|
THREADED POST W/NUT
|
Facility
|
IP
|
$640.50
|
|
| Hospital Charge Code |
270656557
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$96.08 |
| Max. Negotiated Rate |
$96.08 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.08
|
|
|
THREE HOLE CLAMP
|
Facility
|
OP
|
$2,585.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270689180
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$62.30 |
| Max. Negotiated Rate |
$1,292.50 |
| Rate for Payer: Aetna Commercial |
$982.30
|
| Rate for Payer: Aetna Medicare Advantage |
$775.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$659.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$659.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$517.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$659.17
|
| Rate for Payer: Cigna Commercial |
$1,292.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$625.57
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$568.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$387.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$62.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$68.50
|
|
|
THREE HOLE CLAMP
|
Facility
|
IP
|
$2,585.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270689180
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$387.75 |
| Max. Negotiated Rate |
$625.57 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$517.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$625.57
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$568.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$387.75
|
|
|
THRMBC/NFS DIALYSIS CIRCUIT
|
Facility
|
IP
|
$20,340.00
|
|
|
Service Code
|
HCPCS 36904
|
| Hospital Charge Code |
16000951
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,051.00 |
| Max. Negotiated Rate |
$3,051.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,051.00
|
|
|
THRMBC/NFS DIALYSIS CIRCUIT
|
Facility
|
OP
|
$20,340.00
|
|
|
Service Code
|
HCPCS 36904
|
| Hospital Charge Code |
16000951
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$490.19 |
| Max. Negotiated Rate |
$24,407.82 |
| Rate for Payer: Aetna Commercial |
$18,391.91
|
| Rate for Payer: Aetna Medicare Advantage |
$21,908.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24,407.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24,407.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,761.73
|
| 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 |
$24,407.82
|
| Rate for Payer: Cigna Commercial |
$13,553.85
|
| Rate for Payer: Cigna Medicare Advantage |
$6,761.73
|
| Rate for Payer: Clover Medicare Advantage |
$6,423.64
|
| Rate for Payer: EmblemHealth Commercial |
$20,285.19
|
| Rate for Payer: Humana Medicare Advantage |
$6,964.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,761.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,102.00
|
| Rate for Payer: Oxford Commercial |
$8,679.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,051.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,834.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$490.19
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$539.01
|
|
|
THROAT & NOSE CULTURE
|
Facility
|
IP
|
$349.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
38475068
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$52.35 |
| Max. Negotiated Rate |
$52.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.35
|
|
|
THROAT & NOSE CULTURE
|
Facility
|
OP
|
$349.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
38475068
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$174.50 |
| Rate for Payer: Aetna Commercial |
$23.45
|
| Rate for Payer: Aetna Medicare Advantage |
$27.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$31.12
|
| Rate for Payer: Cigna Commercial |
$174.50
|
| Rate for Payer: Cigna Medicare Advantage |
$8.62
|
| Rate for Payer: Clover Medicare Advantage |
$8.19
|
| Rate for Payer: EmblemHealth Commercial |
$25.86
|
| Rate for Payer: Humana Medicare Advantage |
$8.88
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$8.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.90
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.25
|
|
|
THROMBECTOMY/LYSIS DIALYS CIRC
|
Facility
|
IP
|
$27,397.00
|
|
|
Service Code
|
HCPCS 36904
|
| Hospital Charge Code |
321036904
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,109.55 |
| Max. Negotiated Rate |
$4,109.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,109.55
|
|
|
THROMBECTOMY/LYSIS DIALYS CIRC
|
Facility
|
OP
|
$27,397.00
|
|
|
Service Code
|
HCPCS 36904
|
| Hospital Charge Code |
321036904
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$660.27 |
| Max. Negotiated Rate |
$24,407.82 |
| Rate for Payer: Aetna Commercial |
$18,391.91
|
| Rate for Payer: Aetna Medicare Advantage |
$21,908.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24,407.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24,407.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,761.73
|
| 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 |
$24,407.82
|
| Rate for Payer: Cigna Commercial |
$13,553.85
|
| Rate for Payer: Cigna Medicare Advantage |
$6,761.73
|
| Rate for Payer: Clover Medicare Advantage |
$6,423.64
|
| Rate for Payer: EmblemHealth Commercial |
$20,285.19
|
| Rate for Payer: Humana Medicare Advantage |
$6,964.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,761.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,219.10
|
| Rate for Payer: Oxford Commercial |
$8,679.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,109.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,834.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$660.27
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$726.02
