|
REP INIT INCI/ VENTRAL HERNIA
|
Facility
|
OP
|
$30,877.00
|
|
|
Service Code
|
HCPCS 49560
|
| Hospital Charge Code |
16000989
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$744.14 |
| Max. Negotiated Rate |
$15,438.50 |
| Rate for Payer: Aetna Commercial |
$11,733.26
|
| Rate for Payer: Aetna Medicare Advantage |
$9,263.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,873.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,873.64
|
| 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 |
$7,873.64
|
| Rate for Payer: Cigna Commercial |
$15,438.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,263.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,631.55
|
| Rate for Payer: UnitedHealthcare Community & State |
$744.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$818.24
|
|
|
REPLACE CVAD CATH
|
Facility
|
IP
|
$3,931.88
|
|
|
Service Code
|
HCPCS 36580
|
| Hospital Charge Code |
16000947
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$589.78 |
| Max. Negotiated Rate |
$589.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$589.78
|
|
|
REPLACE CVAD CATH
|
Facility
|
OP
|
$3,931.88
|
|
|
Service Code
|
HCPCS 36580
|
| Hospital Charge Code |
16000947
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$94.76 |
| Max. Negotiated Rate |
$6,750.64 |
| Rate for Payer: Aetna Commercial |
$5,086.78
|
| Rate for Payer: Aetna Medicare Advantage |
$6,059.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,750.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,750.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,870.14
|
| 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 |
$6,750.64
|
| Rate for Payer: Cigna Commercial |
$3,748.67
|
| Rate for Payer: Cigna Medicare Advantage |
$1,870.14
|
| Rate for Payer: Clover Medicare Advantage |
$1,776.63
|
| Rate for Payer: EmblemHealth Commercial |
$5,610.42
|
| Rate for Payer: Humana Medicare Advantage |
$1,926.24
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,870.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,179.56
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$589.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,593.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$94.76
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,870.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,870.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$104.19
|
|
|
REPLACE GASTROSTOMY/CECOSTOMY
|
Facility
|
OP
|
$1,891.00
|
|
|
Service Code
|
HCPCS 45760
|
| Hospital Charge Code |
5792245
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$50.11 |
| Max. Negotiated Rate |
$945.50 |
| Rate for Payer: Aetna Commercial |
$718.58
|
| Rate for Payer: Aetna Medicare Advantage |
$567.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$482.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$482.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$482.20
|
| Rate for Payer: Cigna Commercial |
$945.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$567.30
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$283.65
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$50.11
|
|
|
REPLACE GASTROSTOMY/CECOSTOMY
|
Facility
|
IP
|
$1,891.00
|
|
|
Service Code
|
HCPCS 45760
|
| Hospital Charge Code |
5792245
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$283.65 |
| Max. Negotiated Rate |
$283.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$283.65
|
|
|
REPLACE G/C TUBE PERC
|
Facility
|
IP
|
$270.35
|
|
|
Service Code
|
HCPCS 49450
|
| Hospital Charge Code |
5792271
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$40.55 |
| Max. Negotiated Rate |
$40.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.55
|
|
|
REPLACE G/C TUBE PERC
|
Facility
|
OP
|
$270.35
|
|
|
Service Code
|
HCPCS 49450
|
| Hospital Charge Code |
5792271
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$7.16 |
| Max. Negotiated Rate |
$3,889.52 |
| 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) 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 |
$81.11
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.55
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| 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 |
$7.16
|
|
|
REPLACE G/C TUBE PERC
|
Facility
|
IP
|
$2,973.96
|
|
|
Service Code
|
HCPCS 49450
|
| Hospital Charge Code |
16000521
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$446.09 |
| Max. Negotiated Rate |
$446.09 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$446.09
|
|
|
REPLACE G/C TUBE PERC
|
Facility
|
OP
|
$2,973.96
|
|
|
Service Code
|
HCPCS 49450
|
| Hospital Charge Code |
16000521
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$71.67 |
| 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 |
$892.19
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$446.09
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,311.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$71.67
|
| 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 |
$78.81
|
|
|
REPLACE G TUBE WO REV G TRACT
|
Facility
|
OP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
323043762
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$35.95 |
| Max. Negotiated Rate |
$1,071.47 |
| Rate for Payer: Aetna Commercial |
$807.38
|
| Rate for Payer: Aetna Medicare Advantage |
$961.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,071.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,071.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$296.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$255.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,071.47
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: Cigna Medicare Advantage |
$296.83
|
| Rate for Payer: Clover Medicare Advantage |
$281.99
|
| Rate for Payer: EmblemHealth Commercial |
$890.49
|
| Rate for Payer: Humana Medicare Advantage |
$305.73
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$296.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$407.03
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.52
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.95
|
|
|
REPLACE G TUBE WO REV G TRACT
|
Facility
|
OP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
321043762
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$807.38
|
| Rate for Payer: Aetna Medicare Advantage |
$961.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,071.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,071.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$296.83
|
| 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 |
$1,071.47
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: Cigna Medicare Advantage |
$296.83
|
| Rate for Payer: Clover Medicare Advantage |
$281.99
|
| Rate for Payer: EmblemHealth Commercial |
$890.49
|
| Rate for Payer: Humana Medicare Advantage |
$305.73
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$296.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$407.03
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$32.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.95
|
|
|
REPLACE G TUBE WO REV G TRACT
|
Facility
|
OP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
404643762
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$807.38
|
| Rate for Payer: Aetna Medicare Advantage |
$961.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,071.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,071.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$296.83
|
| 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 |
$1,071.47
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: Cigna Medicare Advantage |
