|
CH IGG CSF
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
397073185
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$25.30
|
| Rate for Payer: Aetna Medicare Advantage |
$30.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$33.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$33.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$33.74
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$9.30
|
| Rate for Payer: Clover Medicare Advantage |
$8.84
|
| Rate for Payer: EmblemHealth Commercial |
$27.90
|
| Rate for Payer: Humana Medicare Advantage |
$9.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.40
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.44
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CHI HEMI IMPLANT15X13GREAT TOE
|
Facility
|
IP
|
$7,125.00
|
|
| Hospital Charge Code |
270339478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,068.75 |
| Max. Negotiated Rate |
$1,724.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,425.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,724.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,068.75
|
|
|
CHI HEMI IMPLANT15X13GREAT TOE
|
Facility
|
OP
|
$7,125.00
|
|
| Hospital Charge Code |
270339478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.35 |
| Max. Negotiated Rate |
$3,562.50 |
| Rate for Payer: Aetna Commercial |
$2,707.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,137.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,816.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,816.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,425.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,816.88
|
| Rate for Payer: Cigna Commercial |
$3,562.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,724.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,068.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$225.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$202.35
|
|
|
CHI HEMI IMPLANT15X13GREAT TOE
|
Facility
|
IP
|
$7,125.00
|
|
| Hospital Charge Code |
270339476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,068.75 |
| Max. Negotiated Rate |
$1,724.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,425.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,724.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,068.75
|
|
|
CHI HEMI IMPLANT15X13GREAT TOE
|
Facility
|
OP
|
$7,125.00
|
|
| Hospital Charge Code |
270339476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.35 |
| Max. Negotiated Rate |
$3,562.50 |
| Rate for Payer: Aetna Commercial |
$2,707.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,137.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,816.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,816.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,425.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,816.88
|
| Rate for Payer: Cigna Commercial |
$3,562.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,724.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,068.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$225.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$202.35
|
|
|
CHI HEMI IMPLANT17X15GREAT TOE
|
Facility
|
OP
|
$7,125.00
|
|
| Hospital Charge Code |
270339477
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.35 |
| Max. Negotiated Rate |
$3,562.50 |
| Rate for Payer: Aetna Commercial |
$2,707.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,137.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,816.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,816.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,425.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,816.88
|
| Rate for Payer: Cigna Commercial |
$3,562.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,724.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,068.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$225.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$202.35
|
|
|
CHI HEMI IMPLANT17X15GREAT TOE
|
Facility
|
IP
|
$7,125.00
|
|
| Hospital Charge Code |
270339477
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,068.75 |
| Max. Negotiated Rate |
$1,724.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,425.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,724.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,068.75
|
|
|
CHI HEMI IMPLANT19X17GREAT TOE
|
Facility
|
IP
|
$7,125.00
|
|
| Hospital Charge Code |
270339487
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,068.75 |
| Max. Negotiated Rate |
$1,724.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,425.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,724.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,068.75
|
|
|
CHI HEMI IMPLANT19X17GREAT TOE
|
Facility
|
OP
|
$7,125.00
|
|
| Hospital Charge Code |
270339487
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.35 |
| Max. Negotiated Rate |
$3,562.50 |
| Rate for Payer: Aetna Commercial |
$2,707.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,137.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,816.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,816.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,425.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,816.88
|
| Rate for Payer: Cigna Commercial |
$3,562.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,724.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,068.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$225.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$202.35
|
|
|
CHI HEMI IMPLANT22X19GREAT TOE
|
Facility
|
OP
|
$7,125.00
|
|
| Hospital Charge Code |
270339488
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.35 |
| Max. Negotiated Rate |
$3,562.50 |
| Rate for Payer: Aetna Commercial |
$2,707.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,137.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,816.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,816.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,425.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,816.88
|
| Rate for Payer: Cigna Commercial |
$3,562.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,724.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,068.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$225.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$202.35
|
|
|
CHI HEMI IMPLANT22X19GREAT TOE
|
Facility
|
IP
|
$7,125.00
|
|
| Hospital Charge Code |
270339488
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,068.75 |
| Max. Negotiated Rate |
$1,724.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,425.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,724.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,068.75
|
|
|
CHI HEMI IMPLANT24X21GREAT TOE
|
Facility
|
OP
|
$7,125.00
|
|
| Hospital Charge Code |
270339489
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.35 |
| Max. Negotiated Rate |
$3,562.50 |
| Rate for Payer: Aetna Commercial |
$2,707.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,137.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,816.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,816.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,425.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,816.88
|
