|
PLACEMENT DRUG ELUD STENT SING
|
Facility
|
IP
|
$50,870.23
|
|
| Hospital Charge Code |
74110005
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,630.53 |
| Max. Negotiated Rate |
$7,630.53 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7,630.53
|
|
|
PLACEMENT DRUG ELUD STENT SING
|
Facility
|
IP
|
$50,870.23
|
|
| Hospital Charge Code |
5100041
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,630.53 |
| Max. Negotiated Rate |
$7,630.53 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7,630.53
|
|
|
PLACEMENT DRUG ELUD STENT SING
|
Facility
|
OP
|
$50,870.23
|
|
| Hospital Charge Code |
5100041
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,225.97 |
| Max. Negotiated Rate |
$25,435.12 |
| Rate for Payer: Aetna Commercial |
$19,330.69
|
| Rate for Payer: Aetna Medicare Advantage |
$15,261.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12,971.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12,971.91
|
| 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 |
$12,971.91
|
| Rate for Payer: Cigna Commercial |
$25,435.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15,261.07
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$6,600.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7,630.53
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,225.97
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,348.06
|
|
|
PLACEMENT IVC FILTER PERCU S&I
|
Facility
|
IP
|
$1,370.00
|
|
|
Service Code
|
HCPCS 75940
|
| Hospital Charge Code |
5100316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$205.50 |
| Max. Negotiated Rate |
$205.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$205.50
|
|
|
PLACEMENT IVC FILTER PERCU S&I
|
Facility
|
OP
|
$1,370.00
|
|
|
Service Code
|
HCPCS 75940
|
| Hospital Charge Code |
5100316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.02 |
| Max. Negotiated Rate |
$1,975.00 |
| Rate for Payer: Aetna Commercial |
$520.60
|
| Rate for Payer: Aetna Medicare Advantage |
$411.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$349.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$349.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$349.35
|
| Rate for Payer: Cigna Commercial |
$685.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$411.00
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$205.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$33.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$36.30
|
|
|
PLACEMENT IVC FILTER PERCUT
|
Facility
|
IP
|
$6,404.13
|
|
|
Service Code
|
HCPCS 37620
|
| Hospital Charge Code |
5100315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$960.62 |
| Max. Negotiated Rate |
$960.62 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$960.62
|
|
|
PLACEMENT IVC FILTER PERCUT
|
Facility
|
OP
|
$6,404.13
|
|
|
Service Code
|
HCPCS 37620
|
| Hospital Charge Code |
5100315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$154.34 |
| Max. Negotiated Rate |
$3,202.07 |
| Rate for Payer: Aetna Commercial |
$2,433.57
|
| Rate for Payer: Aetna Medicare Advantage |
$1,921.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,633.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,633.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,633.05
|
| Rate for Payer: Cigna Commercial |
$3,202.07
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,921.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$960.62
|
| Rate for Payer: UnitedHealthcare Community & State |
$154.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$169.71
|
|
|
PLACEMENT OF SETON
|
Facility
|
IP
|
$14,972.60
|
|
|
Service Code
|
HCPCS 46020
|
| Hospital Charge Code |
1600000454
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,245.89 |
| Max. Negotiated Rate |
$2,245.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,245.89
|
|
|
PLACEMENT OF SETON
|
Facility
|
OP
|
$14,972.60
|
|
|
Service Code
|
HCPCS 46020
|
| Hospital Charge Code |
1600000454
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$360.84 |
| Max. Negotiated Rate |
$11,903.20 |
| Rate for Payer: Aetna Commercial |
$8,969.36
|
| Rate for Payer: Aetna Medicare Advantage |
$10,684.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11,903.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11,903.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,297.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,355.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$11,903.20
|
| Rate for Payer: Cigna Commercial |
$6,609.93
|
| Rate for Payer: Cigna Medicare Advantage |
$3,297.56
|
| Rate for Payer: Clover Medicare Advantage |
$3,132.68
|
| Rate for Payer: EmblemHealth Commercial |
$9,892.68
|
| Rate for Payer: Humana Medicare Advantage |
$3,396.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,297.56
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,491.78
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,245.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$360.84
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,297.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,297.56
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$396.77
|
|
