|
SHEATH PINNACLE R/O II INTROD
|
Facility
|
OP
|
$166.00
|
|
| Hospital Charge Code |
270653921
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Aetna Commercial |
$63.08
|
| Rate for Payer: Aetna Medicare Advantage |
$49.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$42.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$42.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$42.33
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$49.80
|
| Rate for Payer: Oxford Commercial |
$33.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$33.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.40
|
|
|
SHEATH PINNACLE R/O II INTRODU
|
Facility
|
IP
|
$159.50
|
|
| Hospital Charge Code |
2709002584
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.93 |
| Max. Negotiated Rate |
$23.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.93
|
|
|
SHEATH PINNACLE R/O II INTRODU
|
Facility
|
OP
|
$159.50
|
|
| Hospital Charge Code |
2709002584
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$79.75 |
| Rate for Payer: Aetna Commercial |
$60.61
|
| Rate for Payer: Aetna Medicare Advantage |
$47.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$40.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$40.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$40.67
|
| Rate for Payer: Cigna Commercial |
$79.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.85
|
| Rate for Payer: Oxford Commercial |
$31.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.93
|
| Rate for Payer: UnitedHealthcare Commercial |
$31.90
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.23
|
|
|
Sheath Pinnacle RO intro 8fx10
|
Facility
|
OP
|
$31.90
|
|
| Hospital Charge Code |
270658251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$15.95 |
| Rate for Payer: Aetna Commercial |
$12.12
|
| Rate for Payer: Aetna Medicare Advantage |
$9.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.13
|
| Rate for Payer: Cigna Commercial |
$15.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.72
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$7.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.79
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.77
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.85
|
|
|
Sheath Pinnacle RO intro 8fx10
|
Facility
|
IP
|
$31.90
|
|
| Hospital Charge Code |
270658251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$7.72 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.72
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$7.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.79
|
|
|
Sheath Pinnacle RO intro 9fx10
|
Facility
|
OP
|
$31.90
|
|
| Hospital Charge Code |
270658245
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$15.95 |
| Rate for Payer: Aetna Commercial |
$12.12
|
| Rate for Payer: Aetna Medicare Advantage |
$9.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.13
|
| Rate for Payer: Cigna Commercial |
$15.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.72
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$7.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.79
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.77
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.85
|
|
|
Sheath Pinnacle RO intro 9fx10
|
Facility
|
IP
|
$31.90
|
|
| Hospital Charge Code |
270658245
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$7.72 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.72
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$7.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.79
|
|
|
SHEATH PINNACLE SUPR 10FR 11cm
|
Facility
|
OP
|
$48.76
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270628419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$24.38 |
| Rate for Payer: Aetna Commercial |
$18.53
|
| Rate for Payer: Aetna Medicare Advantage |
$14.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.43
|
| Rate for Payer: Cigna Commercial |
$24.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.80
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$10.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.31
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.29
|
|
|
SHEATH PINNACLE SUPR 10FR 11cm
|
Facility
|
IP
|
$48.76
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270628419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$11.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.80
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$10.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.31
|
|
|
SHEATH PINNACLE SUPR 10FR 11CM
|
Facility
|
IP
|
$88.80
|
|
| Hospital Charge Code |
270628419C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$21.49 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.76
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.49
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$19.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.32
|
|
|
SHEATH PINNACLE SUPR 10FR 11CM
|
Facility
|
OP
|
$88.80
|
|
| Hospital Charge Code |
270628419C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$44.40 |
| Rate for Payer: Aetna Commercial |
$33.74
|
| Rate for Payer: Aetna Medicare Advantage |
$26.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$22.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$22.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$22.64
|
| Rate for Payer: Cigna Commercial |
$44.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.49
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$19.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.32
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.35
|
|
|
SHEATH PINNACLE SUPR 11FR 25cm
|
Facility
|
IP
|
$113.85
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270635131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.08 |
| Max. Negotiated Rate |
$27.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$22.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.55
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$25.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.08
|
|
|
SHEATH PINNACLE SUPR 11FR 25cm
|
Facility
|
OP
|
$113.85
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270635131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna Commercial |
$43.26
|
| Rate for Payer: Aetna Medicare Advantage |
$34.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$29.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$29.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$22.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$29.03
|
| Rate for Payer: Cigna Commercial |
$56.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.55
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$25.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.08
