|
DRAIN/INJ JOINT/BURSA
|
Facility
|
IP
|
$1,630.99
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
1600000852
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$244.65 |
| Max. Negotiated Rate |
$244.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$244.65
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
OP
|
$1,630.99
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
321520610
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$39.31 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$991.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,181.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,316.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,316.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$364.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,316.35
|
| Rate for Payer: Cigna Commercial |
$730.97
|
| Rate for Payer: Cigna Medicare Advantage |
$364.67
|
| Rate for Payer: Clover Medicare Advantage |
$346.44
|
| Rate for Payer: EmblemHealth Commercial |
$1,094.01
|
| Rate for Payer: Humana Medicare Advantage |
$375.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$364.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$489.30
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$244.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$39.31
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$364.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$364.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$43.22
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
IP
|
$1,630.99
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
321520610
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$244.65 |
| Max. Negotiated Rate |
$244.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$244.65
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
OP
|
$1,630.99
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
321520605
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$39.31 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$991.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,181.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,316.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,316.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$364.67
|
| 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 |
$1,316.35
|
| Rate for Payer: Cigna Commercial |
$730.97
|
| Rate for Payer: Cigna Medicare Advantage |
$364.67
|
| Rate for Payer: Clover Medicare Advantage |
$346.44
|
| Rate for Payer: EmblemHealth Commercial |
$1,094.01
|
| Rate for Payer: Humana Medicare Advantage |
$375.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$364.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$489.30
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$244.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$39.31
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$364.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$364.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$43.22
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
IP
|
$1,630.99
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
321520605
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$244.65 |
| Max. Negotiated Rate |
$244.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$244.65
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
OP
|
$1,147.71
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
16000388
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$27.66 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$991.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,181.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,316.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,316.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$364.67
|
| 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 |
$1,316.35
|
| Rate for Payer: Cigna Commercial |
$730.97
|
| Rate for Payer: Cigna Medicare Advantage |
$364.67
|
| Rate for Payer: Clover Medicare Advantage |
$346.44
|
| Rate for Payer: EmblemHealth Commercial |
$1,094.01
|
| Rate for Payer: Humana Medicare Advantage |
$375.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$364.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$344.31
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$172.16
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.66
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$364.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$364.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$30.41
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
IP
|
$1,147.71
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
16000388
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$172.16 |
| Max. Negotiated Rate |
$172.16 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$172.16
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
OP
|
$1,630.99
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
321520600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$39.31 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$991.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,181.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,316.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,316.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$364.67
|
| 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 |
$1,316.35
|
| Rate for Payer: Cigna Commercial |
$730.97
|
| Rate for Payer: Cigna Medicare Advantage |
$364.67
|
| Rate for Payer: Clover Medicare Advantage |
$346.44
|
| Rate for Payer: EmblemHealth Commercial |
$1,094.01
|
| Rate for Payer: Humana Medicare Advantage |
$375.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$364.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$489.30
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$244.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$39.31
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$364.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$364.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$43.22
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
IP
|
$1,630.99
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
321520600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$244.65 |
| Max. Negotiated Rate |
$244.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$244.65
|
|
|
DRAIN/INJ JOINT/BURSA W/US
|
Facility
|
OP
|
$3,865.20
|
|
|
Service Code
|
HCPCS 20606
|
| Hospital Charge Code |
321520606
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$93.15 |
| Max. Negotiated Rate |
$3,593.00 |
| Rate for Payer: Aetna Commercial |
$2,281.02
|
| Rate for Payer: Aetna Medicare Advantage |
$2,717.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,027.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,027.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$838.61
|
| 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 |
$3,027.13
|
| Rate for Payer: Cigna Commercial |
$1,680.99
|
| Rate for Payer: Cigna Medicare Advantage |
$838.61
|
| Rate for Payer: Clover Medicare Advantage |
$796.68
|
| Rate for Payer: EmblemHealth Commercial |
$2,515.83
|
| Rate for Payer: Humana Medicare Advantage |
$863.77
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$838.61
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,159.56
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$579.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,593.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$93.15
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$838.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$838.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$102.43
|
|
|
DRAIN/INJ JOINT/BURSA W/US
|
Facility
|
OP
|
$1,630.99
|
|
|
Service Code
|
HCPCS 20604
|
| Hospital Charge Code |
321520604
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$39.31 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$991.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,181.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,316.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,316.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$364.67
|
| 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 |
$1,316.35
|
| Rate for Payer: Cigna Commercial |
$730.97
|
| Rate for Payer: Cigna Medicare Advantage |
$364.67
|
| Rate for Payer: Clover Medicare Advantage |
$346.44
|
| Rate for Payer: EmblemHealth Commercial |
$1,094.01
|
| Rate for Payer: Humana Medicare Advantage |
$375.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$364.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$489.30
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$244.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$39.31
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$364.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$364.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$43.22
|
|
|
DRAIN/INJ JOINT/BURSA W/US
|
Facility
|
OP
|
$1,147.71
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
16000794
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$27.66 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$991.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,181.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,316.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,316.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$364.67
