|
STENT CAST COVD 8x59 80 85407
|
Facility
|
IP
|
$13,144.00
|
|
| Hospital Charge Code |
270634582
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,971.60 |
| Max. Negotiated Rate |
$3,180.85 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,628.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,180.85
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,891.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,971.60
|
|
|
STENT CAST COVD 8x59 80 85407
|
Facility
|
IP
|
$13,875.00
|
|
| Hospital Charge Code |
270634582V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.25 |
| Max. Negotiated Rate |
$3,357.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,775.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,357.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,052.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,081.25
|
|
|
STENT CAST COVD 8x59 80 85407
|
Facility
|
OP
|
$13,144.00
|
|
| Hospital Charge Code |
270634582
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$316.77 |
| Max. Negotiated Rate |
$6,572.00 |
| Rate for Payer: Aetna Commercial |
$4,994.72
|
| Rate for Payer: Aetna Medicare Advantage |
$3,943.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,351.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,351.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,628.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,351.72
|
| Rate for Payer: Cigna Commercial |
$6,572.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,180.85
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,891.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,971.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$316.77
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$348.32
|
|
|
STENT CAST COVD 8x59 80 85407
|
Facility
|
OP
|
$13,875.00
|
|
| Hospital Charge Code |
270634582V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$334.39 |
| Max. Negotiated Rate |
$6,937.50 |
| Rate for Payer: Aetna Commercial |
$5,272.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4,162.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,538.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,538.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,775.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,538.12
|
| Rate for Payer: Cigna Commercial |
$6,937.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,357.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,052.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,081.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$334.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$367.69
|
|
|
STENT CAST COVD 9x59 120 85419
|
Facility
|
OP
|
$13,144.00
|
|
| Hospital Charge Code |
270634396
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$316.77 |
| Max. Negotiated Rate |
$6,572.00 |
| Rate for Payer: Aetna Commercial |
$4,994.72
|
| Rate for Payer: Aetna Medicare Advantage |
$3,943.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,351.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,351.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,628.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,351.72
|
| Rate for Payer: Cigna Commercial |
$6,572.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,180.85
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,891.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,971.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$316.77
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$348.32
|
|
|
STENT CAST COVD 9x59 120 85419
|
Facility
|
IP
|
$13,144.00
|
|
| Hospital Charge Code |
270634396V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,971.60 |
| Max. Negotiated Rate |
$3,180.85 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,628.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,180.85
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,891.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,971.60
|
|
|
STENT CAST COVD 9x59 120 85419
|
Facility
|
IP
|
$13,144.00
|
|
| Hospital Charge Code |
270634396
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,971.60 |
| Max. Negotiated Rate |
$3,180.85 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,628.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,180.85
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,891.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,971.60
|
|
|
STENT CAST COVD 9x59 120 85419
|
Facility
|
OP
|
$13,144.00
|
|
| Hospital Charge Code |
270634396V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$316.77 |
| Max. Negotiated Rate |
$6,572.00 |
| Rate for Payer: Aetna Commercial |
$4,994.72
|
| Rate for Payer: Aetna Medicare Advantage |
$3,943.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,351.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,351.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,628.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,351.72
|
| Rate for Payer: Cigna Commercial |
$6,572.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,180.85
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,891.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,971.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$316.77
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$348.32
|
|
|
STENT CENTER BEND STR SZ 10-5
|
Facility
|
OP
|
$266.50
|
|
| Hospital Charge Code |
270673446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$133.25 |
| Rate for Payer: Aetna Commercial |
$101.27
|
| Rate for Payer: Aetna Medicare Advantage |
$79.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$67.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$67.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$53.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$67.96
|
| Rate for Payer: Cigna Commercial |
$133.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$64.49
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$58.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.98
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.42
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.06
|
|
|
STENT CENTER BEND STR SZ 10-5
|
Facility
|
IP
|
$266.50
|
|
| Hospital Charge Code |
270673446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.98 |
| Max. Negotiated Rate |
$64.49 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$53.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$64.49
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$58.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.98
|
|
|
STENT CENTER BEND STR SZ 7-9
|
Facility
|
IP
|
$266.50
|
|
| Hospital Charge Code |
270673445
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.98 |
| Max. Negotiated Rate |
$64.49 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$53.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$64.49
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$58.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.98
