|
CATHETER PUSHING PC-5
|
Facility
|
IP
|
$178.10
|
|
| Hospital Charge Code |
270634355
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.71 |
| Max. Negotiated Rate |
$26.71 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.71
|
|
|
CATHETER PUSHING PC-5
|
Facility
|
OP
|
$178.10
|
|
| Hospital Charge Code |
270634355
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$89.05 |
| Rate for Payer: Aetna Commercial |
$67.68
|
| Rate for Payer: Aetna Medicare Advantage |
$53.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$45.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$45.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$45.42
|
| Rate for Payer: Cigna Commercial |
$89.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$53.43
|
| Rate for Payer: Oxford Commercial |
$35.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.71
|
| Rate for Payer: UnitedHealthcare Commercial |
$35.62
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.72
|
|
|
CATHETER QUICK C 2 3FRx150cm
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270679801S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.75 |
| Max. Negotiated Rate |
$223.85 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$185.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$223.85
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$203.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$138.75
|
|
|
CATHETER QUICK C 2 3FRx150cm
|
Facility
|
IP
|
$1,020.95
|
|
| Hospital Charge Code |
270679801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.14 |
| Max. Negotiated Rate |
$247.07 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$204.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$247.07
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$224.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.14
|
|
|
CATHETER QUICK C 2 3FRx150cm
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270679801S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.29 |
| Max. Negotiated Rate |
$462.50 |
| Rate for Payer: Aetna Commercial |
$351.50
|
| Rate for Payer: Aetna Medicare Advantage |
$277.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$235.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$235.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$185.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$235.88
|
| Rate for Payer: Cigna Commercial |
$462.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$223.85
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$203.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$138.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.51
|
|
|
CATHETER QUICK C 2 3FRx150cm
|
Facility
|
OP
|
$994.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270679801N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.97 |
| Max. Negotiated Rate |
$497.25 |
| Rate for Payer: Aetna Commercial |
$377.91
|
| Rate for Payer: Aetna Medicare Advantage |
$298.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$253.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$253.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$198.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$253.60
|
| Rate for Payer: Cigna Commercial |
$497.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$240.67
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$218.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$149.18
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.97
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.35
|
|
|
CATHETER QUICK C 2 3FRx150cm
|
Facility
|
IP
|
$994.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270679801N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.18 |
| Max. Negotiated Rate |
$240.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$198.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$240.67
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$218.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$149.18
|
|
|
CATHETER QUICK C 2 3FRx150cm
|
Facility
|
OP
|
$1,020.95
|
|
| Hospital Charge Code |
270679801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$510.48 |
| Rate for Payer: Aetna Commercial |
$387.96
|
| Rate for Payer: Aetna Medicare Advantage |
$306.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$260.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$260.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$204.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$260.34
|
| Rate for Payer: Cigna Commercial |
$510.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$247.07
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$224.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.14
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.06
|
|
|
CATHETER QUICK CROSS .018X150C
|
Facility
|
OP
|
$835.00
|
|
| Hospital Charge Code |
270642211
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$417.50 |
| Rate for Payer: Aetna Commercial |
$317.30
|
| Rate for Payer: Aetna Medicare Advantage |
$250.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$212.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$212.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$167.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$212.93
|
| Rate for Payer: Cigna Commercial |
$417.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$202.07
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$183.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$22.13
|
|
|
CATHETER QUICK CROSS .018X150C
|
Facility
|
IP
|
$835.00
|
|
| Hospital Charge Code |
270642211
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.25 |
| Max. Negotiated Rate |
$202.07 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$167.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$202.07
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$183.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.25
|
|
|
CATHETER QUICK CROSS .035x135
|
Facility
|
IP
|
$835.00
|
|
| Hospital Charge Code |
2709003695
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.25 |
| Max. Negotiated Rate |
$125.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.25
|
|
|
CATHETER QUICK CROSS .035x135
|
Facility
|
OP
|
$835.00
|
|
| Hospital Charge Code |
2709003695
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$417.50 |
| Rate for Payer: Aetna Commercial |
$317.30
|
| Rate for Payer: Aetna Medicare Advantage |
$250.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$212.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$212.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$212.93
|
| Rate for Payer: Cigna Commercial |
$417.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$250.50
|
| Rate for Payer: Oxford Commercial |
$167.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$167.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$22.13
|
|
|
CATHETER QUICK CROSS .035X135
|
Facility
|
OP
|
$835.00
|
|
| Hospital Charge Code |
270642212
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$417.50 |
| Rate for Payer: Aetna Commercial |
$317.30
|
| Rate for Payer: Aetna Medicare Advantage |
$250.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$212.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$212.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$167.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$212.93
|
| Rate for Payer: Cigna Commercial |
