|
CATHETER SET CRICOTHYROTOMY
|
Facility
|
IP
|
$2,274.90
|
|
| Hospital Charge Code |
270660191
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$341.24 |
| Max. Negotiated Rate |
$550.53 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$454.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$550.53
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$500.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$341.24
|
|
|
CATHETER SET EVD
|
Facility
|
IP
|
$2,925.00
|
|
| Hospital Charge Code |
270667557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$438.75 |
| Max. Negotiated Rate |
$707.85 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$585.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$707.85
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$643.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$438.75
|
|
|
CATHETER SET EVD
|
Facility
|
OP
|
$2,925.00
|
|
| Hospital Charge Code |
270667557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.49 |
| Max. Negotiated Rate |
$1,462.50 |
| Rate for Payer: Aetna Commercial |
$1,111.50
|
| Rate for Payer: Aetna Medicare Advantage |
$877.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$745.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$745.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$585.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$745.88
|
| Rate for Payer: Cigna Commercial |
$1,462.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$707.85
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$643.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$438.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$70.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$77.51
|
|
|
CATHETER SET SUPRAPUBIC
|
Facility
|
OP
|
$2,287.80
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
270658452
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.14 |
| Max. Negotiated Rate |
$1,143.90 |
| Rate for Payer: Aetna Commercial |
$869.36
|
| Rate for Payer: Aetna Medicare Advantage |
$686.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$583.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$583.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$583.39
|
| Rate for Payer: Cigna Commercial |
$1,143.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$686.34
|
| Rate for Payer: Oxford Commercial |
$457.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$343.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$457.56
|
| Rate for Payer: UnitedHealthcare Community & State |
$55.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$60.63
|
|
|
CATHETER SET SUPRAPUBIC
|
Facility
|
IP
|
$2,287.80
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
270658452
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$343.17 |
| Max. Negotiated Rate |
$343.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$343.17
|
|
|
CATHETER SHOCKWAVE 3.5X60MM
|
Facility
|
OP
|
$17,250.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270698156V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$415.73 |
| Max. Negotiated Rate |
$8,625.00 |
| Rate for Payer: Aetna Commercial |
$6,555.00
|
| Rate for Payer: Aetna Medicare Advantage |
$5,175.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,398.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,398.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,398.75
|
| Rate for Payer: Cigna Commercial |
$8,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,174.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,795.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,587.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$415.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$457.12
|
|
|
CATHETER SHOCKWAVE 3.5X60MM
|
Facility
|
IP
|
$17,250.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270698156V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,587.50 |
| Max. Negotiated Rate |
$4,174.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,174.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,795.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,587.50
|
|
|
CATHETER SILCNE 18F 5cc 165818
|
Facility
|
OP
|
$17.85
|
|
| Hospital Charge Code |
270611853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$8.93 |
| Rate for Payer: Aetna Commercial |
$6.78
|
| Rate for Payer: Aetna Medicare Advantage |
$5.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.55
|
| Rate for Payer: Cigna Commercial |
$8.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.36
|
| Rate for Payer: Oxford Commercial |
$3.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.57
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.47
|
|
|
CATHETER SILCNE 18F 5cc 165818
|
Facility
|
IP
|
$17.85
|
|
| Hospital Charge Code |
270611853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.68
|
|
|
CATHETER SILICONE 8.5 FR X 26
|
Facility
|
OP
|
$630.70
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
270698594
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$315.35 |
| Rate for Payer: Aetna Commercial |
$239.67
|
| Rate for Payer: Aetna Medicare Advantage |
$189.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$160.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$160.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$160.83
|
| Rate for Payer: Cigna Commercial |
$315.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$152.63
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$138.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.61
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.71
|
|
|
CATHETER SILICONE 8.5 FR X 26
|
Facility
|
IP
|
$630.70
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
270698594
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.61 |
| Max. Negotiated Rate |
$152.63 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$152.63
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$138.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.61
|
|
|
CATHETER SILVERHAWK L-SM LG VE
|
Facility
|
OP
|
$15,625.00
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
270657512
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$376.56 |
| Max. Negotiated Rate |
$7,812.50 |
| Rate for Payer: Aetna Commercial |
$5,937.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4,687.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,984.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,984.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,125.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,984.38
|
| Rate for Payer: Cigna Commercial |
$7,812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,781.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,437.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,343.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$376.56
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$414.06
|
|
|
CATHETER SILVERHAWK L-SM LG VE
|
Facility
|
IP
|
$15,625.00
|
|
| Hospital Charge Code |
270642865
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,343.75 |