| Rate for Payer: Cigna Commercial |
$3,562.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,724.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,068.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$225.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$202.35
|
|
|
CHI HEMI IMPLANT24X21GREAT TOE
|
Facility
|
IP
|
$7,125.00
|
|
| Hospital Charge Code |
270339489
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,068.75 |
| Max. Negotiated Rate |
$1,724.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,425.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,724.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,068.75
|
|
|
CHIKUNGUNYA AB IGG IGM W REFLX
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
38479744
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CHIKUNGUNYA AB IGG IGM W REFLX
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
38479744
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$391.36 |
| Rate for Payer: Aetna Commercial |
$35.03
|
| Rate for Payer: Aetna Medicare Advantage |
$41.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$391.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.72
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.88
|
| Rate for Payer: Clover Medicare Advantage |
$12.24
|
| Rate for Payer: EmblemHealth Commercial |
$38.64
|
| Rate for Payer: Humana Medicare Advantage |
$13.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.40
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES
|
Facility
|
IP
|
$48,411.84
|
|
|
Service Code
|
APR-DRG 0111
|
| Min. Negotiated Rate |
$47,462.59 |
| Max. Negotiated Rate |
$48,411.84 |
| Rate for Payer: UnitedHealthcare Community & State |
$47,462.59
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$48,411.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$47,462.59
|
|
|
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES
|
Facility
|
IP
|
$96,867.22
|
|
|
Service Code
|
APR-DRG 0112
|
| Min. Negotiated Rate |
$94,967.86 |
| Max. Negotiated Rate |
$96,867.22 |
| Rate for Payer: UnitedHealthcare Community & State |
$94,967.86
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$96,867.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$94,967.86
|
|
|
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES
|
Facility
|
IP
|
$135,611.23
|
|
|
Service Code
|
APR-DRG 0113
|
| Min. Negotiated Rate |
$132,952.19 |
| Max. Negotiated Rate |
$135,611.23 |
| Rate for Payer: UnitedHealthcare Community & State |
$132,952.19
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$135,611.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$132,952.19
|
|
|
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES
|
Facility
|
IP
|
$1,383,763.02
|
|
|
Service Code
|
MSDRG 018
|
| Min. Negotiated Rate |
$421,338.10 |
| Max. Negotiated Rate |
$1,383,763.02 |
| Rate for Payer: Aetna Medicare Advantage |
$1,383,763.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,020,652.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,020,652.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$443,513.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,020,652.20
|
| Rate for Payer: Cigna Commercial |
$962,674.16
|
| Rate for Payer: Cigna Medicare Advantage |
$443,513.79
|
| Rate for Payer: Clover Medicare Advantage |
$421,338.10
|
| Rate for Payer: EmblemHealth Commercial |
$1,330,541.37
|
| Rate for Payer: Humana Medicare Advantage |
$456,819.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$443,513.79
|
| Rate for Payer: Oxford Commercial |
$760,880.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,018,466.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$443,513.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$443,513.79
|
|
|
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES
|
Facility
|
IP
|
$252,379.95
|
|
|
Service Code
|
APR-DRG 0114
|
| Min. Negotiated Rate |
$247,431.32 |
| Max. Negotiated Rate |
$252,379.95 |
| Rate for Payer: UnitedHealthcare Community & State |
$247,431.32
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$252,379.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$247,431.32
|
|
|
CHIP CANCELLOUS 15cc
|
Facility
|
IP
|
$1,533.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270675127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.95 |
| Max. Negotiated Rate |
$370.99 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$306.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$370.99
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$229.95
|
|
|
CHIP CANCELLOUS 15cc
|
Facility
|
OP
|
$1,533.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270675127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$43.54 |
| Max. Negotiated Rate |
$766.50 |
| Rate for Payer: Aetna Commercial |
$582.54
|
| Rate for Payer: Aetna Medicare Advantage |
$459.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$390.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$390.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$306.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$390.92
|
| Rate for Payer: Cigna Commercial |
$766.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$370.99
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$229.95
|
| Rate for Payer: UnitedHealthcare Community & State |
$48.44
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$43.54
|
|
|
CHIP CANCELLOUS 1.7-10MM 30CC
|
Facility
|
IP
|
$3,025.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270645713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$453.75 |
| Max. Negotiated Rate |
$732.05 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$605.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$732.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$453.75
|
|
|
CHIP CANCELLOUS 1.7-10MM 30CC
|
Facility
|
OP
|
$3,025.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270645713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.91 |
| Max. Negotiated Rate |
$1,512.50 |
| Rate for Payer: Aetna Commercial |
$1,149.50
|
| Rate for Payer: Aetna Medicare Advantage |
$907.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$771.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$771.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$605.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$771.38
|
| Rate for Payer: Cigna Commercial |
$1,512.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$732.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$453.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$95.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$85.91
|
|
|
CHIP CANCELLOUS 5cc
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270675128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna Commercial |
$319.20
|
| Rate for Payer: Aetna Medicare Advantage |
$252.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$214.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$214.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$168.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$214.20
|
| Rate for Payer: Cigna Commercial |
$420.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$203.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$126.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.86
|
|