|
|
|
STENT CENTER BEND STR SZ 7-9
|
Facility
|
OP
|
$266.50
|
|
| Hospital Charge Code |
270673445
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$133.25 |
| Rate for Payer: Aetna Commercial |
$101.27
|
| Rate for Payer: Aetna Medicare Advantage |
$79.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$67.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$67.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$53.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$67.96
|
| Rate for Payer: Cigna Commercial |
$133.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$64.49
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$58.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.98
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.42
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.06
|
|
|
STENT CENTRAL DIALYS SEG ADDON
|
Facility
|
IP
|
$1,034.20
|
|
|
Service Code
|
HCPCS 36908
|
| Hospital Charge Code |
321036908
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$155.13 |
| Max. Negotiated Rate |
$155.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$155.13
|
|
|
STENT CENTRAL DIALYS SEG ADDON
|
Facility
|
IP
|
$1,034.20
|
|
|
Service Code
|
HCPCS 36908
|
| Hospital Charge Code |
366836908
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$155.13 |
| Max. Negotiated Rate |
$155.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$155.13
|
|
|
STENT CENTRAL DIALYS SEG ADDON
|
Facility
|
IP
|
$1,034.20
|
|
|
Service Code
|
HCPCS 36908
|
| Hospital Charge Code |
2709029
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$155.13 |
| Max. Negotiated Rate |
$155.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$155.13
|
|
|
STENT CENTRAL DIALYS SEG ADDON
|
Facility
|
OP
|
$1,034.20
|
|
|
Service Code
|
HCPCS 36908
|
| Hospital Charge Code |
7412063
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$393.00
|
| Rate for Payer: Aetna Medicare Advantage |
$310.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$263.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$263.72
|
| 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 |
$263.72
|
| Rate for Payer: Cigna Commercial |
$517.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$310.26
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$155.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.41
|
|
|
STENT CENTRAL DIALYS SEG ADDON
|
Facility
|
OP
|
$1,034.20
|
|
|
Service Code
|
HCPCS 36908
|
| Hospital Charge Code |
366836908
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$393.00
|
| Rate for Payer: Aetna Medicare Advantage |
$310.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$263.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$263.72
|
| 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 |
$263.72
|
| Rate for Payer: Cigna Commercial |
$517.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$310.26
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$155.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.41
|
|
|
STENT CENTRAL DIALYS SEG ADDON
|
Facility
|
IP
|
$1,034.20
|
|
|
Service Code
|
HCPCS 36908
|
| Hospital Charge Code |
7412063
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$155.13 |
| Max. Negotiated Rate |
$155.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$155.13
|
|
|
STENT CENTRAL DIALYS SEG ADDON
|
Facility
|
OP
|
$1,034.20
|
|
|
Service Code
|
HCPCS 36908
|
| Hospital Charge Code |
321036908
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$393.00
|
| Rate for Payer: Aetna Medicare Advantage |
$310.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$263.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$263.72
|
| 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 |
$263.72
|
| Rate for Payer: Cigna Commercial |
$517.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$310.26
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$155.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.41
|
|
|
STENT CENTRAL DIALYS SEG ADDON
|
Facility
|
OP
|
$1,034.20
|
|
|
Service Code
|
HCPCS 36908
|
| Hospital Charge Code |
2692134
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$393.00
|
| Rate for Payer: Aetna Medicare Advantage |
$310.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$263.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$263.72
|
| 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 |
$263.72
|
| Rate for Payer: Cigna Commercial |
$517.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$310.26
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$155.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.41
|
|
|
STENT CENTRAL DIALYS SEG ADDON
|
Facility
|
IP
|
$1,034.20
|
|
|
Service Code
|
HCPCS 36908
|
| Hospital Charge Code |
2692134
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$155.13 |
| Max. Negotiated Rate |
$155.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$155.13
|
|
|
STENT CENTRAL DIALYS SEG ADDON
|
Facility
|
IP
|
$1,034.20
|
|
|
Service Code
|
HCPCS 36908
|
| Hospital Charge Code |
5100842
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$155.13 |
| Max. Negotiated Rate |
$155.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$155.13
|
|
|
STENT CENTRAL DIALYS SEG ADDON
|
Facility
|
OP
|
$1,034.20
|
|
|
Service Code
|
HCPCS 36908
|
| Hospital Charge Code |
5100842
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$393.00
|
| Rate for Payer: Aetna Medicare Advantage |
$310.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$263.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$263.72
|
| 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 |
$263.72
|
| Rate for Payer: Cigna Commercial |
$517.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$310.26
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$155.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.41
|
|
|
STENT CENTRAL DIALYS SEG ADDON
|
Facility
|
OP
|
$1,034.20
|
|
|
Service Code
|
HCPCS 36908
|
| Hospital Charge Code |
2709029
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$393.00
|
| Rate for Payer: Aetna Medicare Advantage |
$310.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$263.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$263.72
|
| 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 |
$263.72
|
| Rate for Payer: Cigna Commercial |
$517.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$310.26
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$155.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.41
|
|
|
STENT CK URET 6F 22-32 03660
|
Facility
|
IP
|
$458.45
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
270621488
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$68.77 |
| Max. Negotiated Rate |
$110.94 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$91.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$110.94
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$100.86
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$68.77
|
|
