|
WIRE PVASC 40x38x200
|
Facility
|
OP
|
$19,975.00
|
|
| Hospital Charge Code |
270705438
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$481.40 |
| Max. Negotiated Rate |
$9,987.50 |
| Rate for Payer: Aetna Commercial |
$7,590.50
|
| Rate for Payer: Aetna Medicare Advantage |
$5,992.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,093.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,093.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,093.62
|
| Rate for Payer: Cigna Commercial |
$9,987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,992.50
|
| Rate for Payer: Oxford Commercial |
$3,995.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,996.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,995.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$481.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$529.34
|
|
|
WIRE PVASC 60x44x200
|
Facility
|
OP
|
$19,975.00
|
|
| Hospital Charge Code |
270705439
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$481.40 |
| Max. Negotiated Rate |
$9,987.50 |
| Rate for Payer: Aetna Commercial |
$7,590.50
|
| Rate for Payer: Aetna Medicare Advantage |
$5,992.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,093.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,093.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,093.62
|
| Rate for Payer: Cigna Commercial |
$9,987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,992.50
|
| Rate for Payer: Oxford Commercial |
$3,995.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,996.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,995.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$481.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$529.34
|
|
|
WIRE PVASC 60x44x200
|
Facility
|
IP
|
$19,975.00
|
|
| Hospital Charge Code |
270705439
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$2,996.25 |
| Max. Negotiated Rate |
$2,996.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,996.25
|
|
|
WIRE REDUCTION 1.8MM
|
Facility
|
OP
|
$1,094.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691907
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.37 |
| Max. Negotiated Rate |
$547.02 |
| Rate for Payer: Aetna Commercial |
$415.74
|
| Rate for Payer: Aetna Medicare Advantage |
$328.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$278.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$278.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$218.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$278.98
|
| Rate for Payer: Cigna Commercial |
$547.02
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$264.76
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$240.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$164.11
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.99
|
|
|
WIRE REDUCTION 1.8MM
|
Facility
|
IP
|
$1,094.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691907
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$164.11 |
| Max. Negotiated Rate |
$264.76 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$218.81
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$264.76
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$240.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$164.11
|
|
|
WIRE REDUCTION 1.8MM D 400mm L
|
Facility
|
IP
|
$1,091.65
|
|
| Hospital Charge Code |
270681238
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$163.75 |
| Max. Negotiated Rate |
$163.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$163.75
|
|
|
WIRE REDUCTION 1.8MM D 400mm L
|
Facility
|
OP
|
$1,091.65
|
|
| Hospital Charge Code |
270681238
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.31 |
| Max. Negotiated Rate |
$545.83 |
| Rate for Payer: Aetna Commercial |
$414.83
|
| Rate for Payer: Aetna Medicare Advantage |
$327.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$278.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$278.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$278.37
|
| Rate for Payer: Cigna Commercial |
$545.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$327.50
|
| Rate for Payer: Oxford Commercial |
$218.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$163.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$218.33
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.31
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.93
|
|
|
WIRE RNTHRG NS 3cm/22cm/180cm
|
Facility
|
IP
|
$450.00
|
|
| Hospital Charge Code |
2709003599
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.50 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.50
|
|
|
WIRE RNTHRG NS 3cm/22cm/180cm
|
Facility
|
OP
|
$450.00
|
|
| Hospital Charge Code |
2709003599
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.85 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna Commercial |
$171.00
|
| Rate for Payer: Aetna Medicare Advantage |
$135.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$114.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$114.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$114.75
|
| Rate for Payer: Cigna Commercial |
$225.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$135.00
|
| Rate for Payer: Oxford Commercial |
$90.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$90.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.93
|
|
|
WIRE RUNTHROUGH NS 3CM/22CM/18
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270642945N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.50 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$90.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$108.90
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$99.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.50
|
|
|
WIRE RUNTHROUGH NS 3CM/22CM/18
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270642945N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.85 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna Commercial |
$171.00
|
| Rate for Payer: Aetna Medicare Advantage |
$135.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$114.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$114.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$114.75
|
| Rate for Payer: Cigna Commercial |
$225.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$108.90
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$99.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.93
|
|
|
WIRE RUNTHROUGH NS 3CM/22CM/18
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270642945S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$79.50 |
| Max. Negotiated Rate |
$128.26 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$106.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$128.26
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$116.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$79.50
|
|
|
WIRE RUNTHROUGH NS 3CM/22CM/18
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270642945S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.77 |
| Max. Negotiated Rate |
$265.00 |
| Rate for Payer: Aetna Commercial |
$201.40
|
| Rate for Payer: Aetna Medicare Advantage |
$159.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$135.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$135.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$106.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$135.15
|
| Rate for Payer: Cigna Commercial |
