|
IR CYST ASP BREAST
|
Facility
|
OP
|
$1,901.69
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
2680005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$45.83 |
| Max. Negotiated Rate |
$3,593.00 |
| Rate for Payer: Aetna Commercial |
$2,288.28
|
| Rate for Payer: Aetna Medicare Advantage |
$2,725.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,036.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,036.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$841.28
|
| 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 |
$3,036.77
|
| Rate for Payer: Cigna Commercial |
$1,686.34
|
| Rate for Payer: Cigna Medicare Advantage |
$841.28
|
| Rate for Payer: Clover Medicare Advantage |
$799.22
|
| Rate for Payer: EmblemHealth Commercial |
$2,523.84
|
| Rate for Payer: Humana Medicare Advantage |
$866.52
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$841.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$570.51
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$285.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,593.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$45.83
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$50.39
|
|
|
IR CYSTOSTOMY TUBE CHANGE COMP
|
Facility
|
OP
|
$2,588.00
|
|
|
Service Code
|
HCPCS 51710
|
| Hospital Charge Code |
7411627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$62.37 |
| Max. Negotiated Rate |
$3,593.00 |
| Rate for Payer: Aetna Commercial |
$2,253.28
|
| Rate for Payer: Aetna Medicare Advantage |
$2,684.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,990.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,990.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$828.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$862.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,990.31
|
| Rate for Payer: Cigna Commercial |
$1,660.53
|
| Rate for Payer: Cigna Medicare Advantage |
$828.41
|
| Rate for Payer: Clover Medicare Advantage |
$786.99
|
| Rate for Payer: EmblemHealth Commercial |
$2,485.23
|
| Rate for Payer: Humana Medicare Advantage |
$853.26
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$828.41
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$776.40
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$388.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,593.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$62.37
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$828.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$828.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$68.58
|
|
|
IR CYSTOSTOMY TUBE CHANGE COMP
|
Facility
|
OP
|
$2,588.00
|
|
|
Service Code
|
HCPCS 51710
|
| Hospital Charge Code |
2670135
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$62.37 |
| Max. Negotiated Rate |
$3,593.00 |
| Rate for Payer: Aetna Commercial |
$2,253.28
|
| Rate for Payer: Aetna Medicare Advantage |
$2,684.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,990.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,990.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$828.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$862.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,990.31
|
| Rate for Payer: Cigna Commercial |
$1,660.53
|
| Rate for Payer: Cigna Medicare Advantage |
$828.41
|
| Rate for Payer: Clover Medicare Advantage |
$786.99
|
| Rate for Payer: EmblemHealth Commercial |
$2,485.23
|
| Rate for Payer: Humana Medicare Advantage |
$853.26
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$828.41
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$776.40
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$388.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,593.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$62.37
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$828.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$828.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$68.58
|
|
|
IR CYSTOSTOMY TUBE CHANGE COMP
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
HCPCS 51710
|
| Hospital Charge Code |
7411627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$388.20 |
| Max. Negotiated Rate |
$388.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$388.20
|
|
|
IR CYSTOSTOMY TUBE CHANGE COMP
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
HCPCS 51710
|
| Hospital Charge Code |
2670135
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$388.20 |
| Max. Negotiated Rate |
$388.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$388.20
|
|
|
IR CYSTOSTOMY TUBE CHANGE SIMP
|
Facility
|
IP
|
$833.00
|
|
|
Service Code
|
HCPCS 51705
|
| Hospital Charge Code |
7411626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.95 |
| Max. Negotiated Rate |
$124.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$124.95
|
|
|
IR CYSTOSTOMY TUBE CHANGE SIMP
|
Facility
|
IP
|
$1,355.15
|
|
|
Service Code
|
HCPCS 51705
|
| Hospital Charge Code |
321051705
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$203.27 |
| Max. Negotiated Rate |
$203.27 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.27
|
|
|
IR CYSTOSTOMY TUBE CHANGE SIMP
|
Facility
|
OP
|
$833.00
|
|
|
Service Code
|
HCPCS 51705
|
| Hospital Charge Code |
7411626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$20.08 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$807.38
|
| Rate for Payer: Aetna Medicare Advantage |
$961.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,071.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,071.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$296.83
|
| 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 |
$1,071.47
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: Cigna Medicare Advantage |
$296.83
|
| Rate for Payer: Clover Medicare Advantage |
$281.99
|
| Rate for Payer: EmblemHealth Commercial |
$890.49
|
| Rate for Payer: Humana Medicare Advantage |
$305.73
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$296.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$249.90
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$124.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.08
