|
IR-DRAIN FING ABSESS-SIMP
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
7411365
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12.77 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$648.34
|
| Rate for Payer: Aetna Medicare Advantage |
$772.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$860.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$860.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$238.36
|
| 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 |
$860.41
|
| Rate for Payer: Cigna Commercial |
$477.79
|
| Rate for Payer: Cigna Medicare Advantage |
$238.36
|
| Rate for Payer: Clover Medicare Advantage |
$226.44
|
| Rate for Payer: EmblemHealth Commercial |
$715.08
|
| Rate for Payer: Humana Medicare Advantage |
$245.51
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$238.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$159.00
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$79.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.77
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.04
|
|
|
IR-DRAIN OF BREAST LES-BI
|
Facility
|
OP
|
$5,305.00
|
|
|
Service Code
|
HCPCS 1900050
|
| Hospital Charge Code |
2690300
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.85 |
| Max. Negotiated Rate |
$2,652.50 |
| Rate for Payer: Aetna Commercial |
$2,015.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,591.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,352.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,352.78
|
| 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 |
$1,352.78
|
| Rate for Payer: Cigna Commercial |
$2,652.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,591.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$795.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$127.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$140.58
|
|
|
IR-DRAIN OF BREAST LES-BI
|
Facility
|
IP
|
$5,305.00
|
|
|
Service Code
|
HCPCS 1900050
|
| Hospital Charge Code |
7411770
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$795.75 |
| Max. Negotiated Rate |
$795.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$795.75
|
|
|
IR-DRAIN OF BREAST LES-BI
|
Facility
|
IP
|
$5,305.00
|
|
|
Service Code
|
HCPCS 1900050
|
| Hospital Charge Code |
2690300
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$795.75 |
| Max. Negotiated Rate |
$795.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$795.75
|
|
|
IR-DRAIN OF BREAST LES-BI
|
Facility
|
OP
|
$5,305.00
|
|
|
Service Code
|
HCPCS 1900050
|
| Hospital Charge Code |
7411770
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.85 |
| Max. Negotiated Rate |
$2,652.50 |
| Rate for Payer: Aetna Commercial |
$2,015.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,591.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,352.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,352.78
|
| 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 |
$1,352.78
|
| Rate for Payer: Cigna Commercial |
$2,652.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,591.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$795.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$127.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$140.58
|
|
|
IR-DRAIN OF BREAST LES-LT
|
Facility
|
IP
|
$3,392.55
|
|
|
Service Code
|
HCPCS 19000LT
|
| Hospital Charge Code |
2690870
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$508.88 |
| Max. Negotiated Rate |
$508.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$508.88
|
|
|
IR-DRAIN OF BREAST LES-LT
|
Facility
|
OP
|
$3,392.55
|
|
|
Service Code
|
HCPCS 19000LT
|
| Hospital Charge Code |
2690870
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$81.76 |
| Max. Negotiated Rate |
$1,696.28 |
| Rate for Payer: Aetna Commercial |
$1,289.17
|
| Rate for Payer: Aetna Medicare Advantage |
$1,017.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$865.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$865.10
|
| 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 |
$865.10
|
| Rate for Payer: Cigna Commercial |
$1,696.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,017.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$508.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$81.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$89.90
|
|
|
IR-DRAIN OF BREAST LES-LT
|
Facility
|
IP
|
$3,392.55
|
|
|
Service Code
|
HCPCS 19000LT
|
| Hospital Charge Code |
321019000L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$508.88 |
| Max. Negotiated Rate |
$508.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$508.88
|
|
|
IR-DRAIN OF BREAST LES-LT
|
Facility
|
OP
|
$5,305.00
|
|
|
Service Code
|
HCPCS 19000LT
|
| Hospital Charge Code |
7411859
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.85 |
| Max. Negotiated Rate |
$2,652.50 |
| Rate for Payer: Aetna Commercial |
$2,015.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,591.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,352.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,352.78
|
| 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 |
$1,352.78
