|
IR-REPL EXT URET STENT-LT
|
Facility
|
OP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50387LT
|
| Hospital Charge Code |
321050387L
|
|
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-REPL EXT URET STENT-LT
|
Facility
|
OP
|
$4,540.00
|
|
|
Service Code
|
HCPCS 50387LT
|
| Hospital Charge Code |
7411962
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$109.41 |
| Max. Negotiated Rate |
$2,270.00 |
| Rate for Payer: Aetna Commercial |
$1,725.20
|
| Rate for Payer: Aetna Medicare Advantage |
$1,362.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,157.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,157.70
|
| 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 |
$1,157.70
|
| Rate for Payer: Cigna Commercial |
$2,270.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,362.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$681.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$109.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$120.31
|
|
|
IR-REPL EXT URET STENT-LT
|
Facility
|
IP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50387LT
|
| Hospital Charge Code |
2691570
|
|
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-REPL EXT URET STENT-RT
|
Facility
|
OP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50387RT
|
| Hospital Charge Code |
366850387R
|
|
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-REPL EXT URET STENT-RT
|
Facility
|
IP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50387RT
|
| Hospital Charge Code |
411050387R
|
|
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-REPL EXT URET STENT-RT
|
Facility
|
IP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50387RT
|
| Hospital Charge Code |
321050387R
|
|
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-REPL EXT URET STENT-RT
|
Facility
|
OP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50387RT
|
| Hospital Charge Code |
411050387R
|
|
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-REPL EXT URET STENT-RT
|
Facility
|
IP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50387RT
|
| Hospital Charge Code |
2691575
|
|
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-REPL EXT URET STENT-RT
|
Facility
|
OP
|
$4,540.00
|
|
|
Service Code
|
HCPCS 50387RT
|
| Hospital Charge Code |
7411963
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$109.41 |
| Max. Negotiated Rate |
$2,270.00 |
| Rate for Payer: Aetna Commercial |
$1,725.20
|
| Rate for Payer: Aetna Medicare Advantage |
$1,362.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,157.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,157.70
|
| 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 |
$1,157.70
|
| Rate for Payer: Cigna Commercial |
$2,270.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,362.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$681.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$109.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$120.31
|
|
|
IR-REPL EXT URET STENT-RT
|
Facility
|
OP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50387RT
|
| Hospital Charge Code |
2691575
|
|
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-REPL EXT URET STENT-RT
|
Facility
|
IP
|
$4,540.00
|
|
|
Service Code
|
HCPCS 50387RT
|
| Hospital Charge Code |
7411963
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$681.00 |
| Max. Negotiated Rate |
$681.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$681.00
|
|
|
IR-REPL EXT URET STENT-RT
|
Facility
|
IP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50387RT
|
| Hospital Charge Code |
366850387R
|
|
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-REPL EXT URET STENT-RT
|
Facility
|
OP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50387RT
|
| Hospital Charge Code |
321050387R
|
|
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-REPL G-J TUBE W/FLUORO
|
Facility
|
OP
|
$4,358.95
|
|
|
Service Code
|
HCPCS 49452
|
| Hospital Charge Code |
7411599
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$105.05 |
| 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 |
$1,307.68
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$653.84
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,311.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$105.05
|
| 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 |
$115.51
|
|
|
IR-REPL G-J TUBE W/FLUORO
|
Facility
|
IP
|
$4,358.95
|
|
|
Service Code
|
HCPCS 49452
|
| Hospital Charge Code |
7411599
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$653.84 |
| Max. Negotiated Rate |
$653.84 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$653.84
|
|
|
IR-REPL G-J TUBE W/FLUORO
|
Facility
|
IP
|
$4,358.95
|
|
|
Service Code
|
HCPCS 49452
|
| Hospital Charge Code |
366849452
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$653.84 |
| Max. Negotiated Rate |
$653.84 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$653.84
|
|
|
IR-REPL G-J TUBE W/FLUORO
|
Facility
|
IP
|
$1,891.00
|
|
|
Service Code
|
HCPCS 49452
|
| Hospital Charge Code |
2690170
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$283.65 |
| Max. Negotiated Rate |
$283.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$283.65
|
|
|
IR-REPL G-J TUBE W/FLUORO
|
Facility
|
OP
|
$4,358.95
|
|
|
Service Code
|
HCPCS 49452
|
| Hospital Charge Code |
366849452
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$105.05 |
| 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 |
$1,307.68
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$653.84
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,311.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$105.05
|
| 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 |
$115.51
|
|
|
IR-REPL G-J TUBE W/FLUORO
|
Facility
|
OP
|
$1,891.00
|
|
|
Service Code
|
HCPCS 49452
|
| Hospital Charge Code |
2690170
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$45.57 |
| 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 |
$567.30
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$283.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,311.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$45.57
|
| 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 |
$50.11
|
|
|
IR REPLMNT DUOD OR JEJUNST TUB
|
Facility
|
OP
|
$4,358.95
|
|
|
Service Code
|
HCPCS 49451
|
| Hospital Charge Code |
366849451
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$105.05 |
| 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 |
$1,307.68
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$653.84
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,311.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$105.05
|
| 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 |
$115.51
|
|
|
IR REPLMNT DUOD OR JEJUNST TUB
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
HCPCS 49451
|
| Hospital Charge Code |
7411598
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$388.20 |
| Max. Negotiated Rate |
$388.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$388.20
|
|
|
IR REPLMNT DUOD OR JEJUNST TUB
|
Facility
|
OP
|
$2,588.00
|
|
|
Service Code
|
HCPCS 49451
|
| Hospital Charge Code |
7411598
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$62.37 |
| 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 |
$776.40
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$388.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,311.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$62.37
|
| 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 |
$68.58
|
|
|
IR REPLMNT DUOD OR JEJUNST TUB
|
Facility
|
IP
|
$4,358.95
|
|
|
Service Code
|
HCPCS 49451
|
| Hospital Charge Code |
366849451
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$653.84 |
| Max. Negotiated Rate |
$653.84 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$653.84
|
|
|
IR REPLMNT DUOD OR JEJUNST TUB
|
Facility
|
IP
|
$4,397.88
|
|
|
Service Code
|
HCPCS 49451
|
| Hospital Charge Code |
2670035
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$659.68 |
| Max. Negotiated Rate |
$659.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$659.68
|
|
|
IR REPLMNT DUOD OR JEJUNST TUB
|
Facility
|
OP
|
$4,397.88
|
|
|
Service Code
|
HCPCS 49451
|
| Hospital Charge Code |
2670035
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$105.99 |
| 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 |
$1,319.36
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$659.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,311.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$105.99
|
| 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 |
$116.54
|
|
