|
CYSTOCATH 8FR *******
|
Facility
|
IP
|
$166.00
|
|
| Hospital Charge Code |
8000424
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$24.90 |
| Max. Negotiated Rate |
$24.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.90
|
|
|
CYSTOCATH 8FR *******
|
Facility
|
OP
|
$166.00
|
|
| Hospital Charge Code |
8000424
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Aetna Commercial |
$63.08
|
| Rate for Payer: Aetna Medicare Advantage |
$49.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$42.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$42.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$42.33
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$49.80
|
| Rate for Payer: Oxford Commercial |
$33.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$33.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.40
|
|
|
CYSTOCATH SUPRAPUBIC 12FR
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
270331132
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.45 |
| Max. Negotiated Rate |
$68.49 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$56.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$68.49
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$62.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.45
|
|
|
CYSTOCATH SUPRAPUBIC 12FR
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
270331132
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$141.50 |
| Rate for Payer: Aetna Commercial |
$107.54
|
| Rate for Payer: Aetna Medicare Advantage |
$84.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$72.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$72.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$56.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$72.17
|
| Rate for Payer: Cigna Commercial |
$141.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$68.49
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$62.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.45
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.50
|
|
|
CYSTO RX BALO CATH URTL STRX
|
Facility
|
IP
|
$29,933.90
|
|
|
Service Code
|
HCPCS 52284
|
| Hospital Charge Code |
1600000402
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,490.09 |
| Max. Negotiated Rate |
$4,490.09 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,490.09
|
|
|
CYSTO RX BALO CATH URTL STRX
|
Facility
|
OP
|
$29,933.90
|
|
|
Service Code
|
HCPCS 52284
|
| Hospital Charge Code |
1600000402
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$721.41 |
| Max. Negotiated Rate |
$22,993.64 |
| Rate for Payer: Aetna Commercial |
$17,326.29
|
| Rate for Payer: Aetna Medicare Advantage |
$20,638.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$22,993.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$22,993.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,369.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$22,993.64
|
| Rate for Payer: Cigna Commercial |
$12,768.54
|
| Rate for Payer: Cigna Medicare Advantage |
$6,369.96
|
| Rate for Payer: Clover Medicare Advantage |
$6,051.46
|
| Rate for Payer: EmblemHealth Commercial |
$19,109.88
|
| Rate for Payer: Humana Medicare Advantage |
$6,561.06
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,369.96
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,980.17
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,490.09
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$721.41
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,369.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,369.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$793.25
|
|
|
CYSTOSCOPE AND TREATMENT
|
Facility
|
IP
|
$9,649.80
|
|
|
Service Code
|
HCPCS 53210
|
| Hospital Charge Code |
1600000441
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,447.47 |
| Max. Negotiated Rate |
$1,447.47 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,447.47
|
|
|
CYSTOSCOPE AND TREATMENT
|
Facility
|
OP
|
$9,649.80
|
|
|
Service Code
|
HCPCS 53210
|
| Hospital Charge Code |
1600000441
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$232.56 |
| Max. Negotiated Rate |
$15,116.59 |
| Rate for Payer: Aetna Commercial |
$11,390.73
|
| Rate for Payer: Aetna Medicare Advantage |
$13,568.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15,116.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15,116.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4,187.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,742.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15,116.59
|
| Rate for Payer: Cigna Commercial |
$8,394.37
|
| Rate for Payer: Cigna Medicare Advantage |
$4,187.77
|
| Rate for Payer: Clover Medicare Advantage |
$3,978.38
|
| Rate for Payer: EmblemHealth Commercial |
$12,563.31
|
| Rate for Payer: Humana Medicare Advantage |
$4,313.40
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4,187.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,894.94
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,447.47
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,232.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$232.56
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4,187.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$4,187.77
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$255.72
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$23,841.70
|
|
|
Service Code
|
HCPCS 52214
|
| Hospital Charge Code |
1600000274
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,576.26 |
| Max. Negotiated Rate |
$3,576.26 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,576.26
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$23,841.70
|
|
|
Service Code
|
HCPCS 52214
|
| Hospital Charge Code |
1600000274
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$574.58 |
| Max. Negotiated Rate |
$15,116.59 |
| Rate for Payer: Aetna Commercial |
$11,390.73
|
| Rate for Payer: Aetna Medicare Advantage |