|
| 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 |
$1,316.35
|
| Rate for Payer: Cigna Commercial |
$730.97
|
| Rate for Payer: Cigna Medicare Advantage |
$364.67
|
| Rate for Payer: Clover Medicare Advantage |
$346.44
|
| Rate for Payer: EmblemHealth Commercial |
$1,094.01
|
| Rate for Payer: Humana Medicare Advantage |
$375.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$364.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$344.31
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$172.16
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.66
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$364.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$364.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$30.41
|
|
|
DRAIN/INJ JOINT/BURSA W/US
|
Facility
|
OP
|
$1,630.99
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
321520611
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$39.31 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$991.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,181.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,316.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,316.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$364.67
|
| 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 |
$1,316.35
|
| Rate for Payer: Cigna Commercial |
$730.97
|
| Rate for Payer: Cigna Medicare Advantage |
$364.67
|
| Rate for Payer: Clover Medicare Advantage |
$346.44
|
| Rate for Payer: EmblemHealth Commercial |
$1,094.01
|
| Rate for Payer: Humana Medicare Advantage |
$375.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$364.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$489.30
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$244.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$39.31
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$364.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$364.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$43.22
|
|
|
DRAIN/INJ JOINT/BURSA W/US
|
Facility
|
IP
|
$3,865.20
|
|
|
Service Code
|
HCPCS 20606
|
| Hospital Charge Code |
321520606
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$579.78 |
| Max. Negotiated Rate |
$579.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$579.78
|
|
|
DRAIN/INJ JOINT/BURSA W/US
|
Facility
|
IP
|
$1,147.71
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
16000794
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$172.16 |
| Max. Negotiated Rate |
$172.16 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$172.16
|
|
|
DRAIN/INJ JOINT/BURSA W/US
|
Facility
|
IP
|
$1,630.99
|
|
|
Service Code
|
HCPCS 20604
|
| Hospital Charge Code |
321520604
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$244.65 |
| Max. Negotiated Rate |
$244.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$244.65
|
|
|
DRAIN/INJ JOINT/BURSA W/US
|
Facility
|
IP
|
$1,630.99
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
321520611
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$244.65 |
| Max. Negotiated Rate |
$244.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$244.65
|
|
|
DRAIN/INJ MAJOR JNT/BURSA
|
Facility
|
IP
|
$2,521.79
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
160000177
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$378.27 |
| Max. Negotiated Rate |
$378.27 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$378.27
|
|
|
DRAIN/INJ MAJOR JNT/BURSA
|
Facility
|
OP
|
$2,521.79
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
160000177
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$60.78 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$991.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,181.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,316.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,316.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$364.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,316.35
|
| Rate for Payer: Cigna Commercial |
$730.97
|
| Rate for Payer: Cigna Medicare Advantage |
$364.67
|
| Rate for Payer: Clover Medicare Advantage |
$346.44
|
| Rate for Payer: EmblemHealth Commercial |
$1,094.01
|
| Rate for Payer: Humana Medicare Advantage |
$375.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$364.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$756.54
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$378.27
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$60.78
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$364.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$364.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$66.83
|
|
|
DRAIN/INJ MAJOR JNT W US
|
Facility
|
IP
|
$1,253.85
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
7411347
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$188.08 |
| Max. Negotiated Rate |
$188.08 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$188.08
|
|
|
DRAIN/INJ MAJOR JNT W US
|
Facility
|
OP
|
$1,253.85
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
7411347
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$30.22 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$991.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,181.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,316.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,316.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$364.67
|
| 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 |
$1,316.35
|
| Rate for Payer: Cigna Commercial |
$730.97
|
| Rate for Payer: Cigna Medicare Advantage |
$364.67
|
| Rate for Payer: Clover Medicare Advantage |
$346.44
|
| Rate for Payer: EmblemHealth Commercial |
$1,094.01
|
| Rate for Payer: Humana Medicare Advantage |
$375.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$364.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$376.15
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$188.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$30.22
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$364.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$364.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$33.23
|
|
|
DRAIN/INJ MAJOR JNT W US
|
Facility
|
IP
|
$1,449.20
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
2692116
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$217.38 |
| Max. Negotiated Rate |
$217.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$217.38
|
|
|
DRAIN/INJ MAJOR JNT W US
|
Facility
|
IP
|
$1,449.20
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
321020611
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$217.38 |
| Max. Negotiated Rate |
$217.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$217.38
|
|
|
DRAIN/INJ MAJOR JNT W US
|
Facility
|
OP
|
$1,449.20
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
2692116
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$34.93 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$991.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,181.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,316.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,316.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$364.67
|
| 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 |
$1,316.35
|
| Rate for Payer: Cigna Commercial |
$730.97
|
| Rate for Payer: Cigna Medicare Advantage |
$364.67
|
| Rate for Payer: Clover Medicare Advantage |
$346.44
|
| Rate for Payer: EmblemHealth Commercial |
$1,094.01
|
| Rate for Payer: Humana Medicare Advantage |
$375.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$364.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$434.76
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$217.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$34.93
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$364.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$364.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.40
|
|
|
DRAIN/INJ MAJOR JNT W US
|
Facility
|
OP
|
$1,449.20
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
321020611
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$34.93 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$991.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,181.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,316.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,316.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$364.67
|
| 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 |
$1,316.35
|
| Rate for Payer: Cigna Commercial |
$730.97
|
| Rate for Payer: Cigna Medicare Advantage |
$364.67
|
| Rate for Payer: Clover Medicare Advantage |
$346.44
|
| Rate for Payer: EmblemHealth Commercial |
$1,094.01
|
| Rate for Payer: Humana Medicare Advantage |
$375.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$364.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$434.76
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$217.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$34.93
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$364.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$364.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.40
|
|