|
|
|
THROMBECTOMY/LYSIS DIALYS CIRC
|
Facility
|
IP
|
$27,397.00
|
|
|
Service Code
|
HCPCS 36904
|
| Hospital Charge Code |
2692148
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,109.55 |
| Max. Negotiated Rate |
$4,109.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,109.55
|
|
|
THROMBECTOMY/LYSIS DIALYS CIRC
|
Facility
|
IP
|
$24,115.80
|
|
|
Service Code
|
HCPCS 36904
|
| Hospital Charge Code |
2709025
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,617.37 |
| Max. Negotiated Rate |
$3,617.37 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,617.37
|
|
|
THROMBECTOMY/LYSIS DIALYS CIRC
|
Facility
|
OP
|
$24,115.80
|
|
|
Service Code
|
HCPCS 36904
|
| Hospital Charge Code |
7412059
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$581.19 |
| Max. Negotiated Rate |
$24,407.82 |
| Rate for Payer: Aetna Commercial |
$18,391.91
|
| Rate for Payer: Aetna Medicare Advantage |
$21,908.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24,407.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24,407.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,761.73
|
| 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 |
$24,407.82
|
| Rate for Payer: Cigna Commercial |
$13,553.85
|
| Rate for Payer: Cigna Medicare Advantage |
$6,761.73
|
| Rate for Payer: Clover Medicare Advantage |
$6,423.64
|
| Rate for Payer: EmblemHealth Commercial |
$20,285.19
|
| Rate for Payer: Humana Medicare Advantage |
$6,964.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,761.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,234.74
|
| Rate for Payer: Oxford Commercial |
$8,679.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,617.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,834.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$581.19
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$639.07
|
|
|
THROMBECTOMY/LYSIS DIALYS CIRC
|
Facility
|
OP
|
$27,397.00
|
|
|
Service Code
|
HCPCS 36904
|
| Hospital Charge Code |
2692148
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$660.27 |
| Max. Negotiated Rate |
$24,407.82 |
| Rate for Payer: Aetna Commercial |
$18,391.91
|
| Rate for Payer: Aetna Medicare Advantage |
$21,908.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24,407.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24,407.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,761.73
|
| 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 |
$24,407.82
|
| Rate for Payer: Cigna Commercial |
$13,553.85
|
| Rate for Payer: Cigna Medicare Advantage |
$6,761.73
|
| Rate for Payer: Clover Medicare Advantage |
$6,423.64
|
| Rate for Payer: EmblemHealth Commercial |
$20,285.19
|
| Rate for Payer: Humana Medicare Advantage |
$6,964.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,761.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,219.10
|
| Rate for Payer: Oxford Commercial |
$8,679.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,109.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,834.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$660.27
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$726.02
|
|
|
THROMBECTOMY/LYSIS DIALYS CIRC
|
Facility
|
IP
|
$24,115.80
|
|
|
Service Code
|
HCPCS 36904
|
| Hospital Charge Code |
5100838
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,617.37 |
| Max. Negotiated Rate |
$3,617.37 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,617.37
|
|
|
THROMBECTOMY/LYSIS DIALYS CIRC
|
Facility
|
IP
|
$24,115.80
|
|
|
Service Code
|
HCPCS 36904
|
| Hospital Charge Code |
366836904
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,617.37 |
| Max. Negotiated Rate |
$3,617.37 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,617.37
|
|
|
THROMBECTOMY/LYSIS DIALYS CIRC
|
Facility
|
OP
|
$24,115.80
|
|
|
Service Code
|
HCPCS 36904
|
| Hospital Charge Code |
366836904
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$581.19 |
| Max. Negotiated Rate |
$24,407.82 |
| Rate for Payer: Aetna Commercial |
$18,391.91
|
| Rate for Payer: Aetna Medicare Advantage |
$21,908.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24,407.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24,407.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,761.73
|
| 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 |
$24,407.82
|
| Rate for Payer: Cigna Commercial |
$13,553.85
|
| Rate for Payer: Cigna Medicare Advantage |
$6,761.73
|
| Rate for Payer: Clover Medicare Advantage |
$6,423.64
|
| Rate for Payer: EmblemHealth Commercial |
$20,285.19
|
| Rate for Payer: Humana Medicare Advantage |
$6,964.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,761.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,234.74
|
| Rate for Payer: Oxford Commercial |
$8,679.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,617.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,834.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$581.19
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$639.07
|
|
|
THROMBECTOMY/LYSIS DIALYS CIRC
|
Facility
|
IP
|
$24,115.80
|
|
|
Service Code
|
HCPCS 36904
|
| Hospital Charge Code |
7412059
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,617.37 |
| Max. Negotiated Rate |
$3,617.37 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,617.37
|
|
|
THROMBECTOMY/LYSIS DIALYS CIRC
|
Facility
|
OP
|
$24,115.80
|
|
|
Service Code
|
HCPCS 36904
|
| Hospital Charge Code |
5100838
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$581.19 |
| Max. Negotiated Rate |
$24,407.82 |
| Rate for Payer: Aetna Commercial |
$18,391.91
|
| Rate for Payer: Aetna Medicare Advantage |