|
| Rate for Payer: Cigna Commercial |
$2,652.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,591.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$795.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$127.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$140.58
|
|
|
IR-DRAIN OF BREAST LES-LT
|
Facility
|
IP
|
$5,305.00
|
|
|
Service Code
|
HCPCS 19000LT
|
| Hospital Charge Code |
7411859
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$795.75 |
| Max. Negotiated Rate |
$795.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$795.75
|
|
|
IR-DRAIN OF BREAST LES-LT
|
Facility
|
OP
|
$3,392.55
|
|
|
Service Code
|
HCPCS 19000LT
|
| Hospital Charge Code |
321019000L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$81.76 |
| Max. Negotiated Rate |
$1,696.28 |
| Rate for Payer: Aetna Commercial |
$1,289.17
|
| Rate for Payer: Aetna Medicare Advantage |
$1,017.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$865.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$865.10
|
| 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 |
$865.10
|
| Rate for Payer: Cigna Commercial |
$1,696.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,017.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$508.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$81.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$89.90
|
|
|
IR-DRAIN OF BREAST LES-RT
|
Facility
|
OP
|
$3,392.55
|
|
|
Service Code
|
HCPCS 19000RT
|
| Hospital Charge Code |
2690875
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$81.76 |
| Max. Negotiated Rate |
$1,696.28 |
| Rate for Payer: Aetna Commercial |
$1,289.17
|
| Rate for Payer: Aetna Medicare Advantage |
$1,017.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$865.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$865.10
|
| 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 |
$865.10
|
| Rate for Payer: Cigna Commercial |
$1,696.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,017.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$508.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$81.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$89.90
|
|
|
IR-DRAIN OF BREAST LES-RT
|
Facility
|
IP
|
$3,392.55
|
|
|
Service Code
|
HCPCS 19000RT
|
| Hospital Charge Code |
2690875
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$508.88 |
| Max. Negotiated Rate |
$508.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$508.88
|
|
|
IR-DRAIN OF BREAST LES-RT
|
Facility
|
IP
|
$3,392.55
|
|
|
Service Code
|
HCPCS 19000RT
|
| Hospital Charge Code |
321019000R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$508.88 |
| Max. Negotiated Rate |
$508.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$508.88
|
|
|
IR-DRAIN OF BREAST LES-RT
|
Facility
|
IP
|
$5,305.00
|
|
|
Service Code
|
HCPCS 19000RT
|
| Hospital Charge Code |
7411860
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$795.75 |
| Max. Negotiated Rate |
$795.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$795.75
|
|
|
IR-DRAIN OF BREAST LES-RT
|
Facility
|
OP
|
$5,305.00
|
|
|
Service Code
|
HCPCS 19000RT
|
| Hospital Charge Code |
7411860
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.85 |
| Max. Negotiated Rate |
$2,652.50 |
| Rate for Payer: Aetna Commercial |
$2,015.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,591.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,352.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,352.78
|
| 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 |
$1,352.78
|
| Rate for Payer: Cigna Commercial |
$2,652.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,591.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$795.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$127.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$140.58
|
|
|
IR-DRAIN OF BREAST LES-RT
|
Facility
|
OP
|
$3,392.55
|
|
|
Service Code
|
HCPCS 19000RT
|
| Hospital Charge Code |
321019000R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$81.76 |
| Max. Negotiated Rate |
$1,696.28 |
| Rate for Payer: Aetna Commercial |
$1,289.17
|
| Rate for Payer: Aetna Medicare Advantage |
$1,017.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$865.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$865.10
|
| 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 |
$865.10
|
| Rate for Payer: Cigna Commercial |
$1,696.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,017.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$508.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$81.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$89.90
|
|
|
IR DRAIN PELV ABS,TRANSVAG/TRA
|
Facility
|
OP
|
$8,582.36
|
|
|
Service Code
|
HCPCS 49407
|
| Hospital Charge Code |
7411587
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$206.83 |
| Max. Negotiated Rate |
$7,082.74 |
| Rate for Payer: Aetna Commercial |
$5,337.02
|
| Rate for Payer: Aetna Medicare Advantage |
$6,357.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,082.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,082.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,962.14
