|
IR PERC PLACE OF METALLIC CLIP
|
Facility
|
OP
|
$270.60
|
|
| Hospital Charge Code |
26702046
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$1,626.00 |
| Rate for Payer: Aetna Commercial |
$102.83
|
| Rate for Payer: Aetna Medicare Advantage |
$81.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$69.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$69.00
|
| 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 |
$69.00
|
| Rate for Payer: Cigna Commercial |
$135.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$81.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.59
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.17
|
|
|
IR PERC RF ABLATE RENAL TUMOR
|
Facility
|
OP
|
$21,118.85
|
|
|
Service Code
|
HCPCS 50592
|
| Hospital Charge Code |
7411612
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$508.96 |
| Max. Negotiated Rate |
$25,925.77 |
| Rate for Payer: Aetna Commercial |
$19,535.72
|
| Rate for Payer: Aetna Medicare Advantage |
$23,270.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$25,925.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$25,925.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7,182.25
|
| 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 |
$25,925.77
|
| Rate for Payer: Cigna Commercial |
$14,396.79
|
| Rate for Payer: Cigna Medicare Advantage |
$7,182.25
|
| Rate for Payer: Clover Medicare Advantage |
$6,823.14
|
| Rate for Payer: EmblemHealth Commercial |
$21,546.75
|
| Rate for Payer: Humana Medicare Advantage |
$7,397.72
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$7,182.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,335.65
|
| Rate for Payer: Oxford Commercial |
$8,679.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,167.83
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,834.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$508.96
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7,182.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$7,182.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$559.65
|
|
|
IR PERC RF ABLATE RENAL TUMOR
|
Facility
|
OP
|
$21,118.85
|
|
|
Service Code
|
HCPCS 50592
|
| Hospital Charge Code |
5600170
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$508.96 |
| Max. Negotiated Rate |
$25,925.77 |
| Rate for Payer: Aetna Commercial |
$19,535.72
|
| Rate for Payer: Aetna Medicare Advantage |
$23,270.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$25,925.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$25,925.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7,182.25
|
| 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 |
$25,925.77
|
| Rate for Payer: Cigna Commercial |
$14,396.79
|
| Rate for Payer: Cigna Medicare Advantage |
$7,182.25
|
| Rate for Payer: Clover Medicare Advantage |
$6,823.14
|
| Rate for Payer: EmblemHealth Commercial |
$21,546.75
|
| Rate for Payer: Humana Medicare Advantage |
$7,397.72
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$7,182.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,335.65
|
| Rate for Payer: Oxford Commercial |
$8,679.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,167.83
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,834.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$508.96
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7,182.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$7,182.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$559.65
|
|
|
IR PERC RF ABLATE RENAL TUMOR
|
Facility
|
IP
|
$21,118.85
|
|
|
Service Code
|
HCPCS 50592
|
| Hospital Charge Code |
7411612
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,167.83 |
| Max. Negotiated Rate |
$3,167.83 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,167.83
|
|
|
IR PERC RF ABLATE RENAL TUMOR
|
Facility
|
IP
|
$21,118.85
|
|
|
Service Code
|
HCPCS 50592
|
| Hospital Charge Code |
5600170
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,167.83 |
| Max. Negotiated Rate |
$3,167.83 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,167.83
|
|
|
IR PERC TRAN DIL BILIARY DUCTS
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 74363
|
| Hospital Charge Code |
2000935
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
IR PERC TRAN DIL BILIARY DUCTS
|
Facility
|
IP
|
$2,088.00
|
|
|
Service Code
|
HCPCS 74363
|
| Hospital Charge Code |
7411676
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.20 |
| Max. Negotiated Rate |
$313.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$313.20
|
|
|
IR PERC TRAN DIL BILIARY DUCTS
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 74363
|
| Hospital Charge Code |
366874363
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$122.91 |
| Max. Negotiated Rate |
$2,550.00 |
| Rate for Payer: Aetna Commercial |
$1,938.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,300.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,300.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$345.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$2,550.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,530.00
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$122.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$135.15
|
|
|
IR PERC TRAN DIL BILIARY DUCTS
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 74363
|
| Hospital Charge Code |
366874363
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
IR PERC TRAN DIL BILIARY DUCTS
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 74363
|
| Hospital Charge Code |
2000935
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$122.91 |
| Max. Negotiated Rate |
$2,550.00 |
| Rate for Payer: Aetna Commercial |
$1,938.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,300.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,300.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$345.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$2,550.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,530.00
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$122.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$135.15
|
|
|
IR PERC TRAN DIL BILIARY DUCTS
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 74363
|
| Hospital Charge Code |
321074363
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
IR PERC TRAN DIL BILIARY DUCTS
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 74363
|
| Hospital Charge Code |
411074363
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
IR PERC TRAN DIL BILIARY DUCTS
|
Facility
|
OP
|
$2,088.00
|
|
|
Service Code
|
HCPCS 74363
|
| Hospital Charge Code |
7411676
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$50.32 |
| Max. Negotiated Rate |
$1,975.00 |
| Rate for Payer: Aetna Commercial |
$793.44
|
| Rate for Payer: Aetna Medicare Advantage |
$626.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$532.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$532.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$345.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$532.44
|
| Rate for Payer: Cigna Commercial |
