 6MMX40CM
|
Facility
|
OP
|
$2,555.00
|
|
| Hospital Charge Code |
270654642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$61.58 |
| Max. Negotiated Rate |
$1,277.50 |
| Rate for Payer: Aetna Commercial |
$970.90
|
| Rate for Payer: Aetna Medicare Advantage |
$766.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$651.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$651.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$511.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$651.52
|
| Rate for Payer: Cigna Commercial |
$1,277.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$618.31
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$562.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$383.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$61.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$67.71
|
|
|
GRAFT STRETCH 6MMX40CM
|
Facility
|
IP
|
$2,555.00
|
|
| Hospital Charge Code |
270654642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$383.25 |
| Max. Negotiated Rate |
$618.31 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$511.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$618.31
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$562.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$383.25
|
|
|
GRAFT STR TBS HMDVS 6 6 095206
|
Facility
|
IP
|
$2,689.65
|
|
| Hospital Charge Code |
270630283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$403.45 |
| Max. Negotiated Rate |
$650.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$537.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$650.90
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$591.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$403.45
|
|
|
GRAFT STR TBS HMDVS 6 6 095206
|
Facility
|
OP
|
$2,689.65
|
|
| Hospital Charge Code |
270630283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$64.82 |
| Max. Negotiated Rate |
$1,344.83 |
| Rate for Payer: Aetna Commercial |
$1,022.07
|
| Rate for Payer: Aetna Medicare Advantage |
$806.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$685.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$685.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$537.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$685.86
|
| Rate for Payer: Cigna Commercial |
$1,344.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$650.90
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$591.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$403.45
|
| Rate for Payer: UnitedHealthcare Community & State |
$64.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$71.28
|
|
|
GRAFT SURGICAL 19x28cm XENMAT-
|
Facility
|
IP
|
$103,989.87
|
|
| Hospital Charge Code |
270646489
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15,598.48 |
| Max. Negotiated Rate |
$25,165.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$20,797.97
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$25,165.55
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$22,877.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15,598.48
|
|
|
GRAFT SURGICAL 19x28cm XENMAT-
|
Facility
|
OP
|
$103,989.87
|
|
| Hospital Charge Code |
270646489
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,506.16 |
| Max. Negotiated Rate |
$51,994.93 |
| Rate for Payer: Aetna Commercial |
$39,516.15
|
| Rate for Payer: Aetna Medicare Advantage |
$31,196.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$26,517.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$26,517.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$20,797.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$26,517.42
|
| Rate for Payer: Cigna Commercial |
$51,994.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$25,165.55
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$22,877.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15,598.48
|
| Rate for Payer: UnitedHealthcare Community & State |
$2,506.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2,755.73
|
|
|
GRAFT SURGIS GLD HERNIA 276887
|
Facility
|
OP
|
$4,630.00
|
|
| Hospital Charge Code |
270630129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.58 |
| Max. Negotiated Rate |
$2,315.00 |
| Rate for Payer: Aetna Commercial |
$1,759.40
|
| Rate for Payer: Aetna Medicare Advantage |
$1,389.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,180.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,180.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$926.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,180.65
|
| Rate for Payer: Cigna Commercial |
$2,315.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,120.46
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,018.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$694.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$111.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$122.69
|
|
|
GRAFT SURGIS GLD HERNIA 276887
|
Facility
|
IP
|
$4,630.00
|
|
| Hospital Charge Code |
270630129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$694.50 |
| Max. Negotiated Rate |
$1,120.46 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$926.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,120.46
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,018.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$694.50
|
|