$296.83
|
| Rate for Payer: Clover Medicare Advantage |
$281.99
|
| Rate for Payer: EmblemHealth Commercial |
$890.49
|
| Rate for Payer: Humana Medicare Advantage |
$305.73
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$296.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$407.03
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$32.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.95
|
|
|
REPLACE G TUBE WO REV G TRACT
|
Facility
|
IP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
321043762
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$203.52 |
| Max. Negotiated Rate |
$203.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.52
|
|
|
REPLACE G TUBE WO REV G TRACT
|
Facility
|
IP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
411043762
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$203.52 |
| Max. Negotiated Rate |
$203.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.52
|
|
|
REPLACE G TUBE WO REV G TRACT
|
Facility
|
OP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
411043762
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$807.38
|
| Rate for Payer: Aetna Medicare Advantage |
$961.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,071.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,071.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$296.83
|
| 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 |
$1,071.47
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: Cigna Medicare Advantage |
$296.83
|
| Rate for Payer: Clover Medicare Advantage |
$281.99
|
| Rate for Payer: EmblemHealth Commercial |
$890.49
|
| Rate for Payer: Humana Medicare Advantage |
$305.73
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$296.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$407.03
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$32.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.95
|
|
|
REPLACE G TUBE WO REV G TRACT
|
Facility
|
IP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
404643762
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$203.52 |
| Max. Negotiated Rate |
$203.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.52
|
|
|
REPLACE G TUBE WO REV G TRACT
|
Facility
|
IP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
323043762
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$203.52 |
| Max. Negotiated Rate |
$203.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.52
|
|
|
REPLACE G TUBE WO REV G TRACT
|
Facility
|
OP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
366843762
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$807.38
|
| Rate for Payer: Aetna Medicare Advantage |
$961.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,071.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,071.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$296.83
|
| 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 |
$1,071.47
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: Cigna Medicare Advantage |
$296.83
|
| Rate for Payer: Clover Medicare Advantage |
$281.99
|
| Rate for Payer: EmblemHealth Commercial |
$890.49
|
| Rate for Payer: Humana Medicare Advantage |
$305.73
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$296.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$407.03
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$32.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.95
|
|
|
REPLACE G TUBE WO REV G TRACT
|
Facility
|
IP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
366843762
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$203.52 |
| Max. Negotiated Rate |
$203.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.52
|
|
|
REPLACE G TUBE W REV G TRACT
|
Facility
|
IP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43763
|
| Hospital Charge Code |
366843763
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$203.52 |
| Max. Negotiated Rate |
$203.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.52
|
|
|
REPLACE G TUBE W REV G TRACT
|
Facility
|
OP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43763
|
| Hospital Charge Code |
321043763
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$807.38
|
| Rate for Payer: Aetna Medicare Advantage |
$961.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,071.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,071.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$296.83
|
| 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 |
$1,071.47
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: Cigna Medicare Advantage |
$296.83
|
| Rate for Payer: Clover Medicare Advantage |
$281.99
|
| Rate for Payer: EmblemHealth Commercial |
$890.49
|
| Rate for Payer: Humana Medicare Advantage |
$305.73
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$296.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$407.03
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$32.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.95
|
|
|
REPLACE G TUBE W REV G TRACT
|
Facility
|
IP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43763
|
| Hospital Charge Code |
411043763
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$203.52 |
| Max. Negotiated Rate |
$203.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.52
|
|
|
REPLACE G TUBE W REV G TRACT
|
Facility
|
OP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43763
|
| Hospital Charge Code |
404643763
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$807.38
|
| Rate for Payer: Aetna Medicare Advantage |
$961.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,071.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,071.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$296.83
|
| 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 |
$1,071.47
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: Cigna Medicare Advantage |
$296.83
|
| Rate for Payer: Clover Medicare Advantage |
$281.99
|
| Rate for Payer: EmblemHealth Commercial |
$890.49
|
| Rate for Payer: Humana Medicare Advantage |
$305.73
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$296.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$407.03
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$32.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.95
|
|
|
REPLACE G TUBE W REV G TRACT
|
Facility
|
IP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43763
|
| Hospital Charge Code |
321043763
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$203.52 |
| Max. Negotiated Rate |
$203.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.52
|
|
|
REPLACE G TUBE W REV G TRACT
|
Facility
|
OP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43763
|
| Hospital Charge Code |
366843763
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$807.38
|
| Rate for Payer: Aetna Medicare Advantage |
$961.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,071.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,071.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$296.83
|
| 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 |
$1,071.47
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: Cigna Medicare Advantage |
$296.83
|
| Rate for Payer: Clover Medicare Advantage |
$281.99
|
| Rate for Payer: EmblemHealth Commercial |
$890.49
|
| Rate for Payer: Humana Medicare Advantage |
$305.73
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$296.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$407.03
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$32.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.95
|
|