|
PLACEMENT TRANSESOPHAGEAL PROB
|
Facility
|
OP
|
$1,927.00
|
|
|
Service Code
|
HCPCS 93313
|
| Hospital Charge Code |
5308001
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$46.44 |
| Max. Negotiated Rate |
$2,656.00 |
| Rate for Payer: Aetna Commercial |
$1,765.72
|
| Rate for Payer: Aetna Medicare Advantage |
$2,103.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,343.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,343.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$649.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$55.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,343.27
|
| Rate for Payer: Cigna Commercial |
$1,301.24
|
| Rate for Payer: Cigna Medicare Advantage |
$649.16
|
| Rate for Payer: Clover Medicare Advantage |
$616.70
|
| Rate for Payer: EmblemHealth Commercial |
$1,947.48
|
| Rate for Payer: Humana Medicare Advantage |
$668.63
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$649.16
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$578.10
|
| Rate for Payer: Oxford Commercial |
$1,514.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$289.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,656.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$46.44
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$649.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$649.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$51.07
|
|
|
PLACEMENT TRANSESOPHAGEAL PROB
|
Facility
|
IP
|
$1,927.00
|
|
|
Service Code
|
HCPCS 93313
|
| Hospital Charge Code |
5308001
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$289.05 |
| Max. Negotiated Rate |
$289.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$289.05
|
|
|
PLACEMNT CLOSRE DEVICE POSTSUR
|
Facility
|
OP
|
$2,302.51
|
|
| Hospital Charge Code |
5100661
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$55.49 |
| Max. Negotiated Rate |
$1,151.26 |
| Rate for Payer: Aetna Commercial |
$874.95
|
| Rate for Payer: Aetna Medicare Advantage |
$690.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$587.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$587.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$587.14
|
| Rate for Payer: Cigna Commercial |
$1,151.26
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$690.75
|
| Rate for Payer: Oxford Commercial |
$460.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$345.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$460.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$55.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$61.02
|
|
|
PLACEMNT CLOSRE DEVICE POSTSUR
|
Facility
|
IP
|
$2,302.51
|
|
| Hospital Charge Code |
5100661
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$345.38 |
| Max. Negotiated Rate |
$345.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$345.38
|
|
|
PLACER 10mm
|
Facility
|
IP
|
$666.65
|
|
| Hospital Charge Code |
270679217
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.00
|
|
|
PLACER 10mm
|
Facility
|
OP
|
$666.65
|
|
| Hospital Charge Code |
270679217
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$333.32 |
| Rate for Payer: Aetna Commercial |
$253.33
|
| Rate for Payer: Aetna Medicare Advantage |
$200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$170.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$170.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$170.00
|
| Rate for Payer: Cigna Commercial |
$333.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$200.00
|
| Rate for Payer: Oxford Commercial |
$133.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$133.33
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.67
|
|
|
PLACER 8mm
|
Facility
|
OP
|
$666.65
|
|
| Hospital Charge Code |
270679221
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$333.32 |
| Rate for Payer: Aetna Commercial |
$253.33
|
| Rate for Payer: Aetna Medicare Advantage |
$200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$170.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$170.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$170.00
|
| Rate for Payer: Cigna Commercial |
$333.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$200.00
|
| Rate for Payer: Oxford Commercial |
$133.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$133.33
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.67
|
|
|
PLACER 8mm
|
Facility
|
IP
|
$666.65
|
|
| Hospital Charge Code |
270679221
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.00
|
|
|
PLACE STENT PERIPH PERC NONCOR
|
Facility
|
IP
|
$41,896.20
|
|
|
Service Code
|
HCPCS 37236
|
| Hospital Charge Code |
74110043
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,284.43 |
| Max. Negotiated Rate |
$6,284.43 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,284.43
|
|
|
PLACE STENT PERIPH PERC NONCOR
|
Facility
|
OP
|
$41,896.20
|
|
|
Service Code
|
HCPCS 37236
|
| Hospital Charge Code |
5100350
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,009.70 |
| Max. Negotiated Rate |
$49,506.31 |
| Rate for Payer: Aetna Commercial |
$37,304.26
|
| Rate for Payer: Aetna Medicare Advantage |
