|
IR TRNSHPTC PRTGRPHY W/HMO EVL
|
Facility
|
OP
|
$15,254.51
|
|
|
Service Code
|
HCPCS 75885
|
| Hospital Charge Code |
2600114
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$276.46 |
| Max. Negotiated Rate |
$13,540.60 |
| Rate for Payer: Aetna Commercial |
$10,203.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12,153.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,751.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$276.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,540.60
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| Rate for Payer: Clover Medicare Advantage |
$3,563.61
|
| Rate for Payer: EmblemHealth Commercial |
$11,253.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,863.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,751.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,576.35
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,288.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$367.63
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$404.24
|
|
|
IR TRNSHPTC PRTGRPHY W/HMO EVL
|
Facility
|
IP
|
$15,254.51
|
|
|
Service Code
|
HCPCS 75885
|
| Hospital Charge Code |
2600114
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,288.18 |
| Max. Negotiated Rate |
$2,288.18 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,288.18
|
|
|
IR TRNSHPTC PRTGRPHY W/HMO EVL
|
Facility
|
IP
|
$13,436.40
|
|
|
Service Code
|
HCPCS 75885
|
| Hospital Charge Code |
7411723
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,015.46 |
| Max. Negotiated Rate |
$2,015.46 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,015.46
|
|
|
IR TRNSHPTC PRTGRPHY W/HMO EVL
|
Facility
|
OP
|
$13,436.40
|
|
|
Service Code
|
HCPCS 75885
|
| Hospital Charge Code |
7411723
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$276.46 |
| Max. Negotiated Rate |
$13,540.60 |
| Rate for Payer: Aetna Commercial |
$10,203.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12,153.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,751.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$276.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,540.60
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| Rate for Payer: Clover Medicare Advantage |
$3,563.61
|
| Rate for Payer: EmblemHealth Commercial |
$11,253.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,863.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,751.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,030.92
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,015.46
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$323.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$356.06
|
|
|
IR-TRNS IV STNT PRC-IN-BI
|
Facility
|
IP
|
$53,150.12
|
|
|
Service Code
|
HCPCS 3720550
|
| Hospital Charge Code |
2690490
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,972.52 |
| Max. Negotiated Rate |
$7,972.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7,972.52
|
|
|
IR-TRNS IV STNT PRC-IN-BI
|
Facility
|
OP
|
$53,150.12
|
|
|
Service Code
|
HCPCS 3720550
|
| Hospital Charge Code |
2690490
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,280.92 |
| Max. Negotiated Rate |
$26,575.06 |
| Rate for Payer: Aetna Commercial |
$20,197.05
|
| Rate for Payer: Aetna Medicare Advantage |
$15,945.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,553.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,553.28
|
| 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 |
$13,553.28
|
| Rate for Payer: Cigna Commercial |
$26,575.06
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15,945.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7,972.52
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,280.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,408.48
|
|
|
IR-TRNS IV STNT PRC-IN-LT
|
Facility
|
OP
|
$53,150.12
|
|
|
Service Code
|
HCPCS 37205LT
|
| Hospital Charge Code |
2691310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,280.92 |
| Max. Negotiated Rate |
$26,575.06 |
| Rate for Payer: Aetna Commercial |
$20,197.05
|
| Rate for Payer: Aetna Medicare Advantage |
$15,945.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,553.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,553.28
|
| 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 |
$13,553.28
|
| Rate for Payer: Cigna Commercial |
$26,575.06
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15,945.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7,972.52
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,280.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,408.48
|
|
|
IR-TRNS IV STNT PRC-IN-LT
|
Facility
|
IP
|
$53,150.12
|
|
|
Service Code
|
HCPCS 37205LT
|
| Hospital Charge Code |
2691310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,972.52 |
| Max. Negotiated Rate |
$7,972.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7,972.52
|
|
|
IR-TRNS IV STNT PRC-IN-RT
|
Facility
|
OP
|
$53,150.12
|
|
|
Service Code
|
HCPCS 37205RT
|
| Hospital Charge Code |
2691315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,280.92 |
| Max. Negotiated Rate |
$26,575.06 |
| Rate for Payer: Aetna Commercial |
$20,197.05
|
| Rate for Payer: Aetna Medicare Advantage |
$15,945.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,553.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,553.28
|
| 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 |
$13,553.28
|
| Rate for Payer: Cigna Commercial |
$26,575.06
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15,945.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7,972.52
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,280.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,408.48
|
|
|
IR-TRNS IV STNT PRC-IN-RT
|
Facility
|
IP
|
$53,150.12
|
|
|
Service Code
|
HCPCS 37205RT
|
| Hospital Charge Code |
2691315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,972.52 |
| Max. Negotiated Rate |
$7,972.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7,972.52
|
|
|
IR TRNSLMNAL BALN ANGIO VENOUS
|
Facility
|
OP
|
$21,962.30
|
|
|
Service Code
|
HCPCS 75978
|
| Hospital Charge Code |
2600116
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$529.29 |
| Max. Negotiated Rate |
$10,981.15 |
| Rate for Payer: Aetna Commercial |
$8,345.67
|
| Rate for Payer: Aetna Medicare Advantage |
$6,588.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,600.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,600.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,600.39
|
| Rate for Payer: Cigna Commercial |
$10,981.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,588.69
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,294.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$529.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$582.00
|
|
|
IR TRNSLMNAL BALN ANGIO VENOUS
|
Facility
|
IP
|
$21,962.30
|
|
|
Service Code
|
HCPCS 75978
|
| Hospital Charge Code |
