|
GWIRE COUG XT300CM CGRXT300HJ
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270636548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna Medicare Advantage |
$112.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$95.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$95.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$75.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$95.62
|
| Rate for Payer: Cigna Commercial |
$187.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$90.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.65
|
|
|
GWIRE COUG XT300CM CGRXT300HJ
|
Facility
|
OP
|
$719.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270636548N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.43 |
| Max. Negotiated Rate |
$359.62 |
| Rate for Payer: Aetna Commercial |
$273.31
|
| Rate for Payer: Aetna Medicare Advantage |
$215.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$183.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$183.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$143.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$183.41
|
| Rate for Payer: Cigna Commercial |
$359.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$174.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$107.89
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20.43
|
|
|
GWIRE CROSS XT100 190 1003309H
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270636701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna Medicare Advantage |
$112.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$95.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$95.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$75.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$95.62
|
| Rate for Payer: Cigna Commercial |
$187.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$90.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.65
|
|
|
GWIRE CROSS XT100 190 1003309H
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270636701N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$190.00
|
| Rate for Payer: Aetna Medicare Advantage |
$150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$127.50
|
| Rate for Payer: Cigna Commercial |
$250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$121.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.20
|
|
|
GWIRE CROSS XT100 190 1003309H
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270636701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$90.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$75.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$90.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
|
|
GWIRE CROSS XT100 190 1003309H
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270636701N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$121.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$121.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
|
|
GWIRE CROSS XT100 300 1003310H
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270636702N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$121.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$121.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
|
|
GWIRE CROSS XT100 300 1003310H
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270636702
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna Medicare Advantage |
$112.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$95.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$95.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$75.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$95.62
|
| Rate for Payer: Cigna Commercial |
$187.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$90.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.65
|
|
|
GWIRE CROSS XT100 300 1003310H
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270636702N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$190.00
|
| Rate for Payer: Aetna Medicare Advantage |
$150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$127.50
|
| Rate for Payer: Cigna Commercial |
$250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$121.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.20
|
|
|
GWIRE CROSS XT100 300 1003310H
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270636702
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$90.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$75.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$90.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
|
|
GWIRE MIRACLEB 12 180 8290301
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270642966C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$101.25 |
| Max. Negotiated Rate |
$163.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$135.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$163.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$101.25
|
|
|
GWIRE MIRACLEB 12 180 8290301
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270642966C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.17 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: Aetna Medicare Advantage |
$202.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$172.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$172.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$135.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$172.12
|
| Rate for Payer: Cigna Commercial |
$337.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$163.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$101.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.33
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.17
|
|
|
GWIRE MIRACLEBR 12X300 8290302
|
Facility
|
IP
|
$625.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270642967C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$93.75 |
| Max. Negotiated Rate |
$151.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$151.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.75
|
|
|
GWIRE MIRACLEBR 12X300 8290302
|
Facility
|
OP
|
$625.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270642967C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.75 |
| Max. Negotiated Rate |
$312.50 |
| Rate for Payer: Aetna Commercial |
$237.50
|
| Rate for Payer: Aetna Medicare Advantage |
$187.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$159.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$159.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$125.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$159.38
|
| Rate for Payer: Cigna Commercial |
$312.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$151.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.75
|
|
|
GWIRE NEURO SS .014X300
|
Facility
|
OP
|
$4,022.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270697470S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$114.24 |
| Max. Negotiated Rate |
$2,011.25 |
| Rate for Payer: Aetna Commercial |
$1,528.55
|
| Rate for Payer: Aetna Medicare Advantage |
$1,206.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,025.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,025.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$804.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,025.74
|
| Rate for Payer: Cigna Commercial |
$2,011.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$973.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$603.38
|
| Rate for Payer: UnitedHealthcare Community & State |
$127.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$114.24
|
|
|
GWIRE NEURO SS .014X300
|
Facility
|
IP
|
$4,022.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270697470S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$603.38 |
| Max. Negotiated Rate |
$973.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$804.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$973.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$603.38
|
|
|
GWIRE NIT PLAT 18X40 MAK001N40
|
Facility
|
OP
|
$113.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270660311
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$56.62 |
| Rate for Payer: Aetna Commercial |
$43.03
|
| Rate for Payer: Aetna Medicare Advantage |
$33.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$28.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$28.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$22.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$28.88
|
| Rate for Payer: Cigna Commercial |
$56.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.41
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.99
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.22
|
|
|
GWIRE NIT PLAT 18X40 MAK001N40
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270660311N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.55 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.55
|
|
|
GWIRE NIT PLAT 18X40 MAK001N40
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270660311N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$68.50 |
| Rate for Payer: Aetna Commercial |
$52.06
|
| Rate for Payer: Aetna Medicare Advantage |
$41.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.94
|
| Rate for Payer: Cigna Commercial |
$68.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.55
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.33
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.89
|
|
|
GWIRE NIT PLAT 18X40 MAK001N40
|
Facility
|
IP
|
$113.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270660311S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$27.41 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$22.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.41
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.99
|
|
|
GWIRE NIT PLAT 18X40 MAK001N40
|
Facility
|
IP
|
$113.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270660311
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$27.41 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$22.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.41
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.99
|
|
|
GWIRE NIT PLAT 18X40 MAK001N40
|
Facility
|
OP
|
$113.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270660311S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$56.62 |
| Rate for Payer: Aetna Commercial |
$43.03
|
| Rate for Payer: Aetna Medicare Advantage |
$33.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$28.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$28.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$22.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$28.88
|
| Rate for Payer: Cigna Commercial |
$56.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.41
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.99
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.22
|
|
|
GWIRE PROWTR 180CM 1277601
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270636741
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$90.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$75.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$90.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
|
|
GWIRE PROWTR 180CM 1277601
|
Facility
|
OP
|
$2,108.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270636741N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$59.87 |
| Max. Negotiated Rate |
$1,054.00 |
| Rate for Payer: Aetna Commercial |
$801.04
|
| Rate for Payer: Aetna Medicare Advantage |
$632.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$537.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$537.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$421.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$537.54
|
| Rate for Payer: Cigna Commercial |
$1,054.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$510.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$316.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$66.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$59.87
|
|
|
GWIRE PROWTR 180CM 1277601
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270636741
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna Medicare Advantage |
$112.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$95.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$95.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$75.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$95.62
|
| Rate for Payer: Cigna Commercial |
$187.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$90.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.65
|
|
