|
IR-REM OBS G/G-J/COLO TUB
|
Facility
|
OP
|
$4,459.55
|
|
|
Service Code
|
HCPCS 49460
|
| Hospital Charge Code |
321049460
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$107.48 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Aetna Commercial |
$2,930.85
|
| Rate for Payer: Aetna Medicare Advantage |
$3,491.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,889.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,889.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,077.52
|
| 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 |
$3,889.52
|
| Rate for Payer: Cigna Commercial |
$2,159.89
|
| Rate for Payer: Cigna Medicare Advantage |
$1,077.52
|
| Rate for Payer: Clover Medicare Advantage |
$1,023.64
|
| Rate for Payer: EmblemHealth Commercial |
$3,232.56
|
| Rate for Payer: Humana Medicare Advantage |
$1,109.85
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,077.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,337.87
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$668.93
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,311.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$107.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,077.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,077.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$118.18
|
|
|
IR-REM OBS G/G-J/COLO TUB
|
Facility
|
OP
|
$3,717.20
|
|
|
Service Code
|
HCPCS 49460
|
| Hospital Charge Code |
366849460
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.58 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Aetna Commercial |
$2,930.85
|
| Rate for Payer: Aetna Medicare Advantage |
$3,491.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,889.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,889.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,077.52
|
| 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 |
$3,889.52
|
| Rate for Payer: Cigna Commercial |
$2,159.89
|
| Rate for Payer: Cigna Medicare Advantage |
$1,077.52
|
| Rate for Payer: Clover Medicare Advantage |
$1,023.64
|
| Rate for Payer: EmblemHealth Commercial |
$3,232.56
|
| Rate for Payer: Humana Medicare Advantage |
$1,109.85
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,077.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,115.16
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$557.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,311.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$89.58
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,077.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,077.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$98.51
|
|
|
IR REM OF IMPLANT VEN ACCS DEV
|
Facility
|
OP
|
$2,024.90
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
2004743
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$3,593.00 |
| Rate for Payer: Aetna Commercial |
$2,027.08
|
| Rate for Payer: Aetna Medicare Advantage |
$2,414.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,690.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,690.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$745.25
|
| 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 |
$2,690.13
|
| Rate for Payer: Cigna Commercial |
$1,493.86
|
| Rate for Payer: Cigna Medicare Advantage |
$745.25
|
| Rate for Payer: Clover Medicare Advantage |
$707.99
|
| Rate for Payer: EmblemHealth Commercial |
$2,235.75
|
| Rate for Payer: Humana Medicare Advantage |
$767.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$745.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$607.47
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$303.74
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,593.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$48.80
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$745.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$745.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$53.66
|
|
|
IR REM OF IMPLANT VEN ACCS DEV
|
Facility
|
IP
|
$2,024.90
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
2004743
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$303.74 |
| Max. Negotiated Rate |
$303.74 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$303.74
|
|
|
IR REMOVAL OF IMPLANT VEN DEV
|
Facility
|
IP
|
$2,024.90
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
2101148
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$303.74 |
| Max. Negotiated Rate |
$303.74 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$303.74
|
|
|
IR REMOVAL OF IMPLANT VEN DEV
|
Facility
|
OP
|
$2,024.90
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
2101148
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$3,593.00 |
| Rate for Payer: Aetna Commercial |
$2,027.08
|
| Rate for Payer: Aetna Medicare Advantage |
$2,414.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,690.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,690.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$745.25
|
| 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 |
$2,690.13
|
| Rate for Payer: Cigna Commercial |
$1,493.86
|
| Rate for Payer: Cigna Medicare Advantage |
$745.25
|
| Rate for Payer: Clover Medicare Advantage |
$707.99
|
| Rate for Payer: EmblemHealth Commercial |
$2,235.75
|
| Rate for Payer: Humana Medicare Advantage |
$767.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$745.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$607.47
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$303.74
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,593.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$48.80
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$745.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$745.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$53.66
|
|
|
IR REMOVE BILE DUCT STONE
|
Facility
|
OP
|
$4,222.25
|
|
| Hospital Charge Code |
2101151
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$101.76 |
| Max. Negotiated Rate |
$2,111.12 |
| Rate for Payer: Aetna Commercial |
$1,604.45
|
| Rate for Payer: Aetna Medicare Advantage |