|
| 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 |
$7,082.74
|
| Rate for Payer: Cigna Commercial |
$3,933.12
|
| Rate for Payer: Cigna Medicare Advantage |
$1,962.14
|
| Rate for Payer: Clover Medicare Advantage |
$1,864.03
|
| Rate for Payer: EmblemHealth Commercial |
$5,886.42
|
| Rate for Payer: Humana Medicare Advantage |
$2,021.00
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,962.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,574.71
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,287.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,311.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$206.83
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,962.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,962.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$227.43
|
|
|
IR DRAIN PELV ABS,TRANSVAG/TRA
|
Facility
|
IP
|
$8,054.80
|
|
|
Service Code
|
HCPCS 49407
|
| Hospital Charge Code |
321049407
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,208.22 |
| Max. Negotiated Rate |
$1,208.22 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,208.22
|
|
|
IR DRAIN PELV ABS,TRANSVAG/TRA
|
Facility
|
OP
|
$8,054.80
|
|
|
Service Code
|
HCPCS 49407
|
| Hospital Charge Code |
2680225
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$194.12 |
| Max. Negotiated Rate |
$7,082.74 |
| Rate for Payer: Aetna Commercial |
$5,337.02
|
| Rate for Payer: Aetna Medicare Advantage |
$6,357.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,082.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,082.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,962.14
|
| 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 |
$7,082.74
|
| Rate for Payer: Cigna Commercial |
$3,933.12
|
| Rate for Payer: Cigna Medicare Advantage |
$1,962.14
|
| Rate for Payer: Clover Medicare Advantage |
$1,864.03
|
| Rate for Payer: EmblemHealth Commercial |
$5,886.42
|
| Rate for Payer: Humana Medicare Advantage |
$2,021.00
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,962.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,416.44
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,208.22
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,311.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$194.12
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,962.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,962.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$213.45
|
|
|
IR DRAIN PELV ABS,TRANSVAG/TRA
|
Facility
|
IP
|
$8,582.36
|
|
|
Service Code
|
HCPCS 49407
|
| Hospital Charge Code |
7411587
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,287.35 |
| Max. Negotiated Rate |
$1,287.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,287.35
|
|
|
IR DRAIN PELV ABS,TRANSVAG/TRA
|
Facility
|
IP
|
$8,054.80
|
|
|
Service Code
|
HCPCS 49407
|
| Hospital Charge Code |
2680225
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,208.22 |
| Max. Negotiated Rate |
$1,208.22 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,208.22
|
|
|
IR DRAIN PELV ABS,TRANSVAG/TRA
|
Facility
|
OP
|
$8,054.80
|
|
|
Service Code
|
HCPCS 49407
|
| Hospital Charge Code |
321049407
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$194.12 |
| Max. Negotiated Rate |
$7,082.74 |
| Rate for Payer: Aetna Commercial |
$5,337.02
|
| Rate for Payer: Aetna Medicare Advantage |
$6,357.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,082.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,082.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,962.14
|
| 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 |
$7,082.74
|
| Rate for Payer: Cigna Commercial |
$3,933.12
|
| Rate for Payer: Cigna Medicare Advantage |
$1,962.14
|
| Rate for Payer: Clover Medicare Advantage |
$1,864.03
|
| Rate for Payer: EmblemHealth Commercial |
$5,886.42
|
| Rate for Payer: Humana Medicare Advantage |
$2,021.00
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,962.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,416.44
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,208.22
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,311.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$194.12
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,962.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,962.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$213.45
|
|
|
IR-DRAIN PERIU ABSCE DEEP
|
Facility
|
OP
|
$7,145.00
|
|
|
Service Code
|
HCPCS 53040
|
| Hospital Charge Code |
2690200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$172.19 |
| 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 |
$2,143.50
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,071.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$172.19
|
| 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 |
$189.34
|
|
|
IR-DRAIN PERIU ABSCE DEEP
|
Facility
|
IP
|
$7,145.00
|
|
|
Service Code
|
HCPCS 53040
|
| Hospital Charge Code |
7411630
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,071.75 |
| Max. Negotiated Rate |
$1,071.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,071.75
|
|