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$22.07
|
|
|
IR CYSTOSTOMY TUBE CHANGE SIMP
|
Facility
|
OP
|
$1,355.15
|
|
|
Service Code
|
HCPCS 51705
|
| Hospital Charge Code |
321051705
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.66 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$807.38
|
| Rate for Payer: Aetna Medicare Advantage |
$961.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,071.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,071.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$296.83
|
| 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 |
$1,071.47
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: Cigna Medicare Advantage |
$296.83
|
| Rate for Payer: Clover Medicare Advantage |
$281.99
|
| Rate for Payer: EmblemHealth Commercial |
$890.49
|
| Rate for Payer: Humana Medicare Advantage |
$305.73
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$296.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$406.55
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.27
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$32.66
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.91
|
|
|
IR CYSTOSTOMY TUBE CHANGE SIMP
|
Facility
|
OP
|
$1,355.15
|
|
|
Service Code
|
HCPCS 51705
|
| Hospital Charge Code |
2670140
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.66 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$807.38
|
| Rate for Payer: Aetna Medicare Advantage |
$961.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,071.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,071.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$296.83
|
| 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 |
$1,071.47
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: Cigna Medicare Advantage |
$296.83
|
| Rate for Payer: Clover Medicare Advantage |
$281.99
|
| Rate for Payer: EmblemHealth Commercial |
$890.49
|
| Rate for Payer: Humana Medicare Advantage |
$305.73
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$296.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$406.55
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.27
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$32.66
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.91
|
|
|
IR CYSTOSTOMY TUBE CHANGE SIMP
|
Facility
|
IP
|
$1,355.15
|
|
|
Service Code
|
HCPCS 51705
|
| Hospital Charge Code |
2670140
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$203.27 |
| Max. Negotiated Rate |
$203.27 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.27
|
|
|
IR-CYSTOURETHROSCOPY
|
Facility
|
IP
|
$1,822.00
|
|
|
Service Code
|
HCPCS 52000
|
| Hospital Charge Code |
2690190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$273.30 |
| Max. Negotiated Rate |
$273.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$273.30
|
|
|
IR-CYSTOURETHROSCOPY
|
Facility
|
OP
|
$1,822.00
|
|
|
Service Code
|
HCPCS 52000
|
| Hospital Charge Code |
7411628
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$43.91 |
| Max. Negotiated Rate |
$3,593.00 |
| Rate for Payer: Aetna Commercial |
$2,253.28
|
| Rate for Payer: Aetna Medicare Advantage |
$2,684.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,990.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,990.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$828.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$862.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,990.31
|
| Rate for Payer: Cigna Commercial |
$1,660.53
|
| Rate for Payer: Cigna Medicare Advantage |
$828.41
|
| Rate for Payer: Clover Medicare Advantage |
$786.99
|
| Rate for Payer: EmblemHealth Commercial |
$2,485.23
|
| Rate for Payer: Humana Medicare Advantage |
$853.26
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$828.41
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$546.60
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$273.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,593.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$43.91
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$828.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$828.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$48.28
|
|
|
IR-CYSTOURETHROSCOPY
|
Facility
|
OP
|
$1,822.00
|
|
|
Service Code
|
HCPCS 52000
|
| Hospital Charge Code |
2690190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$43.91 |
| Max. Negotiated Rate |
$3,593.00 |
| Rate for Payer: Aetna Commercial |
$2,253.28
|
| Rate for Payer: Aetna Medicare Advantage |
$2,684.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,990.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,990.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$828.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$862.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,990.31
|
| Rate for Payer: Cigna Commercial |
$1,660.53
|
| Rate for Payer: Cigna Medicare Advantage |
$828.41
|
| Rate for Payer: Clover Medicare Advantage |
$786.99
|
| Rate for Payer: EmblemHealth Commercial |
$2,485.23
|
| Rate for Payer: Humana Medicare Advantage |
$853.26
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$828.41
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$546.60
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$273.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,593.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$43.91
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$828.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$828.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$48.28
|
|
|
IR-CYSTOURETHROSCOPY
|
Facility
|
IP
|
$1,822.00
|
|
|
Service Code
|
HCPCS 52000
|
| Hospital Charge Code |
7411628
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$273.30 |
| Max. Negotiated Rate |
$273.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$273.30
|
|
|
IR CYSTURETHROSCOPY
|
Facility
|
IP
|
$11,620.55
|
|
|
Service Code
|
HCPCS 52351
|
| Hospital Charge Code |
2004523
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,743.08 |
| Max. Negotiated Rate |