$21,908.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24,407.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24,407.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,761.73
|
| 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 |
$24,407.82
|
| Rate for Payer: Cigna Commercial |
$13,553.85
|
| Rate for Payer: Cigna Medicare Advantage |
$6,761.73
|
| Rate for Payer: Clover Medicare Advantage |
$6,423.64
|
| Rate for Payer: EmblemHealth Commercial |
$20,285.19
|
| Rate for Payer: Humana Medicare Advantage |
$6,964.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,761.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,234.74
|
| Rate for Payer: Oxford Commercial |
$8,679.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,617.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,834.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$581.19
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$639.07
|
|
|
THROMBECTOMY/LYSIS DIALYS CIRC
|
Facility
|
OP
|
$24,115.80
|
|
|
Service Code
|
HCPCS 36904
|
| Hospital Charge Code |
2709025
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$581.19 |
| Max. Negotiated Rate |
$24,407.82 |
| Rate for Payer: Aetna Commercial |
$18,391.91
|
| Rate for Payer: Aetna Medicare Advantage |
$21,908.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24,407.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24,407.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,761.73
|
| 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 |
$24,407.82
|
| Rate for Payer: Cigna Commercial |
$13,553.85
|
| Rate for Payer: Cigna Medicare Advantage |
$6,761.73
|
| Rate for Payer: Clover Medicare Advantage |
$6,423.64
|
| Rate for Payer: EmblemHealth Commercial |
$20,285.19
|
| Rate for Payer: Humana Medicare Advantage |
$6,964.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,761.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,234.74
|
| Rate for Payer: Oxford Commercial |
$8,679.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,617.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,834.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$581.19
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$639.07
|
|
|
THROMBECTOMY SET 4FR SOLENT
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
270650590S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.00 |
| Max. Negotiated Rate |
$5,000.00 |
| Rate for Payer: Aetna Commercial |
$3,800.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,550.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,550.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,550.00
|
| Rate for Payer: Cigna Commercial |
$5,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,420.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,200.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,500.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$241.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$265.00
|
|
|
THROMBECTOMY SET 4FR SOLENT
|
Facility
|
IP
|
$10,000.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
270650590
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$2,420.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,420.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,200.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,500.00
|
|
|
THROMBECTOMY SET 4FR SOLENT
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
270650590
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.00 |
| Max. Negotiated Rate |
$5,000.00 |
| Rate for Payer: Aetna Commercial |
$3,800.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,550.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,550.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,550.00
|
| Rate for Payer: Cigna Commercial |
$5,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,420.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,200.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,500.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$241.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$265.00
|
|
|
THROMBECTOMY SET 4FR SOLENT
|
Facility
|
OP
|
$2,240.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
270650590N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.98 |
| Max. Negotiated Rate |
$1,120.00 |
| Rate for Payer: Aetna Commercial |
$851.20
|
| Rate for Payer: Aetna Medicare Advantage |
$672.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$571.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$571.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$448.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,120.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$542.08
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$492.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$336.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$53.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$59.36
|
|
|
THROMBECTOMY SET 4FR SOLENT
|
Facility
|
IP
|
$10,000.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
270650590S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$2,420.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,420.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,200.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,500.00
|
|
|
THROMBECTOMY SET 4FR SOLENT
|
Facility
|
IP
|
$2,240.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
270650590N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$336.00 |
| Max. Negotiated Rate |
$542.08 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$448.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$542.08
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$492.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$336.00
|
|
