|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270697476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,787.95 |
| Max. Negotiated Rate |
$22,626.50 |
| Rate for Payer: Aetna Commercial |
$13,575.90
|
| Rate for Payer: Aetna Medicare Advantage |
$13,575.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11,539.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11,539.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9,050.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$11,539.51
|
| Rate for Payer: Cigna Commercial |
$22,626.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10,951.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,787.95
|
|