$1,266.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,076.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,076.67
|
| 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 |
$1,076.67
|
| Rate for Payer: Cigna Commercial |
$2,111.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,266.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$633.34
|
| Rate for Payer: UnitedHealthcare Community & State |
$101.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$111.89
|
|
|
IR REMOVE BILE DUCT STONE
|
Facility
|
IP
|
$4,222.25
|
|
| Hospital Charge Code |
2101151
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$633.34 |
| Max. Negotiated Rate |
$633.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$633.34
|
|
|
IR REMOVE HEPATIC SHUNT (TIPS)
|
Facility
|
OP
|
$27,397.00
|
|
|
Service Code
|
HCPCS 37183
|
| Hospital Charge Code |
321037183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$660.27 |
| Max. Negotiated Rate |
$24,407.82 |
| Rate for Payer: Aetna Commercial |
$18,391.91
|
| Rate for Payer: Aetna Medicare Advantage |
$21,908.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24,407.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24,407.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,761.73
|
| 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 |
$24,407.82
|
| Rate for Payer: Cigna Commercial |
$13,553.85
|
| Rate for Payer: Cigna Medicare Advantage |
$6,761.73
|
| Rate for Payer: Clover Medicare Advantage |
$6,423.64
|
| Rate for Payer: EmblemHealth Commercial |
$20,285.19
|
| Rate for Payer: Humana Medicare Advantage |
$6,964.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,761.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,219.10
|
| Rate for Payer: Oxford Commercial |
$9,689.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,109.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$16,605.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$660.27
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$726.02
|
|
|
IR REMOVE HEPATIC SHUNT (TIPS)
|
Facility
|
IP
|
$25,423.30
|
|
|
Service Code
|
HCPCS 37183
|
| Hospital Charge Code |
411037183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,813.49 |
| Max. Negotiated Rate |
$3,813.49 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,813.49
|
|
|
IR REMOVE HEPATIC SHUNT (TIPS)
|
Facility
|
IP
|
$25,423.30
|
|
|
Service Code
|
HCPCS 37183
|
| Hospital Charge Code |
366837183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,813.49 |
| Max. Negotiated Rate |
$3,813.49 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,813.49
|
|
|
IR REMOVE HEPATIC SHUNT (TIPS)
|
Facility
|
OP
|
$25,423.30
|
|
|
Service Code
|
HCPCS 37183
|
| Hospital Charge Code |
366837183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$612.70 |
| Max. Negotiated Rate |
$24,407.82 |
| Rate for Payer: Aetna Commercial |
$18,391.91
|
| Rate for Payer: Aetna Medicare Advantage |
$21,908.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24,407.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24,407.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,761.73
|
| 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 |
$24,407.82
|
| Rate for Payer: Cigna Commercial |
$13,553.85
|
| Rate for Payer: Cigna Medicare Advantage |
$6,761.73
|
| Rate for Payer: Clover Medicare Advantage |
$6,423.64
|
| Rate for Payer: EmblemHealth Commercial |
$20,285.19
|
| Rate for Payer: Humana Medicare Advantage |
$6,964.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,761.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,626.99
|
| Rate for Payer: Oxford Commercial |
$9,689.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,813.49
|
| Rate for Payer: UnitedHealthcare Commercial |
$16,605.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$612.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$673.72
|
|
|
IR REMOVE HEPATIC SHUNT (TIPS)
|
Facility
|
IP
|
$27,397.00
|
|
|
Service Code
|
HCPCS 37183
|
| Hospital Charge Code |
321037183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,109.55 |
| Max. Negotiated Rate |
$4,109.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,109.55
|
|
|
IR REMOVE HEPATIC SHUNT (TIPS)
|
Facility
|
OP
|
$41,896.20
|
|
|
Service Code
|
HCPCS 37183
|
| Hospital Charge Code |
7411493
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,009.70 |
| Max. Negotiated Rate |
$24,407.82 |
| Rate for Payer: Aetna Commercial |
$18,391.91
|
| Rate for Payer: Aetna Medicare Advantage |
$21,908.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24,407.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24,407.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,761.73
|
| 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 |
$24,407.82
|
| Rate for Payer: Cigna Commercial |
$13,553.85
|
| Rate for Payer: Cigna Medicare Advantage |
$6,761.73
|
| Rate for Payer: Clover Medicare Advantage |
$6,423.64
|
| Rate for Payer: EmblemHealth Commercial |
$20,285.19
|
| Rate for Payer: Humana Medicare Advantage |
$6,964.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,761.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12,568.86
|
| Rate for Payer: Oxford Commercial |
$9,689.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,284.43
|
| Rate for Payer: UnitedHealthcare Commercial |
$16,605.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,009.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,110.25
|
|
|
IR REMOVE HEPATIC SHUNT (TIPS)
|
Facility
|
OP
|
$27,397.00
|
|
|
Service Code
|
HCPCS 37183
|
| Hospital Charge Code |
2011298
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$660.27 |
| Max. Negotiated Rate |
$24,407.82 |
| Rate for Payer: Aetna Commercial |
$18,391.91
|
| Rate for Payer: Aetna Medicare Advantage |
$21,908.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24,407.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24,407.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,761.73
|
| 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 |
$24,407.82
|
| Rate for Payer: Cigna Commercial |
$13,553.85
|