$13,568.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15,116.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15,116.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4,187.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,016.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15,116.59
|
| Rate for Payer: Cigna Commercial |
$8,394.37
|
| Rate for Payer: Cigna Medicare Advantage |
$4,187.77
|
| Rate for Payer: Clover Medicare Advantage |
$3,978.38
|
| Rate for Payer: EmblemHealth Commercial |
$12,563.31
|
| Rate for Payer: Humana Medicare Advantage |
$4,313.40
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4,187.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,152.51
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,576.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$574.58
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4,187.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$4,187.77
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$631.81
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$15,511.63
|
|
|
Service Code
|
HCPCS 52281
|
| Hospital Charge Code |
160000205
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$373.83 |
| Max. Negotiated Rate |
$8,964.44 |
| Rate for Payer: Aetna Commercial |
$6,754.93
|
| Rate for Payer: Aetna Medicare Advantage |
$8,046.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,964.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,964.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,483.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,016.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,964.44
|
| Rate for Payer: Cigna Commercial |
$4,978.04
|
| Rate for Payer: Cigna Medicare Advantage |
$2,483.43
|
| Rate for Payer: Clover Medicare Advantage |
$2,359.26
|
| Rate for Payer: EmblemHealth Commercial |
$7,450.29
|
| Rate for Payer: Humana Medicare Advantage |
$2,557.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,483.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,653.49
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,326.74
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,311.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$373.83
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,483.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,483.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$411.06
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$15,511.63
|
|
|
Service Code
|
HCPCS 52281
|
| Hospital Charge Code |
160000205
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,326.74 |
| Max. Negotiated Rate |
$2,326.74 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,326.74
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$7,953.26
|
|
|
Service Code
|
HCPCS 52260
|
| Hospital Charge Code |
1600000489
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$191.67 |
| Max. Negotiated Rate |
$8,964.44 |
| Rate for Payer: Aetna Commercial |
$6,754.93
|
| Rate for Payer: Aetna Medicare Advantage |
$8,046.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,964.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,964.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,483.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,016.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,964.44
|
| Rate for Payer: Cigna Commercial |
$4,978.04
|
| Rate for Payer: Cigna Medicare Advantage |
$2,483.43
|
| Rate for Payer: Clover Medicare Advantage |
$2,359.26
|
| Rate for Payer: EmblemHealth Commercial |
$7,450.29
|
| Rate for Payer: Humana Medicare Advantage |
$2,557.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,483.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,385.98
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,192.99
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,311.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$191.67
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,483.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,483.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$210.76
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$7,953.26
|
|
|
Service Code
|
HCPCS 52260
|
| Hospital Charge Code |
1600000489
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,192.99 |
| Max. Negotiated Rate |
$1,192.99 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,192.99
|
|
|
CYSTOSCOPY CHEMODENERVATION
|
Facility
|
OP
|
$8,304.76
|
|
|
Service Code
|
HCPCS 52287
|
| Hospital Charge Code |
160000175
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$200.14 |
| Max. Negotiated Rate |
$8,964.44 |
| Rate for Payer: Aetna Commercial |
$6,754.93
|
| Rate for Payer: Aetna Medicare Advantage |
$8,046.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,964.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,964.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,483.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,964.44
|
| Rate for Payer: Cigna Commercial |
$4,978.04
|
| Rate for Payer: Cigna Medicare Advantage |
$2,483.43
|
| Rate for Payer: Clover Medicare Advantage |
$2,359.26
|
| Rate for Payer: EmblemHealth Commercial |
$7,450.29
|
| Rate for Payer: Humana Medicare Advantage |
$2,557.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,483.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,491.43
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,245.71
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,311.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$200.14
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,483.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,483.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$220.08
|
|
|
CYSTOSCOPY CHEMODENERVATION
|
Facility
|
OP
|
$8,304.76
|
|
|
Service Code
|
HCPCS 52287
|
| Hospital Charge Code |
1600000819
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$200.14 |
| Max. Negotiated Rate |
$8,964.44 |
| Rate for Payer: Aetna Commercial |
$6,754.93
|
| Rate for Payer: Aetna Medicare Advantage |