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.02
|
|
|
SHEATH PINNACLE SUPR 11FR 25cm
|
Facility
|
OP
|
$113.85
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270635131O
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna Commercial |
$43.26
|
| Rate for Payer: Aetna Medicare Advantage |
$34.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$29.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$29.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$22.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$29.03
|
| Rate for Payer: Cigna Commercial |
$56.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.55
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$25.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.08
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.02
|
|
|
SHEATH PINNACLE SUPR 11FR 25cm
|
Facility
|
IP
|
$113.85
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270635131O
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.08 |
| Max. Negotiated Rate |
$27.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$22.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.55
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$25.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.08
|
|
|
SHEATH PINNACLE SUPR 11FR 25CM
|
Facility
|
IP
|
$165.60
|
|
| Hospital Charge Code |
270635131C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$40.08 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$33.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$40.08
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$36.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.84
|
|
|
SHEATH PINNACLE SUPR 11FR 25CM
|
Facility
|
OP
|
$165.60
|
|
| Hospital Charge Code |
270635131C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: Aetna Medicare Advantage |
$49.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$42.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$42.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$42.23
|
| Rate for Payer: Cigna Commercial |
$82.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$40.08
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$36.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.84
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.39
|
|
|
SHEATH PINNACLE TERUMO 4.5CM
|
Facility
|
OP
|
$427.50
|
|
| Hospital Charge Code |
270652539
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Aetna Commercial |
$162.45
|
| Rate for Payer: Aetna Medicare Advantage |
$128.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$109.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$109.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$109.01
|
| Rate for Payer: Cigna Commercial |
$213.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$128.25
|
| Rate for Payer: Oxford Commercial |
$85.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$85.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.33
|
|
|
SHEATH PINNACLE TERUMO 4.5CM
|
Facility
|
IP
|
$427.50
|
|
| Hospital Charge Code |
270652539
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.12 |
| Max. Negotiated Rate |
$64.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.12
|
|
|
SHEATH PIN R/O IIIN 5X6 RSB501
|
Facility
|
IP
|
$121.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270654336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.23 |
| Max. Negotiated Rate |
$29.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.40
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$26.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.23
|
|
|
SHEATH PIN R/O IIIN 5X6 RSB501
|
Facility
|
OP
|
$148.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270654336N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$74.25 |
| Rate for Payer: Aetna Commercial |
$56.43
|
| Rate for Payer: Aetna Medicare Advantage |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$37.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$37.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$37.87
|
| Rate for Payer: Cigna Commercial |
$74.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.94
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$32.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.27
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.94
|
|
|
SHEATH PIN R/O IIIN 5X6 RSB501
|
Facility
|
IP
|
$148.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270654336N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.27 |
| Max. Negotiated Rate |
$35.94 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.94
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$32.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.27
|
|
|
SHEATH PIN R/O IIIN 5X6 RSB501
|
Facility
|
IP
|
$121.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270654336S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.23 |
| Max. Negotiated Rate |
$29.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.40
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$26.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.23
|
|
|
SHEATH PIN R/O IIIN 5X6 RSB501
|
Facility
|
OP
|
$121.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270654336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$60.75 |
| Rate for Payer: Aetna Commercial |
$46.17
|
| Rate for Payer: Aetna Medicare Advantage |
$36.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$30.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$30.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$30.98
|
| Rate for Payer: Cigna Commercial |
$60.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.40
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$26.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.23
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.93
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.22
|
|
|
SHEATH PIN R/O IIIN 5X6 RSB501
|
Facility
|
OP
|
$121.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270654336S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$60.75 |
| Rate for Payer: Aetna Commercial |
$46.17
|
| Rate for Payer: Aetna Medicare Advantage |
$36.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$30.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$30.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$30.98
|
| Rate for Payer: Cigna Commercial |
$60.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.40
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$26.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.23
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.93
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.22
|
|
