|
REPLACE G TUBE W REV G TRACT
|
Facility
|
IP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43763
|
| Hospital Charge Code |
323043763
|
|
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 W REV G TRACT
|
Facility
|
OP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43763
|
| Hospital Charge Code |
411043763
|
|
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 |
404643763
|
|
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 |
323043763
|
|
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 |
$377.19
|
| 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
|
|
|
REPLACEMENT OF TISSUE EXPANDER WITH PERMANENT IMPLANT
|
Facility
|
OP
|
$31,117.67
|
|
|
Service Code
|
CPT 11970
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,355.00 |
| Max. Negotiated Rate |
$31,117.67 |
| Rate for Payer: Aetna Commercial |
$23,447.95
|
| Rate for Payer: Aetna Medicare Advantage |
$27,930.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31,117.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31,117.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8,620.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,355.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$31,117.67
|
| Rate for Payer: Cigna Commercial |
$17,279.91
|
| Rate for Payer: Cigna Medicare Advantage |
$8,620.57
|
| Rate for Payer: Clover Medicare Advantage |
$8,189.54
|
| Rate for Payer: EmblemHealth Commercial |
$25,861.71
|
| Rate for Payer: Humana Medicare Advantage |
$8,879.19
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$8,620.57
|
| Rate for Payer: Oxford Commercial |
$7,559.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$12,870.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8,620.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$8,620.57
|
|
|
REPLACE PICC CATH
|
Facility
|
OP
|
$3,931.88
|
|
|
Service Code
|
HCPCS 36584
|
| Hospital Charge Code |
16000737
|
|
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 PICC CATH
|
Facility
|
IP
|
$3,931.88
|
|
|
Service Code
|
HCPCS 36584
|
| Hospital Charge Code |
16000737
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$589.78 |
| Max. Negotiated Rate |
$589.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$589.78
|
|
|
REP LACERAT 2.5 CM/<; FLR-MOUT
|
Facility
|
IP
|
$511.12
|
|
|
Service Code
|
HCPCS 41250
|
| Hospital Charge Code |
16000960
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$76.67 |
| Max. Negotiated Rate |
$76.67 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$76.67
|
|
|
REP LACERAT 2.5 CM/<; FLR-MOUT
|
Facility
|
OP
|
$511.12
|
|
|
Service Code
|
HCPCS 41250
|
| Hospital Charge Code |
16000960
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$1,443.56
|
| Rate for Payer: Aetna Medicare Advantage |
$1,719.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,915.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,915.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$530.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,016.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,915.74
|
| Rate for Payer: Cigna Commercial |
$1,063.82
|
| Rate for Payer: Cigna Medicare Advantage |
$530.72
|
| Rate for Payer: Clover Medicare Advantage |
$504.18
|
| Rate for Payer: EmblemHealth Commercial |
$1,592.16
|
| Rate for Payer: Humana Medicare Advantage |
$546.64
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$530.72
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.34
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$76.67
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.32
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$530.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$530.72
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.54
|
|
|
REPLACE REVISE BRAIN SHUNT
|
Facility
|
OP
|
$30,813.76
|
|
|
Service Code
|
HCPCS 62230
|
| Hospital Charge Code |
1600000545
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$742.61 |
| Max. Negotiated Rate |
$37,634.52 |
| Rate for Payer: Aetna Commercial |
$28,358.56
|
| Rate for Payer: Aetna Medicare Advantage |
$33,780.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$37,634.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$37,634.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$10,425.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,016.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$37,634.52
|
| Rate for Payer: Cigna Commercial |
$20,898.76
|
| Rate for Payer: Cigna Medicare Advantage |
$10,425.94
|
| Rate for Payer: Clover Medicare Advantage |
$9,904.64
|
| Rate for Payer: EmblemHealth Commercial |
$31,277.82
|
| Rate for Payer: Humana Medicare Advantage |
$10,738.72
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$10,425.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,244.13
|
| Rate for Payer: Oxford Commercial |
$7,559.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,622.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$12,870.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$742.61
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$10,425.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$10,425.94
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$816.56
|
|
|
REPLACE REVISE BRAIN SHUNT
|
Facility
|
IP
|
$30,813.76
|
|
|
Service Code
|
HCPCS 62230
|
| Hospital Charge Code |
1600000545
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,622.06 |
| Max. Negotiated Rate |
$4,622.06 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,622.06
|
|
|
REPLACE SAGITTAL SAW KEY
|
Facility
|
IP
|
$1,311.00
|
|
| Hospital Charge Code |
270683665
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.65 |
| Max. Negotiated Rate |
$196.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$196.65
|
|
|
REPLACE SAGITTAL SAW KEY
|
Facility
|
OP
|
$1,311.00
|
|
| Hospital Charge Code |
270683665
