|
CATH AVIATOR PLUS 4x40mm 142cm
|
Facility
|
IP
|
$2,300.00
|
|
| Hospital Charge Code |
270639629C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$556.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$460.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$556.60
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$506.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$345.00
|
|
|
CATH AVIATOR PLUS 4x40mm 142cm
|
Facility
|
OP
|
$2,300.00
|
|
| Hospital Charge Code |
270639629C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$55.43 |
| Max. Negotiated Rate |
$1,150.00 |
| Rate for Payer: Aetna Commercial |
$874.00
|
| Rate for Payer: Aetna Medicare Advantage |
$690.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$586.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$586.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$460.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$586.50
|
| Rate for Payer: Cigna Commercial |
$1,150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$556.60
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$506.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$345.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$55.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$60.95
|
|
|
CATH AVIATOR PLUS 5X20MM 142CM
|
Facility
|
IP
|
$2,500.00
|
|
| Hospital Charge Code |
270641370
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$375.00 |
| Max. Negotiated Rate |
$605.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$605.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$550.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$375.00
|
|
|
CATH AVIATOR PLUS 5X20MM 142CM
|
Facility
|
OP
|
$2,500.00
|
|
| Hospital Charge Code |
270641370
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.25 |
| Max. Negotiated Rate |
$1,250.00 |
| Rate for Payer: Aetna Commercial |
$950.00
|
| Rate for Payer: Aetna Medicare Advantage |
$750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$637.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$637.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$605.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$550.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$375.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$60.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$66.25
|
|
|
CATH AVIATOR PLUS 6x20mm 142cm
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270631631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$254.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$210.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$254.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$231.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.50
|
|
|
CATH AVIATOR PLUS 6x20mm 142cm
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270631631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.30 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Aetna Commercial |
$399.00
|
| Rate for Payer: Aetna Medicare Advantage |
$315.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$210.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$267.75
|
| Rate for Payer: Cigna Commercial |
$525.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$254.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$231.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$25.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.82
|
|
|
CATH AVIATOR PLUS 6x40mm 142cm
|
Facility
|
IP
|
$2,300.00
|
|
| Hospital Charge Code |
270639864C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$556.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$460.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$556.60
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$506.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$345.00
|
|
|
CATH AVIATOR PLUS 6x40mm 142cm
|
Facility
|
OP
|
$2,300.00
|
|
| Hospital Charge Code |
270639864C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$55.43 |
| Max. Negotiated Rate |
$1,150.00 |
| Rate for Payer: Aetna Commercial |
$874.00
|
| Rate for Payer: Aetna Medicare Advantage |
$690.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$586.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$586.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$460.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$586.50
|
| Rate for Payer: Cigna Commercial |
$1,150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$556.60
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$506.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$345.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$55.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$60.95
|
|
|
CATH AVIATOR PLUS 7x20mm 142cm
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270639316
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$556.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$460.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$556.60
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$506.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$345.00
|
|
|
CATH AVIATOR PLUS 7x20mm 142cm
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270639316S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$556.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$460.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$556.60
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$506.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$345.00
|
|
|
CATH AVIATOR PLUS 7x20mm 142cm
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270639316
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$55.43 |
| Max. Negotiated Rate |
$1,150.00 |
| Rate for Payer: Aetna Commercial |
$874.00
|
| Rate for Payer: Aetna Medicare Advantage |
$690.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$586.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$586.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$460.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$586.50
|
| Rate for Payer: Cigna Commercial |
$1,150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$556.60
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$506.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$345.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$55.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$60.95
|
|
|
CATH AVIATOR PLUS 7x20mm 142cm
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270639316S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$55.43 |
| Max. Negotiated Rate |
$1,150.00 |
| Rate for Payer: Aetna Commercial |
$874.00
|
| Rate for Payer: Aetna Medicare Advantage |
$690.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$586.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$586.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$460.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$586.50
|
| Rate for Payer: Cigna Commercial |
$1,150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$556.60
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$506.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$345.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$55.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$60.95
|
|
|
CATH AVIATOR PLUX 5X20MM 142
|
Facility
|
OP
|
$1,710.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270641370S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$855.00 |
| Rate for Payer: Aetna Commercial |
$649.80
|
| Rate for Payer: Aetna Medicare Advantage |
$513.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$436.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$436.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$342.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$436.05