| Rate for Payer: Cigna Medicare Advantage |
$6,761.73
|
| Rate for Payer: Clover Medicare Advantage |
$6,423.64
|
| Rate for Payer: EmblemHealth Commercial |
$20,285.19
|
| Rate for Payer: Humana Medicare Advantage |
$6,964.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,761.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,219.10
|
| Rate for Payer: Oxford Commercial |
$9,689.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,109.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$16,605.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$660.27
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$726.02
|
|
|
IR REMOVE HEPATIC SHUNT (TIPS)
|
Facility
|
IP
|
$27,397.00
|
|
|
Service Code
|
HCPCS 37183
|
| Hospital Charge Code |
2011298
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,109.55 |
| Max. Negotiated Rate |
$4,109.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,109.55
|
|
|
IR REMOVE HEPATIC SHUNT (TIPS)
|
Facility
|
IP
|
$41,896.20
|
|
|
Service Code
|
HCPCS 37183
|
| Hospital Charge Code |
7411493
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,284.43 |
| Max. Negotiated Rate |
$6,284.43 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,284.43
|
|
|
IR REMOVE HEPATIC SHUNT (TIPS)
|
Facility
|
OP
|
$25,423.30
|
|
|
Service Code
|
HCPCS 37183
|
| Hospital Charge Code |
411037183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$612.70 |
| Max. Negotiated Rate |
$24,407.82 |
| Rate for Payer: Aetna Commercial |
$18,391.91
|
| Rate for Payer: Aetna Medicare Advantage |
$21,908.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24,407.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24,407.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,761.73
|
| 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 |
$24,407.82
|
| Rate for Payer: Cigna Commercial |
$13,553.85
|
| Rate for Payer: Cigna Medicare Advantage |
$6,761.73
|
| Rate for Payer: Clover Medicare Advantage |
$6,423.64
|
| Rate for Payer: EmblemHealth Commercial |
$20,285.19
|
| Rate for Payer: Humana Medicare Advantage |
$6,964.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,761.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,626.99
|
| Rate for Payer: Oxford Commercial |
$9,689.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,813.49
|
| Rate for Payer: UnitedHealthcare Commercial |
$16,605.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$612.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$673.72
|
|
|
IR-REM/REPL URET STNT-BI
|
Facility
|
OP
|
$7,568.00
|
|
|
Service Code
|
HCPCS 5038250
|
| Hospital Charge Code |
7411819
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$182.39 |
| Max. Negotiated Rate |
$3,784.00 |
| Rate for Payer: Aetna Commercial |
$2,875.84
|
| Rate for Payer: Aetna Medicare Advantage |
$2,270.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,929.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,929.84
|
| 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 |
$1,929.84
|
| Rate for Payer: Cigna Commercial |
$3,784.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,270.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,135.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$182.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$200.55
|
|
|
IR-REM/REPL URET STNT-BI
|
Facility
|
OP
|
$7,568.00
|
|
|
Service Code
|
HCPCS 5038250
|
| Hospital Charge Code |
2690610
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$182.39 |
| Max. Negotiated Rate |
$3,784.00 |
| Rate for Payer: Aetna Commercial |
$2,875.84
|
| Rate for Payer: Aetna Medicare Advantage |
$2,270.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,929.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,929.84
|
| 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 |
$1,929.84
|
| Rate for Payer: Cigna Commercial |
$3,784.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,270.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,135.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$182.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$200.55
|
|
|
IR-REM/REPL URET STNT-BI
|
Facility
|
IP
|
$7,568.00
|
|
|
Service Code
|
HCPCS 5038250
|
| Hospital Charge Code |
2690610
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,135.20 |
| Max. Negotiated Rate |
$1,135.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,135.20
|
|
|
IR-REM/REPL URET STNT-BI
|
Facility
|
IP
|
$7,568.00
|
|
|
Service Code
|
HCPCS 5038250
|
| Hospital Charge Code |
7411819
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,135.20 |
| Max. Negotiated Rate |
$1,135.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,135.20
|
|
|
IR-REM/REPL URET STNT-LT
|
Facility
|
IP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50382RT
|
| Hospital Charge Code |
411050382L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,528.17 |
| Max. Negotiated Rate |
$1,528.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,528.17
|
|
|
IR-REM/REPL URET STNT-LT
|
Facility
|
OP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50382LT
|
| Hospital Charge Code |
2691550
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$245.53 |
| Max. Negotiated Rate |
$5,093.90 |
| Rate for Payer: Aetna Commercial |
$3,871.36
|
| Rate for Payer: Aetna Medicare Advantage |
$3,056.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,597.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,597.89
|
| 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 |
$2,597.89
|
| Rate for Payer: Cigna Commercial |
$5,093.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,056.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,528.17
|
| Rate for Payer: UnitedHealthcare Community & State |
$245.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$269.98
|
|
|
IR-REM/REPL URET STNT-LT
|
Facility
|
IP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50382LT
|
| Hospital Charge Code |
2691550
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,528.17 |
| Max. Negotiated Rate |
$1,528.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,528.17
|
|