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$655.50 |
| Rate for Payer: Aetna Commercial |
$498.18
|
| Rate for Payer: Aetna Medicare Advantage |
$393.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$334.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$334.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$334.31
|
| Rate for Payer: Cigna Commercial |
$655.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$393.30
|
| Rate for Payer: Oxford Commercial |
$262.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$196.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$262.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$31.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$34.74
|
|
|
REPLACE TUNNELED CV CATH
|
Facility
|
IP
|
$18,530.00
|
|
|
Service Code
|
HCPCS 36578
|
| Hospital Charge Code |
411093601
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,779.50 |
| Max. Negotiated Rate |
$2,779.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,779.50
|
|
|
REPLACE TUNNELED CV CATH
|
Facility
|
OP
|
$9,970.96
|
|
|
Service Code
|
HCPCS 36500
|
| Hospital Charge Code |
16000946
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$240.30 |
| Max. Negotiated Rate |
$4,985.48 |
| Rate for Payer: Aetna Commercial |
$3,788.96
|
| Rate for Payer: Aetna Medicare Advantage |
$2,991.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,542.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,542.59
|
| 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 |
$2,542.59
|
| Rate for Payer: Cigna Commercial |
$4,985.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,991.29
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,495.64
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$240.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$264.23
|
|
|
REPLACE TUNNELED CV CATH
|
Facility
|
OP
|
$18,530.00
|
|
|
Service Code
|
HCPCS 36578
|
| Hospital Charge Code |
411093601
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$446.57 |
| 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 |
$3,194.00
|
| 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 |
$3,751.17
|
| 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 |
$5,559.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$6,600.00
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,779.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,232.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$446.57
|
| 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 |
$491.05
|
|
|
REPLACE TUNNELED CV CATH
|
Facility
|
OP
|
$22,851.90
|
|
|
Service Code
|
HCPCS 36581
|
| Hospital Charge Code |
16000581
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$550.73 |
| 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 |
$1,016.00
|
| 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 |
$3,751.17
|
| 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 |
$6,855.57
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,427.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,232.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$550.73
|
| 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 |
$605.58
|
|
|
REPLACE TUNNELED CV CATH
|
Facility
|
IP
|
$22,851.90
|
|
|
Service Code
|
HCPCS 36581
|
| Hospital Charge Code |
16000581
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,427.78 |
| Max. Negotiated Rate |
$3,427.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,427.78
|
|
|
REPLACE TUNNELED CV CATH
|
Facility
|
IP
|
$9,970.96
|
|
|
Service Code
|
HCPCS 36500
|
| Hospital Charge Code |
16000946
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,495.64 |
| Max. Negotiated Rate |
$1,495.64 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,495.64
|
|
|
REPLAC TUBE D/J PERC FLUR/CONT
|
Facility
|
IP
|
$2,087.20
|
|
|
Service Code
|
HCPCS 49451
|
| Hospital Charge Code |
5700495
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.08 |
| Max. Negotiated Rate |
$313.08 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$313.08
|
|
|
REPLAC TUBE D/J PERC FLUR/CONT
|
Facility
|
OP
|
$2,087.20
|
|
|
Service Code
|
HCPCS 49451
|
| Hospital Charge Code |
5700495
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$55.31 |
| 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 |
$626.16
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$313.08
|
| 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 |
$55.31
|
|
|
REPL EXT URET STENT-BI
|
Facility
|
OP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 5038750
|
| Hospital Charge Code |
2011505
|
|
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
|
|
|
REPL EXT URET STENT-BI
|
Facility
|
OP
|
$6,757.27
|
|
|
Service Code
|
HCPCS 5038750
|
| Hospital Charge Code |
7412032
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$162.85 |
| Max. Negotiated Rate |
$3,378.64 |
| Rate for Payer: Aetna Commercial |
$2,567.76
|
| Rate for Payer: Aetna Medicare Advantage |
$2,027.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,723.10
|
| 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 |
$1,723.10
|
| Rate for Payer: Cigna Commercial |
$3,378.64
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,027.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,013.59
|
| Rate for Payer: UnitedHealthcare Community & State |
$162.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$179.07
|
|
|
REPL EXT URET STENT-BI
|
Facility
|
IP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 5038750
|
| Hospital Charge Code |
2011505
|
|
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
|
|
|
REPL EXT URET STENT-BI
|
Facility
|
IP
|
$6,757.27
|
|
|
Service Code
|
HCPCS 5038750
|
| Hospital Charge Code |
7412032
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,013.59 |
| Max. Negotiated Rate |
$1,013.59 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,013.59
|
|
