|
MESH ULTRAPRO HERN SYS MED
|
Facility
|
IP
|
$4,082.90
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270698949
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.43 |
| Max. Negotiated Rate |
$988.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$816.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$988.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$612.43
|
|
|
MESH VENTIO ST HERNIA SMALL
|
Facility
|
IP
|
$3,500.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270688689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$847.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$700.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$847.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$525.00
|
|
|
MESH VENTIO ST HERNIA SMALL
|
Facility
|
OP
|
$3,500.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270688689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.40 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna Commercial |
$1,330.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,050.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$892.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$892.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$700.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$892.50
|
| Rate for Payer: Cigna Commercial |
$1,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$847.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$525.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$110.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$99.40
|
|
|
MESH VENTRAL 4 X 6 ELLIPCE
|
Facility
|
IP
|
$3,897.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270690904
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$584.55 |
| Max. Negotiated Rate |
$943.07 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$779.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$943.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$584.55
|
|
|
MESH VENTRAL 4 X 6 ELLIPCE
|
Facility
|
OP
|
$3,897.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270690904
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.67 |
| Max. Negotiated Rate |
$1,948.50 |
| Rate for Payer: Aetna Commercial |
$1,480.86
|
| Rate for Payer: Aetna Medicare Advantage |
$1,169.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$993.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$993.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$779.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$993.74
|
| Rate for Payer: Cigna Commercial |
$1,948.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$943.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$584.55
|
| Rate for Payer: UnitedHealthcare Community & State |
$123.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$110.67
|
|
|
MESH VENTRALEX ST PATCH LARGE
|
Facility
|
OP
|
$7,832.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270698961
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$222.43 |
| Max. Negotiated Rate |
$3,916.00 |
| Rate for Payer: Aetna Commercial |
$2,976.16
|
| Rate for Payer: Aetna Medicare Advantage |
$2,349.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,997.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,997.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,566.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,997.16
|
| Rate for Payer: Cigna Commercial |
$3,916.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,895.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,174.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$247.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$222.43
|
|
|
MESH VENTRALEX ST PATCH LARGE
|
Facility
|
IP
|
$7,832.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270698961
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,174.80 |
| Max. Negotiated Rate |
$1,895.34 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,566.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,895.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,174.80
|
|
|
MESH VENTRALEX ST PATCH MEDIUM
|
Facility
|
OP
|
$7,034.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270698958
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$199.78 |
| Max. Negotiated Rate |
$3,517.25 |
| Rate for Payer: Aetna Commercial |
$2,673.11
|
| Rate for Payer: Aetna Medicare Advantage |
$2,110.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,793.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,793.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,406.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,793.80
|
| Rate for Payer: Cigna Commercial |
$3,517.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,702.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,055.17
|
| Rate for Payer: UnitedHealthcare Community & State |
$222.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$199.78
|
|
|
MESH VENTRALEX ST PATCH MEDIUM
|
Facility
|
IP
|
$7,034.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270698958
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.17 |
| Max. Negotiated Rate |
$1,702.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,406.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,702.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,055.17
|
|
|
MESH VENTRALEX ST PATCH SMALL
|
Facility
|
IP
|
$5,868.65
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270698963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$880.30 |
| Max. Negotiated Rate |
$1,420.21 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,173.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,420.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$880.30
|
|
|
MESH VENTRALEX ST PATCH SMALL
|
Facility
|
OP
|
$5,868.65
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270698963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$166.67 |
| Max. Negotiated Rate |
$2,934.32 |
| Rate for Payer: Aetna Commercial |
$2,230.09
|
| Rate for Payer: Aetna Medicare Advantage |
$1,760.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,496.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,496.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,173.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,496.51
|
| Rate for Payer: Cigna Commercial |
$2,934.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,420.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$880.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$185.45
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$166.67
|
|
|
MESH VENTRALIGHT 10 X 13 ELLIP
|
Facility
|
IP
|
$14,140.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270690902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,121.07 |
| Max. Negotiated Rate |
$3,422.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,828.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,422.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,121.07
|
|
|
MESH VENTRALIGHT 10 X 13 ELLIP
|
Facility
|
OP
|
$14,140.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270690902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$401.59 |
| Max. Negotiated Rate |
$7,070.25 |
| Rate for Payer: Aetna Commercial |
$5,373.39
|
| Rate for Payer: Aetna Medicare Advantage |
$4,242.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,605.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,605.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,828.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,605.83
|
| Rate for Payer: Cigna Commercial |
$7,070.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,422.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,121.07