$265.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$128.26
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$116.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$79.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.77
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.04
|
|
|
WIRE RUNTHROUGH NS 3CM/22CM/18
|
Facility
|
IP
|
$3,100.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270642945
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.00 |
| Max. Negotiated Rate |
$750.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$620.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$750.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$682.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$465.00
|
|
|
WIRE RUNTHROUGH NS 3CM/22CM/18
|
Facility
|
OP
|
$3,100.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270642945
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.71 |
| Max. Negotiated Rate |
$1,550.00 |
| Rate for Payer: Aetna Commercial |
$1,178.00
|
| Rate for Payer: Aetna Medicare Advantage |
$930.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$790.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$790.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$620.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$790.50
|
| Rate for Payer: Cigna Commercial |
$1,550.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$750.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$682.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$465.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$74.71
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$82.15
|
|
|
WIRE SAFE JC 018x45 TSCF181453
|
Facility
|
IP
|
$84.25
|
|
| Hospital Charge Code |
270633613
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.64 |
| Max. Negotiated Rate |
$20.39 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$16.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.39
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$18.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.64
|
|
|
WIRE SAFE JC 018x45 TSCF181453
|
Facility
|
OP
|
$84.25
|
|
| Hospital Charge Code |
270633613
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$42.12 |
| Rate for Payer: Aetna Commercial |
$32.02
|
| Rate for Payer: Aetna Medicare Advantage |
$25.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$21.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$21.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$16.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$21.48
|
| Rate for Payer: Cigna Commercial |
$42.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.39
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$18.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.64
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.23
|
|
|
WIRE SMOOTH 2 MM
|
Facility
|
IP
|
$660.00
|
|
| Hospital Charge Code |
270684458
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.00
|
|
|
WIRE SMOOTH 2 MM
|
Facility
|
OP
|
$660.00
|
|
| Hospital Charge Code |
270684458
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna Commercial |
$250.80
|
| Rate for Payer: Aetna Medicare Advantage |
$198.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$168.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$168.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$168.30
|
| Rate for Payer: Cigna Commercial |
$330.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$198.00
|
| Rate for Payer: Oxford Commercial |
$132.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$132.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.49
|
|
|
WIRE SPADE-POINT 1.8X400 29239
|
Facility
|
IP
|
$788.70
|
|
| Hospital Charge Code |
270633841
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.31 |
| Max. Negotiated Rate |
$190.87 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$157.74
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$190.87
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$173.51
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$118.31
|
|
|
WIRE SPADE-POINT 1.8X400 29239
|
Facility
|
OP
|
$788.70
|
|
| Hospital Charge Code |
270633841
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.01 |
| Max. Negotiated Rate |
$394.35 |
| Rate for Payer: Aetna Commercial |
$299.71
|
| Rate for Payer: Aetna Medicare Advantage |
$236.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$201.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$201.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$157.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$201.12
|
| Rate for Payer: Cigna Commercial |
$394.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$190.87
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$173.51
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$118.31
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20.90
|
|
|
WIRE SPADE-POINT 2.0x400MM
|
Facility
|
OP
|
$1,059.85
|
|
| Hospital Charge Code |
270638915
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.54 |
| Max. Negotiated Rate |
$529.92 |
| Rate for Payer: Aetna Commercial |
$402.74
|
| Rate for Payer: Aetna Medicare Advantage |
$317.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$270.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$270.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$211.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$270.26
|
| Rate for Payer: Cigna Commercial |
$529.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$256.48
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$233.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$158.98
|
| Rate for Payer: UnitedHealthcare Community & State |
$25.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.09
|
|
|
WIRE SPADE-POINT 2.0x400MM
|
Facility
|
IP
|
$1,059.85
|
|
| Hospital Charge Code |
270638915
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.98 |
| Max. Negotiated Rate |
$256.48 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$211.97
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$256.48
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$233.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$158.98
|
|
|
WIRE SPAD-PT 1.8mmX350mm 29238
|
Facility
|
OP
|
$250.50
|
|
| Hospital Charge Code |
270633449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$125.25 |
| Rate for Payer: Aetna Commercial |
$95.19
|
| Rate for Payer: Aetna Medicare Advantage |
$75.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$63.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$63.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$50.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$63.88
|
| Rate for Payer: Cigna Commercial |
$125.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$60.62
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$55.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.58
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.64
|
|
|
WIRE SPAD-PT 1.8mmX350mm 29238
|
Facility
|
IP
|
$250.50
|
|
| Hospital Charge Code |
270633449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.58 |
| Max. Negotiated Rate |
$60.62 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$50.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$60.62
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$55.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.58
|
|