|
| Rate for Payer: Cigna Commercial |
$855.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$413.82
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$376.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$256.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$41.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$45.31
|
|
|
CATH AVIATOR PLUX 5X20MM 142
|
Facility
|
IP
|
$1,710.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270641370S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.50 |
| Max. Negotiated Rate |
$413.82 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$342.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$413.82
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$376.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$256.50
|
|
|
CATH BAKER JEJUNOSTOMY 16FR
|
Facility
|
IP
|
$694.45
|
|
| Hospital Charge Code |
270679142
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.17 |
| Max. Negotiated Rate |
$104.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$104.17
|
|
|
CATH BAKER JEJUNOSTOMY 16FR
|
Facility
|
OP
|
$694.45
|
|
| Hospital Charge Code |
270679142
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.74 |
| Max. Negotiated Rate |
$347.23 |
| Rate for Payer: Aetna Commercial |
$263.89
|
| Rate for Payer: Aetna Medicare Advantage |
$208.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$177.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$177.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$177.08
|
| Rate for Payer: Cigna Commercial |
$347.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$208.34
|
| Rate for Payer: Oxford Commercial |
$138.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$104.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$138.89
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.40
|
|
|
CATH BAL 2.5x40x135 T254013501
|
Facility
|
IP
|
$3,968.00
|
|
| Hospital Charge Code |
270635038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$595.20 |
| Max. Negotiated Rate |
$960.26 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$793.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$960.26
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$872.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$595.20
|
|
|
CATH BAL 2.5x40x135 T254013501
|
Facility
|
OP
|
$4,960.00
|
|
| Hospital Charge Code |
270634038
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.54 |
| Max. Negotiated Rate |
$2,480.00 |
| Rate for Payer: Aetna Commercial |
$1,884.80
|
| Rate for Payer: Aetna Medicare Advantage |
$1,488.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,264.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,264.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,264.80
|
| Rate for Payer: Cigna Commercial |
$2,480.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,488.00
|
| Rate for Payer: Oxford Commercial |
$992.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$744.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$992.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$119.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$131.44
|
|
|
CATH BAL 2.5x40x135 T254013501
|
Facility
|
IP
|
$4,960.00
|
|
| Hospital Charge Code |
270634038
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$744.00 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$744.00
|
|
|
CATH BAL 2.5x40x135 T254013501
|
Facility
|
IP
|
$4,232.25
|
|
| Hospital Charge Code |
270635038V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$634.84 |
| Max. Negotiated Rate |
$1,024.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$846.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,024.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$931.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$634.84
|
|
|
CATH BAL 2.5x40x135 T254013501
|
Facility
|
OP
|
$3,968.00
|
|
| Hospital Charge Code |
270635038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.63 |
| Max. Negotiated Rate |
$1,984.00 |
| Rate for Payer: Aetna Commercial |
$1,507.84
|
| Rate for Payer: Aetna Medicare Advantage |
$1,190.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,011.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,011.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$793.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,011.84
|
| Rate for Payer: Cigna Commercial |
$1,984.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$960.26
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$872.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$595.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$95.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$105.15
|
|
|
CATH BAL 2.5x40x135 T254013501
|
Facility
|
OP
|
$4,232.25
|
|
| Hospital Charge Code |
270635038V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$2,116.12 |
| Rate for Payer: Aetna Commercial |
$1,608.26
|
| Rate for Payer: Aetna Medicare Advantage |
$1,269.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,079.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,079.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$846.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,079.22
|
| Rate for Payer: Cigna Commercial |
$2,116.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,024.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$931.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$634.84
|
| Rate for Payer: UnitedHealthcare Community & State |
$102.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$112.15
|
|
|
CATH BAL 3.5x40x135 T354013501
|
Facility
|
OP
|
$4,232.25
|
|
| Hospital Charge Code |
270635040V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$2,116.12 |
| Rate for Payer: Aetna Commercial |
$1,608.26
|
| Rate for Payer: Aetna Medicare Advantage |
$1,269.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,079.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,079.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$846.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,079.22
|
| Rate for Payer: Cigna Commercial |
$2,116.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,024.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$931.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$634.84
|
| Rate for Payer: UnitedHealthcare Community & State |
$102.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$112.15
|
|
|
CATH BAL 3.5x40x135 T354013501
|
Facility
|
IP
|
$3,968.00
|
|
| Hospital Charge Code |
270635040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$595.20 |
| Max. Negotiated Rate |
$960.26 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$793.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$960.26
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$872.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$595.20
|
|
|
CATH BAL 3.5x40x135 T354013501
|
Facility
|
OP
|
$3,968.00
|
|
| Hospital Charge Code |
270635040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.63 |
| Max. Negotiated Rate |
$1,984.00 |
| Rate for Payer: Aetna Commercial |
$1,507.84
|
| Rate for Payer: Aetna Medicare Advantage |
$1,190.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,011.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,011.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$793.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,011.84
|
| Rate for Payer: Cigna Commercial |
$1,984.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$960.26
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$872.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$595.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$95.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$105.15
|
|
