|
CATHETER PERFORMA
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
2709000688
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
CATHETER PERFORMA
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
2709000688
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$15.20
|
| Rate for Payer: Aetna Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.20
|
| Rate for Payer: Cigna Commercial |
$20.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.00
|
| Rate for Payer: Oxford Commercial |
$8.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.06
|
|
|
CATHETER PERFORMA 145 DEGREE C
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
270658203
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$9.68 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.68
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
CATHETER PERFORMA 145 DEGREE C
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
270658203
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$15.20
|
| Rate for Payer: Aetna Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.20
|
| Rate for Payer: Cigna Commercial |
$20.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.68
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.06
|
|
|
CATHETER PERFORMA 5 F 65 CM
|
Facility
|
OP
|
$135.60
|
|
| Hospital Charge Code |
270690529
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$67.80 |
| Rate for Payer: Aetna Commercial |
$51.53
|
| Rate for Payer: Aetna Medicare Advantage |
$40.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.58
|
| Rate for Payer: Cigna Commercial |
$67.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$40.68
|
| Rate for Payer: Oxford Commercial |
$27.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$27.12
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.59
|
|
|
CATHETER PERFORMA 5 F 65 CM
|
Facility
|
IP
|
$135.60
|
|
| Hospital Charge Code |
270690529
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.34 |
| Max. Negotiated Rate |
$20.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.34
|
|
|
CATHETER PERFORMA AMPLATZ LEF
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
270658195
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$9.68 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.68
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
CATHETER PERFORMA AMPLATZ LEF
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
270658192
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$15.20
|
| Rate for Payer: Aetna Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.20
|
| Rate for Payer: Cigna Commercial |
$20.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.68
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.06
|
|
|
CATHETER PERFORMA AMPLATZ LEF
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
270658195
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$15.20
|
| Rate for Payer: Aetna Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.20
|
| Rate for Payer: Cigna Commercial |
$20.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.68
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.06
|
|
|
CATHETER PERFORMA AMPLATZ LEF
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
270658192
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$9.68 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.68
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
CATHETER PERFORMA AMPLATZ RIGH
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
270658191
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$15.20
|
| Rate for Payer: Aetna Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.20
|
| Rate for Payer: Cigna Commercial |
$20.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.68
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.06
|
|
|
CATHETER PERFORMA AMPLATZ RIGH
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
270658191
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$9.68 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.68
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
CATHETER PERFORMA AMPLATZ RIGH
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
270658189
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$9.68 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.68
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
CATHETER PERFORMA AMPLATZ RIGH
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
270658189
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$15.20
|
| Rate for Payer: Aetna Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.20
|
| Rate for Payer: Cigna Commercial |
$20.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.68
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.06
|
|
|
CATHETER PERFORMA JUDKINS LEFT
|
Facility
|
OP
|
$37.35
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270658176
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$18.68 |
| Rate for Payer: Aetna Commercial |
$14.19
|
| Rate for Payer: Aetna Medicare Advantage |
$11.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.52
|
| Rate for Payer: Cigna Commercial |
$18.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.04
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.99
|
|
|
CATHETER PERFORMA JUDKINS LEFT
|
Facility
|
IP
|
$37.35
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270658176
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$9.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.04
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.60
|
|
|
CATHETER PERFORMA JUDKINS LEFT
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
270658164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$9.68 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.68
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
CATHETER PERFORMA JUDKINS LEFT
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
270658164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$15.20
|
| Rate for Payer: Aetna Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.20
|
| Rate for Payer: Cigna Commercial |
$20.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.68
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.06
|
|
|
CATHETER PERFORMA JUDKINS LEFT
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
270658177
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$9.68 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.68
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
CATHETER PERFORMA JUDKINS LEFT
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
270658177
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$15.20
|
| Rate for Payer: Aetna Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.20
|
| Rate for Payer: Cigna Commercial |
$20.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.68
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.06
|
|
|
CATHETER PERFORMA JUDKINS RIGH
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
270658181
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$9.68 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.68
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
CATHETER PERFORMA JUDKINS RIGH
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
270658185
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$9.68 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.68
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
CATHETER PERFORMA JUDKINS RIGH
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
270658181
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$15.20
|
| Rate for Payer: Aetna Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.20
|
| Rate for Payer: Cigna Commercial |
$20.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.68
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.06
|
|
|
CATHETER PERFORMA JUDKINS RIGH
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
270658185
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$15.20
|
| Rate for Payer: Aetna Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.20
|
| Rate for Payer: Cigna Commercial |
$20.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.68
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.06
|
|
|
CATHETER PERFORMA JUDKINS RIGH
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270658179
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$15.20
|
| Rate for Payer: Aetna Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.20
|
| Rate for Payer: Cigna Commercial |
$20.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.68
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.06
|
|
