|
IR I&D ABSCESS DEEP LEG OR ANK
|
Facility
|
IP
|
$8,548.96
|
|
|
Service Code
|
HCPCS 27603
|
| Hospital Charge Code |
2680100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,282.34 |
| Max. Negotiated Rate |
$1,282.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,282.34
|
|
|
IR I&D ABSCESS DEEP LEG OR ANK
|
Facility
|
OP
|
$8,548.96
|
|
|
Service Code
|
HCPCS 27603
|
| Hospital Charge Code |
7411371
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$206.03 |
| Max. Negotiated Rate |
$12,456.64 |
| Rate for Payer: Aetna Commercial |
$9,386.39
|
| Rate for Payer: Aetna Medicare Advantage |
$11,180.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12,456.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12,456.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,450.88
|
| 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 |
$12,456.64
|
| Rate for Payer: Cigna Commercial |
$6,917.28
|
| Rate for Payer: Cigna Medicare Advantage |
$3,450.88
|
| Rate for Payer: Clover Medicare Advantage |
$3,278.34
|
| Rate for Payer: EmblemHealth Commercial |
$10,352.64
|
| Rate for Payer: Humana Medicare Advantage |
$3,554.41
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,450.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,564.69
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,282.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$206.03
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$226.55
|
|
|
IR I&D DEEP ABSCESS NECK/THORA
|
Facility
|
OP
|
$8,548.96
|
|
|
Service Code
|
HCPCS 21501
|
| Hospital Charge Code |
2680045
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$206.03 |
| Max. Negotiated Rate |
$12,456.64 |
| Rate for Payer: Aetna Commercial |
$9,386.39
|
| Rate for Payer: Aetna Medicare Advantage |
$11,180.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12,456.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12,456.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,450.88
|
| 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 |
$12,456.64
|
| Rate for Payer: Cigna Commercial |
$6,917.28
|
| Rate for Payer: Cigna Medicare Advantage |
$3,450.88
|
| Rate for Payer: Clover Medicare Advantage |
$3,278.34
|
| Rate for Payer: EmblemHealth Commercial |
$10,352.64
|
| Rate for Payer: Humana Medicare Advantage |
$3,554.41
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,450.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,564.69
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,282.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$206.03
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$226.55
|
|
|
IR I&D DEEP ABSCESS NECK/THORA
|
Facility
|
OP
|
$8,548.96
|
|
|
Service Code
|
HCPCS 20501
|
| Hospital Charge Code |
7411350
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$206.03 |
| Max. Negotiated Rate |
$4,274.48 |
| Rate for Payer: Aetna Commercial |
$3,248.60
|
| Rate for Payer: Aetna Medicare Advantage |
$2,564.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,179.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,179.98
|
| 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 |
$2,179.98
|
| Rate for Payer: Cigna Commercial |
$4,274.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,564.69
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,282.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$206.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$226.55
|
|
|
IR I&D DEEP ABSCESS NECK/THORA
|
Facility
|
IP
|
$8,548.96
|
|
|
Service Code
|
HCPCS 20501
|
| Hospital Charge Code |
7411350
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,282.34 |
| Max. Negotiated Rate |
$1,282.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,282.34
|
|
|
IR I&D DEEP ABSCESS NECK/THORA
|
Facility
|
IP
|
$8,548.96
|
|
|
Service Code
|
HCPCS 21501
|
| Hospital Charge Code |
2680045
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,282.34 |
| Max. Negotiated Rate |
$1,282.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,282.34
|
|
|
IR I&D DEEP ABSCESS UP ARM/ELB
|
Facility
|
IP
|
$8,548.96
|
|
|
Service Code
|
HCPCS 23930
|
| Hospital Charge Code |
7411361
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,282.34 |
| Max. Negotiated Rate |
$1,282.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,282.34
|
|
|
IR I&D DEEP ABSCESS UP ARM/ELB
|
Facility
|
OP
|
$8,548.96
|
|
|
Service Code
|
HCPCS 23930
|
| Hospital Charge Code |
7411361
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$206.03 |
| Max. Negotiated Rate |
$12,456.64 |
| Rate for Payer: Aetna Commercial |
$9,386.39
|
| Rate for Payer: Aetna Medicare Advantage |
$11,180.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12,456.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12,456.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,450.88
|
| 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 |
$12,456.64
|
| Rate for Payer: Cigna Commercial |