$44,435.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49,506.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49,506.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13,714.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49,506.31
|
| Rate for Payer: Cigna Commercial |
$27,491.26
|
| Rate for Payer: Cigna Medicare Advantage |
$13,714.80
|
| Rate for Payer: Clover Medicare Advantage |
$13,029.06
|
| Rate for Payer: EmblemHealth Commercial |
$41,144.40
|
| Rate for Payer: Humana Medicare Advantage |
$14,126.24
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13,714.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12,568.86
|
| Rate for Payer: Oxford Commercial |
$9,689.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,284.43
|
| Rate for Payer: UnitedHealthcare Commercial |
$16,605.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,009.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13,714.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$13,714.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,110.25
|
|
|
PLACE STENT PERIPH PERC NONCOR
|
Facility
|
IP
|
$41,896.20
|
|
|
Service Code
|
HCPCS 37236
|
| Hospital Charge Code |
5100350
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,284.43 |
| Max. Negotiated Rate |
$6,284.43 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,284.43
|
|
|
PLACE STENT PERIPH PERC NONCOR
|
Facility
|
OP
|
$41,896.20
|
|
|
Service Code
|
HCPCS 37236
|
| Hospital Charge Code |
74110043
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,009.70 |
| Max. Negotiated Rate |
$49,506.31 |
| Rate for Payer: Aetna Commercial |
$37,304.26
|
| Rate for Payer: Aetna Medicare Advantage |
$44,435.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49,506.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49,506.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13,714.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49,506.31
|
| Rate for Payer: Cigna Commercial |
$27,491.26
|
| Rate for Payer: Cigna Medicare Advantage |
$13,714.80
|
| Rate for Payer: Clover Medicare Advantage |
$13,029.06
|
| Rate for Payer: EmblemHealth Commercial |
$41,144.40
|
| Rate for Payer: Humana Medicare Advantage |
$14,126.24
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13,714.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12,568.86
|
| Rate for Payer: Oxford Commercial |
$9,689.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,284.43
|
| Rate for Payer: UnitedHealthcare Commercial |
$16,605.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,009.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13,714.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$13,714.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,110.25
|
|
|
PLACE STENT PERIPH PERC NONCOR
|
Facility
|
IP
|
$56,620.95
|
|
|
Service Code
|
HCPCS 37236
|
| Hospital Charge Code |
5700318
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,493.14 |
| Max. Negotiated Rate |
$8,493.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8,493.14
|
|
|
PLACE STENT PERIPH PERC NONCOR
|
Facility
|
OP
|
$56,620.95
|
|
|
Service Code
|
HCPCS 37236
|
| Hospital Charge Code |
5700318
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,364.56 |
| Max. Negotiated Rate |
$49,506.31 |
| Rate for Payer: Aetna Commercial |
$37,304.26
|
| Rate for Payer: Aetna Medicare Advantage |
$44,435.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49,506.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49,506.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13,714.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49,506.31
|
| Rate for Payer: Cigna Commercial |
$27,491.26
|
| Rate for Payer: Cigna Medicare Advantage |
$13,714.80
|
| Rate for Payer: Clover Medicare Advantage |
$13,029.06
|
| Rate for Payer: EmblemHealth Commercial |
$41,144.40
|
| Rate for Payer: Humana Medicare Advantage |
$14,126.24
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13,714.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16,986.28
|
| Rate for Payer: Oxford Commercial |
$9,689.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8,493.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$16,605.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,364.56
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13,714.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$13,714.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,500.46
|
|
|
PLAIN WASHER 3 PK
|
Facility
|
OP
|
$440.00
|
|
| Hospital Charge Code |
270684106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna Commercial |
$167.20
|
| Rate for Payer: Aetna Medicare Advantage |
$132.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$112.20
|
| Rate for Payer: Cigna Commercial |
$220.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$132.00
|
| Rate for Payer: Oxford Commercial |
$88.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$88.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.66
|
|
|
PLAIN WASHER 3 PK
|
Facility
|
IP
|
$440.00
|
|
| Hospital Charge Code |
270684106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$66.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.00
|
|