$417.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$202.07
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$183.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$22.13
|
|
|
CATHETER QUICK CROSS .035X135
|
Facility
|
IP
|
$835.00
|
|
| Hospital Charge Code |
270642212
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.25 |
| Max. Negotiated Rate |
$202.07 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$167.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$202.07
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$183.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.25
|
|
|
CATHETER REACT 68
|
Facility
|
IP
|
$11,600.00
|
|
| Hospital Charge Code |
270685185
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,740.00 |
| Max. Negotiated Rate |
$1,740.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,740.00
|
|
|
CATHETER REACT 68
|
Facility
|
OP
|
$11,600.00
|
|
| Hospital Charge Code |
270685185
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$279.56 |
| Max. Negotiated Rate |
$5,800.00 |
| Rate for Payer: Aetna Commercial |
$4,408.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,480.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,958.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,958.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,958.00
|
| Rate for Payer: Cigna Commercial |
$5,800.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,480.00
|
| Rate for Payer: Oxford Commercial |
$2,320.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,740.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,320.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$279.56
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$307.40
|
|
|
CATHETER RED72KIT TUBING
|
Facility
|
IP
|
$13,975.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
270693923C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.25 |
| Max. Negotiated Rate |
$3,381.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,795.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,381.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,074.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,096.25
|
|
|
CATHETER RED72KIT TUBING
|
Facility
|
OP
|
$13,975.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
270693923C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$336.80 |
| Max. Negotiated Rate |
$6,987.50 |
| Rate for Payer: Aetna Commercial |
$5,310.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4,192.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,563.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,563.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,795.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,563.62
|
| Rate for Payer: Cigna Commercial |
$6,987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,381.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,074.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,096.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$336.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$370.34
|
|
|
CATHETER REDDICK CHOLAGIOGRAPH
|
Facility
|
OP
|
$2,873.75
|
|
| Hospital Charge Code |
270657231
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.26 |
| Max. Negotiated Rate |
$1,436.88 |
| Rate for Payer: Aetna Commercial |
$1,092.03
|
| Rate for Payer: Aetna Medicare Advantage |
$862.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$732.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$732.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$574.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$732.81
|
| Rate for Payer: Cigna Commercial |
$1,436.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$695.45
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$632.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$431.06
|
| Rate for Payer: UnitedHealthcare Community & State |
$69.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$76.15
|
|
|
CATHETER REDDICK CHOLAGIOGRAPH
|
Facility
|
OP
|
$2,738.75
|
|
| Hospital Charge Code |
270651797
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$1,369.38 |
| Rate for Payer: Aetna Commercial |
$1,040.72
|
| Rate for Payer: Aetna Medicare Advantage |
$821.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$698.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$698.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$547.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$698.38
|
| Rate for Payer: Cigna Commercial |
$1,369.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$662.78
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$602.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$410.81
|
| Rate for Payer: UnitedHealthcare Community & State |
$66.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$72.58
|
|
|
CATHETER REDDICK CHOLAGIOGRAPH
|
Facility
|
IP
|
$2,738.75
|
|
| Hospital Charge Code |
270651797
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$410.81 |
| Max. Negotiated Rate |
$662.78 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$547.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$662.78
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$602.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$410.81
|
|
|
CATHETER REDDICK CHOLAGIOGRAPH
|
Facility
|
IP
|
$2,873.75
|
|
| Hospital Charge Code |
270657231
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$431.06 |
| Max. Negotiated Rate |
$695.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$574.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$695.45
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$632.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$431.06
|
|
|
CATHETER REDDICK CHOLAGIOGRAPH
|
Facility
|
IP
|
$2,873.75
|
|
| Hospital Charge Code |
270657233
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$431.06 |
| Max. Negotiated Rate |
$695.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$574.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$695.45
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$632.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$431.06
|
|
|
CATHETER REDDICK CHOLAGIOGRAPH
|
Facility
|
OP
|
$2,873.75
|
|
| Hospital Charge Code |
270657233
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.26 |
| Max. Negotiated Rate |
$1,436.88 |
| Rate for Payer: Aetna Commercial |
$1,092.03
|
| Rate for Payer: Aetna Medicare Advantage |
$862.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$732.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$732.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$574.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$732.81
|
| Rate for Payer: Cigna Commercial |
$1,436.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$695.45
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$632.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$431.06
|
| Rate for Payer: UnitedHealthcare Community & State |
$69.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$76.15
|
|
|
CATHETER REPERFUSION 3MAX
|
Facility
|
IP
|
$7,450.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270682973N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,117.50 |
| Max. Negotiated Rate |
$1,802.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,490.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,802.90
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,639.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,117.50
|
|