$6,917.28
|
| Rate for Payer: Cigna Medicare Advantage |
$3,450.88
|
| Rate for Payer: Clover Medicare Advantage |
$3,278.34
|
| Rate for Payer: EmblemHealth Commercial |
$10,352.64
|
| Rate for Payer: Humana Medicare Advantage |
$3,554.41
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,450.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,564.69
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,282.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$206.03
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$226.55
|
|
|
IR I&D DEEP ABSCESS UP ARM/ELB
|
Facility
|
OP
|
$8,548.96
|
|
|
Service Code
|
HCPCS 23930
|
| Hospital Charge Code |
2680060
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$206.03 |
| Max. Negotiated Rate |
$12,456.64 |
| Rate for Payer: Aetna Commercial |
$9,386.39
|
| Rate for Payer: Aetna Medicare Advantage |
$11,180.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12,456.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12,456.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,450.88
|
| 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 |
$12,456.64
|
| Rate for Payer: Cigna Commercial |
$6,917.28
|
| Rate for Payer: Cigna Medicare Advantage |
$3,450.88
|
| Rate for Payer: Clover Medicare Advantage |
$3,278.34
|
| Rate for Payer: EmblemHealth Commercial |
$10,352.64
|
| Rate for Payer: Humana Medicare Advantage |
$3,554.41
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,450.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,564.69
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,282.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$206.03
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$226.55
|
|
|
IR I&D DEEP ABSCESS UP ARM/ELB
|
Facility
|
IP
|
$8,548.96
|
|
|
Service Code
|
HCPCS 23930
|
| Hospital Charge Code |
2680060
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,282.34 |
| Max. Negotiated Rate |
$1,282.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,282.34
|
|
|
IR I&D DEEP THIGH OR KNEE
|
Facility
|
IP
|
$8,548.96
|
|
|
Service Code
|
HCPCS 27301
|
| Hospital Charge Code |
2680090
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,282.34 |
| Max. Negotiated Rate |
$1,282.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,282.34
|
|
|
IR I&D DEEP THIGH OR KNEE
|
Facility
|
OP
|
$8,548.96
|
|
|
Service Code
|
HCPCS 27301
|
| Hospital Charge Code |
2680090
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$206.03 |
| Max. Negotiated Rate |
$12,456.64 |
| Rate for Payer: Aetna Commercial |
$9,386.39
|
| Rate for Payer: Aetna Medicare Advantage |
$11,180.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12,456.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12,456.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,450.88
|
| 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 |
$12,456.64
|
| Rate for Payer: Cigna Commercial |
$6,917.28
|
| Rate for Payer: Cigna Medicare Advantage |
$3,450.88
|
| Rate for Payer: Clover Medicare Advantage |
$3,278.34
|
| Rate for Payer: EmblemHealth Commercial |
$10,352.64
|
| Rate for Payer: Humana Medicare Advantage |
$3,554.41
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,450.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,564.69
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,282.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$206.03
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$226.55
|
|
|
IR I&D DEEP THIGH OR KNEE
|
Facility
|
OP
|
$8,548.96
|
|
|
Service Code
|
HCPCS 27301
|
| Hospital Charge Code |
7411369
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$206.03 |
| Max. Negotiated Rate |
$12,456.64 |
| Rate for Payer: Aetna Commercial |
$9,386.39
|
| Rate for Payer: Aetna Medicare Advantage |
$11,180.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12,456.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12,456.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,450.88
|
| 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 |
$12,456.64
|
| Rate for Payer: Cigna Commercial |
$6,917.28
|
| Rate for Payer: Cigna Medicare Advantage |
$3,450.88
|
| Rate for Payer: Clover Medicare Advantage |
$3,278.34
|
| Rate for Payer: EmblemHealth Commercial |
$10,352.64
|
| Rate for Payer: Humana Medicare Advantage |
$3,554.41
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,450.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,564.69
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,282.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$206.03
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$226.55
|
|
|
IR I&D DEEP THIGH OR KNEE
|
Facility
|
IP
|
$8,548.96
|
|
|
Service Code
|
HCPCS 27301
|
| Hospital Charge Code |
7411369
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,282.34 |
| Max. Negotiated Rate |
$1,282.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,282.34
|