|
| Rate for Payer: UnitedHealthcare Community & State |
$446.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$401.59
|
|
|
MESH VENTRALIGHT 6 X 10 OVAL
|
Facility
|
IP
|
$8,371.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270690905
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,255.72 |
| Max. Negotiated Rate |
$2,025.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,674.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,025.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,255.72
|
|
|
MESH VENTRALIGHT 6 X 10 OVAL
|
Facility
|
OP
|
$8,371.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270690905
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.75 |
| Max. Negotiated Rate |
$4,185.75 |
| Rate for Payer: Aetna Commercial |
$3,181.17
|
| Rate for Payer: Aetna Medicare Advantage |
$2,511.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,134.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,134.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,674.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,134.73
|
| Rate for Payer: Cigna Commercial |
$4,185.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,025.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,255.72
|
| Rate for Payer: UnitedHealthcare Community & State |
$264.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$237.75
|
|
|
MESH VENTRALIGHT RECG 12 X 14
|
Facility
|
IP
|
$14,905.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270690903
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,235.75 |
| Max. Negotiated Rate |
$3,607.01 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,981.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,607.01
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,235.75
|
|
|
MESH VENTRALIGHT RECG 12 X 14
|
Facility
|
OP
|
$14,905.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270690903
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$423.30 |
| Max. Negotiated Rate |
$7,452.50 |
| Rate for Payer: Aetna Commercial |
$5,663.90
|
| Rate for Payer: Aetna Medicare Advantage |
$4,471.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,800.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,800.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,981.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,800.78
|
| Rate for Payer: Cigna Commercial |
$7,452.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,607.01
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,235.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$471.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$423.30
|
|
|
MESH VENTRAL PHASIX 10X12IN
|
Facility
|
OP
|
$72,185.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270698769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,050.05 |
| Max. Negotiated Rate |
$36,092.50 |
| Rate for Payer: Aetna Commercial |
$27,430.30
|
| Rate for Payer: Aetna Medicare Advantage |
$21,655.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18,407.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18,407.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14,437.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18,407.17
|
| Rate for Payer: Cigna Commercial |
$36,092.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17,468.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10,827.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$2,281.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2,050.05
|
|
|
MESH VENTRAL PHASIX 10X12IN
|
Facility
|
IP
|
$72,185.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270698769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,827.75 |
| Max. Negotiated Rate |
$17,468.77 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14,437.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17,468.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10,827.75
|
|
|
MESH VENTRIO 8.7 x 10
|
Facility
|
IP
|
$9,775.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270663620
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,466.25 |
| Max. Negotiated Rate |
$2,365.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,955.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,365.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,466.25
|
|
|
MESH VENTRIO 8.7 x 10
|
Facility
|
OP
|
$9,775.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270663620
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$277.61 |
| Max. Negotiated Rate |
$4,887.50 |
| Rate for Payer: Aetna Commercial |
$3,714.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,932.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,492.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,492.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,955.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,492.62
|
| Rate for Payer: Cigna Commercial |
$4,887.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,365.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,466.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$308.89
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$277.61
|
|
|
MESH VENTRIO OVAL LG 5.4x7.0
|
Facility
|
IP
|
$6,400.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270647197
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$960.00 |
| Max. Negotiated Rate |
$1,548.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,280.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,548.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$960.00
|
|
|
MESH VENTRIO OVAL LG 5.4x7.0
|
Facility
|
OP
|
$6,400.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270647197
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$181.76 |
| Max. Negotiated Rate |
$3,200.00 |
| Rate for Payer: Aetna Commercial |
$2,432.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,920.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,632.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,632.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,280.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,632.00
|
| Rate for Payer: Cigna Commercial |
$3,200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,548.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$960.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$202.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$181.76
|
|
|
MESH VENTRIO OVAL MED 4.3x5.5
|
Facility
|
OP
|
$5,050.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270647196
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$143.42 |
| Max. Negotiated Rate |
$2,525.00 |
| Rate for Payer: Aetna Commercial |
$1,919.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,515.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,287.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,287.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,010.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,287.75
|
| Rate for Payer: Cigna Commercial |
$2,525.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,222.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$757.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$159.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$143.42
|
|
|
MESH VENTRIO OVAL MED 4.3x5.5
|
Facility
|
IP
|
$5,050.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270647196
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$757.50 |
| Max. Negotiated Rate |
$1,222.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,010.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,222.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$757.50
|
|