$8,046.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,964.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,964.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,483.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,964.44
|
| Rate for Payer: Cigna Commercial |
$4,978.04
|
| Rate for Payer: Cigna Medicare Advantage |
$2,483.43
|
| Rate for Payer: Clover Medicare Advantage |
$2,359.26
|
| Rate for Payer: EmblemHealth Commercial |
$7,450.29
|
| Rate for Payer: Humana Medicare Advantage |
$2,557.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,483.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,491.43
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,245.71
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,311.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$200.14
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,483.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,483.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$220.08
|
|
|
CYSTOSCOPY CHEMODENERVATION
|
Facility
|
IP
|
$8,304.76
|
|
|
Service Code
|
HCPCS 52287
|
| Hospital Charge Code |
160000175
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,245.71 |
| Max. Negotiated Rate |
$1,245.71 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,245.71
|
|
|
CYSTOSCOPY CHEMODENERVATION
|
Facility
|
IP
|
$8,304.76
|
|
|
Service Code
|
HCPCS 52287
|
| Hospital Charge Code |
1600000819
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,245.71 |
| Max. Negotiated Rate |
$1,245.71 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,245.71
|
|
|
CYSTOSCOPY W/BIOPSY (S)
|
Facility
|
IP
|
$23,841.70
|
|
|
Service Code
|
HCPCS 52204
|
| Hospital Charge Code |
16000998
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,576.26 |
| Max. Negotiated Rate |
$3,576.26 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,576.26
|
|
|
CYSTOSCOPY W/BIOPSY (S)
|
Facility
|
OP
|
$23,841.70
|
|
|
Service Code
|
HCPCS 52204
|
| Hospital Charge Code |
16000998
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$574.58 |
| Max. Negotiated Rate |
$8,964.44 |
| Rate for Payer: Aetna Commercial |
$6,754.93
|
| Rate for Payer: Aetna Medicare Advantage |
$8,046.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,964.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,964.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,483.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,016.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,964.44
|
| Rate for Payer: Cigna Commercial |
$4,978.04
|
| Rate for Payer: Cigna Medicare Advantage |
$2,483.43
|
| Rate for Payer: Clover Medicare Advantage |
$2,359.26
|
| Rate for Payer: EmblemHealth Commercial |
$7,450.29
|
| Rate for Payer: Humana Medicare Advantage |
$2,557.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,483.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,152.51
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,576.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$574.58
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,483.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,483.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$631.81
|
|
|
CYSTOSPAZ/0.15MG/TAB
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
60632765
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
|
|
CYSTOSPAZ/0.15MG/TAB
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
60632765
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$1.14
|
| Rate for Payer: Aetna Medicare Advantage |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.77
|
| Rate for Payer: Cigna Commercial |
$1.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.90
|
| Rate for Payer: Oxford Commercial |
$0.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.08
|
|
|
CYSTOSTOMY CYSTOTOMY W DRAINAG
|
Facility
|
OP
|
$8,304.76
|
|
|
Service Code
|
HCPCS 51040
|
| Hospital Charge Code |
1600000711
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$200.14 |
| Max. Negotiated Rate |
$8,964.44 |
| Rate for Payer: Aetna Commercial |
$6,754.93
|
| Rate for Payer: Aetna Medicare Advantage |
$8,046.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,964.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,964.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,483.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,964.44
|
| Rate for Payer: Cigna Commercial |
$4,978.04
|
| Rate for Payer: Cigna Medicare Advantage |
$2,483.43
|
| Rate for Payer: Clover Medicare Advantage |
$2,359.26
|
| Rate for Payer: EmblemHealth Commercial |
$7,450.29
|
| Rate for Payer: Humana Medicare Advantage |
$2,557.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,483.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,491.43
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,245.71
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$200.14
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,483.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,483.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$220.08
|
|
|
CYSTOSTOMY CYSTOTOMY W DRAINAG
|
Facility
|
IP
|
$8,304.76
|
|
|
Service Code
|
HCPCS 51040
|
| Hospital Charge Code |
1600000711
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,245.71 |
| Max. Negotiated Rate |
$1,245.71 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,245.71
|
|
|
CYSTOTOME IRRIG 25G 120-25F-12
|
Facility
|
OP
|
$16.95
|
|
| Hospital Charge Code |
270600229
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$8.47 |
| Rate for Payer: Aetna Commercial |
$6.44
|
| Rate for Payer: Aetna Medicare Advantage |
$5.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.32
|
| Rate for Payer: Cigna Commercial |
$8.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.08
|
| Rate for Payer: Oxford Commercial |
$3.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.54
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.39
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.45
|
|