|
|
IR I&D HEMATOMA, SEROMA OR FLU
|
Facility
|
IP
|
$8,036.95
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
2680001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,205.54 |
| Max. Negotiated Rate |
$1,205.54 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,205.54
|
|
|
IR I&D HEMATOMA, SEROMA OR FLU
|
Facility
|
IP
|
$5,456.19
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
7411335
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$818.43 |
| Max. Negotiated Rate |
$818.43 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$818.43
|
|
|
IR I&D HEMATOMA, SEROMA OR FLU
|
Facility
|
OP
|
$8,036.95
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
2680001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$193.69 |
| 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 |
$2,411.09
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,205.54
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,311.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$193.69
|
| 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 |
$212.98
|
|
|
IR I&D HEMATOMA, SEROMA OR FLU
|
Facility
|
IP
|
$8,036.95
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
403410140
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,205.54 |
| Max. Negotiated Rate |
$1,205.54 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,205.54
|
|
|
IR I&D HEMATOMA, SEROMA OR FLU
|
Facility
|
OP
|
$5,456.19
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
7411335
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$131.49 |
| 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 |
$1,636.86
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$818.43
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,311.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$131.49
|
| 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 |
$144.59
|
|
|
IR I&D HEMATOMA, SEROMA OR FLU
|
Facility
|
OP
|
$8,036.95
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
403410140
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$193.69 |
| 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 |
$3,194.00
|
| 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 |
$2,411.09
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$6,600.00
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,205.54
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,311.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$193.69
|
| 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 |
$212.98
|
|
|
IR-ID SENTINEL NODE-BI
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
HCPCS 3879250
|
| Hospital Charge Code |
7411814
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$1,626.00 |
| Rate for Payer: Aetna Commercial |
$142.12
|
| Rate for Payer: Aetna Medicare Advantage |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$95.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$95.37
|
| 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 |
$95.37
|
| Rate for Payer: Cigna Commercial |
$187.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$112.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.91
|
|
|
IR-ID SENTINEL NODE-BI
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
HCPCS 3879250
|
| Hospital Charge Code |
7411814
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$56.10 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.10
|
|
|
IR-ID SENTINEL NODE-BI
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
HCPCS 3879250
|
| Hospital Charge Code |
2690580
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$56.10 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.10
|
|
|
IR-ID SENTINEL NODE-BI
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
HCPCS 3879250
|
| Hospital Charge Code |
2690580
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$1,626.00 |
| Rate for Payer: Aetna Commercial |
$142.12
|
| Rate for Payer: Aetna Medicare Advantage |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$95.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$95.37
|
| 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 |
$95.37
|
| Rate for Payer: Cigna Commercial |
$187.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$112.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.91
|
|
|
IR-ID SENTINEL NODE-LT
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
HCPCS 38792LT
|
| Hospital Charge Code |
7411948
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$1,626.00 |
| Rate for Payer: Aetna Commercial |
$142.12
|
| Rate for Payer: Aetna Medicare Advantage |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$95.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$95.37
|
| 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 |
$95.37
|
| Rate for Payer: Cigna Commercial |
$187.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$112.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.91
|
|