$1,743.08 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,743.08
|
|
|
IR CYSTURETHROSCOPY
|
Facility
|
OP
|
$11,620.55
|
|
|
Service Code
|
HCPCS 52351
|
| Hospital Charge Code |
2004523
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$280.06 |
| 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 |
$1,355.00
|
| 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 |
$3,486.16
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,743.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$280.06
|
| 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 |
$307.94
|
|
|
IR & D DEEP FOREARM OR WRIST
|
Facility
|
OP
|
$9,394.00
|
|
|
Service Code
|
HCPCS 25028
|
| Hospital Charge Code |
2680070
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$226.40 |
| Max. Negotiated Rate |
$14,031.70 |
| Rate for Payer: Aetna Commercial |
$10,573.24
|
| Rate for Payer: Aetna Medicare Advantage |
$12,594.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14,031.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14,031.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,887.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$862.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14,031.70
|
| Rate for Payer: Cigna Commercial |
$7,791.93
|
| Rate for Payer: Cigna Medicare Advantage |
$3,887.22
|
| Rate for Payer: Clover Medicare Advantage |
$3,692.86
|
| Rate for Payer: EmblemHealth Commercial |
$11,661.66
|
| Rate for Payer: Humana Medicare Advantage |
$4,003.84
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,887.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,818.20
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,409.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$226.40
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,887.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,887.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$248.94
|
|
|
IR & D DEEP FOREARM OR WRIST
|
Facility
|
IP
|
$9,394.00
|
|
|
Service Code
|
HCPCS 25028
|
| Hospital Charge Code |
2680070
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,409.10 |
| Max. Negotiated Rate |
$1,409.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,409.10
|
|
|
IR & D DEEP FOREARM OR WRIST
|
Facility
|
IP
|
$9,394.00
|
|
|
Service Code
|
HCPCS 25028
|
| Hospital Charge Code |
7411363
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,409.10 |
| Max. Negotiated Rate |
$1,409.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,409.10
|
|
|
IR & D DEEP FOREARM OR WRIST
|
Facility
|
OP
|
$9,394.00
|
|
|
Service Code
|
HCPCS 25028
|
| Hospital Charge Code |
7411363
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$226.40 |
| Max. Negotiated Rate |
$14,031.70 |
| Rate for Payer: Aetna Commercial |
$10,573.24
|
| Rate for Payer: Aetna Medicare Advantage |
$12,594.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14,031.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14,031.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,887.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$862.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14,031.70
|
| Rate for Payer: Cigna Commercial |
$7,791.93
|
| Rate for Payer: Cigna Medicare Advantage |
$3,887.22
|
| Rate for Payer: Clover Medicare Advantage |
$3,692.86
|
| Rate for Payer: EmblemHealth Commercial |
$11,661.66
|
| Rate for Payer: Humana Medicare Advantage |
$4,003.84
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,887.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,818.20
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,409.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$226.40
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,887.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,887.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$248.94
|
|
|
IR DIGITAL SUBTR ANGIO
|
Facility
|
OP
|
$1,628.85
|
|
| Hospital Charge Code |
2001642
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.26 |
| Max. Negotiated Rate |
$1,975.00 |
| Rate for Payer: Aetna Commercial |
$618.96
|
| Rate for Payer: Aetna Medicare Advantage |
$488.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$415.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$415.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$415.36
|
| Rate for Payer: Cigna Commercial |
$814.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$488.65
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$244.33
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$39.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$43.16
|
|
|
IR DIGITAL SUBTR ANGIO
|
Facility
|
IP
|
$1,628.85
|
|
| Hospital Charge Code |
2001642
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$244.33 |
| Max. Negotiated Rate |
$244.33 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$244.33
|
|
|
IR DILATE BILIARY DUCT/AMPULLA
|
Facility
|
OP
|
$732.00
|
|
|
Service Code
|
HCPCS 47542
|
| Hospital Charge Code |
2692121
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$278.16
|
| Rate for Payer: Aetna Medicare Advantage |
$219.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$186.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$186.66
|
| 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 |
$186.66
|
| Rate for Payer: Cigna Commercial |
$366.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.60
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$109.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.40
|
|
|
IR DILATE BILIARY DUCT/AMPULLA
|
Facility
|
OP
|
$732.00
|
|
|
Service Code
|
HCPCS 47542
|
| Hospital Charge Code |
7411570
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$278.16
|
| Rate for Payer: Aetna Medicare Advantage |
$219.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$186.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$186.66
|
| 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 |
$186.66
|
| Rate for Payer: Cigna Commercial |
$366.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.60
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$109.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.40
|
|