$1,044.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$626.40
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$313.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$50.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$55.33
|
|
|
IR PERC TRAN DIL BILIARY DUCTS
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 74363
|
| Hospital Charge Code |
321074363
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$122.91 |
| Max. Negotiated Rate |
$2,550.00 |
| Rate for Payer: Aetna Commercial |
$1,938.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,300.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,300.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$345.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$2,550.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,530.00
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$122.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$135.15
|
|
|
IR PERC TRAN DIL BILIARY DUCTS
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 74363
|
| Hospital Charge Code |
411074363
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$122.91 |
| Max. Negotiated Rate |
$2,550.00 |
| Rate for Payer: Aetna Commercial |
$1,938.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,300.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,300.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$345.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$2,550.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,530.00
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$122.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$135.15
|
|
|
IR PERC TRANSLM BAL ANG VENOUS
|
Facility
|
IP
|
$5,659.55
|
|
|
Service Code
|
HCPCS 35476
|
| Hospital Charge Code |
2001355
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$848.93 |
| Max. Negotiated Rate |
$848.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$848.93
|
|
|
IR PERC TRANSLM BAL ANG VENOUS
|
Facility
|
OP
|
$5,659.55
|
|
|
Service Code
|
HCPCS 35476
|
| Hospital Charge Code |
2001355
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$136.40 |
| Max. Negotiated Rate |
$2,829.78 |
| Rate for Payer: Aetna Commercial |
$2,150.63
|
| Rate for Payer: Aetna Medicare Advantage |
$1,697.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,443.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,443.19
|
| 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 |
$1,443.19
|
| Rate for Payer: Cigna Commercial |
$2,829.78
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,697.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$848.93
|
| Rate for Payer: UnitedHealthcare Community & State |
$136.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$149.98
|
|
|
IR-PERCUT ABLATE LIVER RF
|
Facility
|
IP
|
$14,506.00
|
|
|
Service Code
|
HCPCS 47380
|
| Hospital Charge Code |
2690130
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,175.90 |
| Max. Negotiated Rate |
$2,175.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,175.90
|
|
|
IR-PERCUT ABLATE LIVER RF
|
Facility
|
OP
|
$14,506.00
|
|
|
Service Code
|
HCPCS 47380
|
| Hospital Charge Code |
7411555
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$349.59 |
| Max. Negotiated Rate |
$10,232.00 |
| Rate for Payer: Aetna Commercial |
$5,512.28
|
| Rate for Payer: Aetna Medicare Advantage |
$4,351.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,699.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,699.03
|
| 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 |
$3,699.03
|
| Rate for Payer: Cigna Commercial |
$7,253.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,351.80
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,175.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,232.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$349.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$384.41
|
|
|
IR-PERCUT ABLATE LIVER RF
|
Facility
|
OP
|
$14,506.00
|
|
|
Service Code
|
HCPCS 47380
|
| Hospital Charge Code |
2690130
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$349.59 |
| Max. Negotiated Rate |
$10,232.00 |
| Rate for Payer: Aetna Commercial |
$5,512.28
|
| Rate for Payer: Aetna Medicare Advantage |
$4,351.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,699.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,699.03
|
| 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 |
$3,699.03
|
| Rate for Payer: Cigna Commercial |
$7,253.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,351.80
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,175.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,232.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$349.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$384.41
|
|
|
IR-PERCUT ABLATE LIVER RF
|
Facility
|
IP
|
$14,506.00
|
|
|
Service Code
|
HCPCS 47380
|
| Hospital Charge Code |
7411555
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,175.90 |
| Max. Negotiated Rate |
$2,175.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,175.90
|
|
|
IR PERCUTANEOUS GI TUBE PLCMNT
|
Facility
|
IP
|
$602.00
|
|
|
Service Code
|
HCPCS 74350
|
| Hospital Charge Code |
2600107
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$90.30 |
| Max. Negotiated Rate |
$90.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.30
|
|
|
IR PERCUTANEOUS GI TUBE PLCMNT
|
Facility
|
OP
|
$602.00
|
|
|
Service Code
|
HCPCS 74350
|
| Hospital Charge Code |
2600107
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.51 |
| Max. Negotiated Rate |
$1,975.00 |
| Rate for Payer: Aetna Commercial |
$228.76
|
| Rate for Payer: Aetna Medicare Advantage |
$180.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$153.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$153.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$153.51
|
| Rate for Payer: Cigna Commercial |
$301.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$180.60
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.51
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.95
|
|
|
IR PERCUTANEOUS NEPHROSTOMY
|
Facility
|
OP
|
$2,217.65
|
|
| Hospital Charge Code |
2002103
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$1,975.00 |
| Rate for Payer: Aetna Commercial |
$842.71
|
| Rate for Payer: Aetna Medicare Advantage |
$665.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$565.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$565.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$565.50
|
| Rate for Payer: Cigna Commercial |
$1,108.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$665.29
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$332.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$53.45
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$58.77
|
|
|
IR PERCUTANEOUS NEPHROSTOMY
|
Facility
|
IP
|
$2,217.65
|
|
| Hospital Charge Code |
2002103
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$332.65 |
| Max. Negotiated Rate |
$332.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$332.65
|
|