| Max. Negotiated Rate |
$3,781.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,781.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,437.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,343.75
|
|
|
CATHETER SILVERHAWK L-SM LG VE
|
Facility
|
IP
|
$15,625.00
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
270657512
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,343.75 |
| Max. Negotiated Rate |
$3,781.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,781.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,437.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,343.75
|
|
|
CATHETER SILVERHAWK L-SM LG VE
|
Facility
|
OP
|
$15,625.00
|
|
| Hospital Charge Code |
270642865
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$376.56 |
| Max. Negotiated Rate |
$7,812.50 |
| Rate for Payer: Aetna Commercial |
$5,937.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4,687.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,984.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,984.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,125.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,984.38
|
| Rate for Payer: Cigna Commercial |
$7,812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,781.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,437.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,343.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$376.56
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$414.06
|
|
|
CATHETER SIM2 RIST 120CM
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270696077S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$145.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$132.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.00
|
|
|
CATHETER SIM2 RIST 120CM
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270696077S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.46 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$228.00
|
| Rate for Payer: Aetna Medicare Advantage |
$180.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$153.00
|
| Rate for Payer: Cigna Commercial |
$300.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$132.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.90
|
|
|
CATHETER SIM I 5FR
|
Facility
|
IP
|
$27.91
|
|
| Hospital Charge Code |
270651799
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.19
|
|
|
CATHETER SIM I 5FR
|
Facility
|
OP
|
$27.91
|
|
| Hospital Charge Code |
270651799
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$13.96 |
| Rate for Payer: Aetna Commercial |
$10.61
|
| Rate for Payer: Aetna Medicare Advantage |
$8.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.12
|
| Rate for Payer: Cigna Commercial |
$13.96
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.37
|
| Rate for Payer: Oxford Commercial |
$5.58
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.58
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.74
|
|
|
CATHETER SOLIAIRE PLAT 4X40 MM
|
Facility
|
OP
|
$37,475.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
270685020S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$903.15 |
| Max. Negotiated Rate |
$18,737.50 |
| Rate for Payer: Aetna Commercial |
$14,240.50
|
| Rate for Payer: Aetna Medicare Advantage |
$11,242.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9,556.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9,556.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,495.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9,556.12
|
| Rate for Payer: Cigna Commercial |
$18,737.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,068.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8,244.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,621.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$903.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$993.09
|
|
|
CATHETER SOLIAIRE PLAT 4X40 MM
|
Facility
|
IP
|
$37,475.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
270685020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,621.25 |
| Max. Negotiated Rate |
$9,068.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,495.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,068.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8,244.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,621.25
|
|
|
CATHETER SOLIAIRE PLAT 4X40 MM
|
Facility
|
OP
|
$37,475.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
270685020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$903.15 |
| Max. Negotiated Rate |
$18,737.50 |
| Rate for Payer: Aetna Commercial |
$14,240.50
|
| Rate for Payer: Aetna Medicare Advantage |
$11,242.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9,556.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9,556.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,495.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9,556.12
|
| Rate for Payer: Cigna Commercial |
$18,737.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,068.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8,244.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,621.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$903.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$993.09
|
|
|
CATHETER SOLIAIRE PLAT 4X40 MM
|
Facility
|
IP
|
$37,475.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
270685020S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,621.25 |
| Max. Negotiated Rate |
$9,068.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,495.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,068.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8,244.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,621.25
|
|
|
CATHETER SOLIDCROWNORBITAL2.25
|
Facility
|
IP
|
$15,975.00
|
|
| Hospital Charge Code |
270642391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,396.25 |
| Max. Negotiated Rate |
$3,865.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,195.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,865.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,514.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,396.25
|
|
|
CATHETER SOLIDCROWNORBITAL2.25
|
Facility
|
OP
|
$15,975.00
|
|
| Hospital Charge Code |
270642391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$385.00 |
| Max. Negotiated Rate |
$7,987.50 |
| Rate for Payer: Aetna Commercial |
$6,070.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4,792.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,073.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,073.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,195.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,073.62
|
| Rate for Payer: Cigna Commercial |
$7,987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,865.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,514.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,396.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$385.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$423.34
|
|