7411742
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$3,294.34 |
| Max. Negotiated Rate |
$3,294.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,294.34
|
|
|
IR TRNSLMNAL BALN ANGIO VENOUS
|
Facility
|
OP
|
$21,962.30
|
|
|
Service Code
|
HCPCS 75978
|
| Hospital Charge Code |
7411742
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$529.29 |
| Max. Negotiated Rate |
$10,981.15 |
| Rate for Payer: Aetna Commercial |
$8,345.67
|
| Rate for Payer: Aetna Medicare Advantage |
$6,588.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,600.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,600.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,600.39
|
| Rate for Payer: Cigna Commercial |
$10,981.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,588.69
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,294.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$529.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$582.00
|
|
|
IR TRNSLMNAL BALN ANGIO VENOUS
|
Facility
|
IP
|
$21,962.30
|
|
|
Service Code
|
HCPCS 75978
|
| Hospital Charge Code |
2600116
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$3,294.34 |
| Max. Negotiated Rate |
$3,294.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,294.34
|
|
|
IR TRSHPTC PRTGRPY W/O HMO EVL
|
Facility
|
IP
|
$3,084.40
|
|
|
Service Code
|
HCPCS 75887
|
| Hospital Charge Code |
366875887
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$462.66 |
| Max. Negotiated Rate |
$462.66 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$462.66
|
|
|
IR TRSHPTC PRTGRPY W/O HMO EVL
|
Facility
|
OP
|
$3,084.40
|
|
|
Service Code
|
HCPCS 75887
|
| Hospital Charge Code |
7411724
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$74.33 |
| Max. Negotiated Rate |
$13,540.60 |
| Rate for Payer: Aetna Commercial |
$10,203.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12,153.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,751.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$351.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,540.60
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| Rate for Payer: Clover Medicare Advantage |
$3,563.61
|
| Rate for Payer: EmblemHealth Commercial |
$11,253.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,863.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,751.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$925.32
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$462.66
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$74.33
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$81.74
|
|
|
IR TRSHPTC PRTGRPY W/O HMO EVL
|
Facility
|
IP
|
$3,084.40
|
|
|
Service Code
|
HCPCS 75887
|
| Hospital Charge Code |
7411724
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$462.66 |
| Max. Negotiated Rate |
$462.66 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$462.66
|
|
|
IR TRSHPTC PRTGRPY W/O HMO EVL
|
Facility
|
OP
|
$3,084.40
|
|
|
Service Code
|
HCPCS 75887
|
| Hospital Charge Code |
366875887
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$74.33 |
| Max. Negotiated Rate |
$13,540.60 |
| Rate for Payer: Aetna Commercial |
$10,203.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12,153.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,751.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$351.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,540.60
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| Rate for Payer: Clover Medicare Advantage |
$3,563.61
|
| Rate for Payer: EmblemHealth Commercial |
$11,253.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,863.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,751.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$925.32
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$462.66
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$74.33
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$81.74
|
|
|
IR TRSHPTC PRTGRPY W/O HMO EVL
|
Facility
|
IP
|
$6,404.20
|
|
|
Service Code
|
HCPCS 75887
|
| Hospital Charge Code |
2600115
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$960.63 |
| Max. Negotiated Rate |
$960.63 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$960.63
|
|
|
IR TRSHPTC PRTGRPY W/O HMO EVL
|
Facility
|
OP
|
$6,404.20
|
|
|
Service Code
|
HCPCS 75887
|
| Hospital Charge Code |
2600115
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$154.34 |
| Max. Negotiated Rate |
$13,540.60 |
| Rate for Payer: Aetna Commercial |
$10,203.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12,153.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,751.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$351.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,540.60
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| Rate for Payer: Clover Medicare Advantage |
$3,563.61
|
| Rate for Payer: EmblemHealth Commercial |
$11,253.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,863.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,751.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,921.26
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$960.63
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$154.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$169.71
|
|
|
IR TUBE OR CATH CHANGE
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
321075984
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
IR TUBE OR CATH CHANGE
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
2600117
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
IR TUBE OR CATH CHANGE
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
2600117
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.61 |
| 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 |
$99.61
|
| 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 TUBE OR CATH CHANGE
|
Facility
|
OP
|
$1,608.85
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
7411745
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$38.77 |
| Max. Negotiated Rate |
$1,975.00 |
| Rate for Payer: Aetna Commercial |
$611.36
|
| Rate for Payer: Aetna Medicare Advantage |
$482.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$410.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$410.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$99.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$410.26
|
| Rate for Payer: Cigna Commercial |
$804.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$482.65
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$241.33
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$38.77
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$42.63
|
|
|
IR TUBE OR CATH CHANGE
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
321075984
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.61 |
| 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 |
$99.61
|
| 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
|
|
