|
EGD-OSCOPY W/PEG***
|
Facility
|
OP
|
$527.00
|
|
| Hospital Charge Code |
2300366
|
|
Hospital Revenue Code
|
759
|
| Min. Negotiated Rate |
$68.51 |
| Max. Negotiated Rate |
$263.50 |
| Rate for Payer: Aetna Commercial |
$158.10
|
| Rate for Payer: Aetna Medicare Advantage |
$158.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$134.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$134.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$134.38
|
| Rate for Payer: Cigna Commercial |
$263.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$68.51
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$79.05
|
|
|
EGD-OSCOPY W/PEG***
|
Facility
|
IP
|
$527.00
|
|
| Hospital Charge Code |
2300366
|
|
Hospital Revenue Code
|
759
|
| Min. Negotiated Rate |
$79.05 |
| Max. Negotiated Rate |
$79.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$79.05
|
|
|
EGD-OSCOPY W/PEJ***
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
HCPCS 99999
|
| Hospital Charge Code |
2300283
|
|
Hospital Revenue Code
|
759
|
| Min. Negotiated Rate |
$50.83 |
| Max. Negotiated Rate |
$195.50 |
| Rate for Payer: Aetna Commercial |
$117.30
|
| Rate for Payer: Aetna Medicare Advantage |
$117.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$99.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$99.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$99.70
|
| Rate for Payer: Cigna Commercial |
$195.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$50.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.65
|
|
|
EGD-OSCOPY W/PEJ***
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
HCPCS 99999
|
| Hospital Charge Code |
2300283
|
|
Hospital Revenue Code
|
759
|
| Min. Negotiated Rate |
$58.65 |
| Max. Negotiated Rate |
$58.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.65
|
|
|
EGD-OSCOPY W/PNEUM ACHALASIA**
|
Facility
|
IP
|
$283.00
|
|
| Hospital Charge Code |
2300135
|
|
Hospital Revenue Code
|
759
|
| Min. Negotiated Rate |
$42.45 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.45
|
|
|
EGD-OSCOPY W/PNEUM ACHALASIA**
|
Facility
|
OP
|
$283.00
|
|
| Hospital Charge Code |
2300135
|
|
Hospital Revenue Code
|
759
|
| Min. Negotiated Rate |
$36.79 |
| Max. Negotiated Rate |
$141.50 |
| Rate for Payer: Aetna Commercial |
$84.90
|
| Rate for Payer: Aetna Medicare Advantage |
$84.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$72.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$72.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$72.17
|
| Rate for Payer: Cigna Commercial |
$141.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.45
|
|
|
EGD-OSCOPY W/REMOVAL PEG***
|
Facility
|
OP
|
$351.00
|
|
| Hospital Charge Code |
2300358
|
|
Hospital Revenue Code
|
759
|
| Min. Negotiated Rate |
$45.63 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Aetna Commercial |
$105.30
|
| Rate for Payer: Aetna Medicare Advantage |
$105.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$89.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$89.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$89.50
|
| Rate for Payer: Cigna Commercial |
$175.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$45.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.65
|
|
|
EGD-OSCOPY W/REMOVAL PEG***
|
Facility
|
IP
|
$351.00
|
|
| Hospital Charge Code |
2300358
|
|
Hospital Revenue Code
|
759
|
| Min. Negotiated Rate |
$52.65 |
| Max. Negotiated Rate |
$52.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.65
|
|
|
EGD-OSCOPY W/SCLEROTHERAPY***
|
Facility
|
OP
|
$356.00
|
|
| Hospital Charge Code |
2300150
|
|
Hospital Revenue Code
|
759
|
| Min. Negotiated Rate |
$46.28 |
| Max. Negotiated Rate |
$178.00 |
| Rate for Payer: Aetna Commercial |
$106.80
|
| Rate for Payer: Aetna Medicare Advantage |
$106.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$90.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$90.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$90.78
|
| Rate for Payer: Cigna Commercial |
$178.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.40
|
|
|
EGD-OSCOPY W/SCLEROTHERAPY***
|
Facility
|
IP
|
$356.00
|
|
| Hospital Charge Code |
2300150
|
|
Hospital Revenue Code
|
759
|
| Min. Negotiated Rate |
$53.40 |
| Max. Negotiated Rate |
$53.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.40
|
|
|
EGD VARICES LIGATION
|
Facility
|
OP
|
$7,999.56
|
|
|
Service Code
|
HCPCS 43244
|
| Hospital Charge Code |
16000743
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,039.94 |
| Max. Negotiated Rate |
$4,569.67 |
| Rate for Payer: Aetna Commercial |
$2,399.87
|
| Rate for Payer: Aetna Medicare Advantage |
$2,399.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,039.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,039.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,039.89
|
| Rate for Payer: Cigna Commercial |
$4,569.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,039.94
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,199.93
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,687.00
|
|
|
EGD VARICES LIGATION
|
Facility
|
IP
|
$7,999.56
|
|
|
Service Code
|
HCPCS 43244
|
| Hospital Charge Code |
16000743
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,199.93 |
| Max. Negotiated Rate |
$1,199.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,199.93
|
|
|
EGFR GENE COM VARIANTS
|
Facility
|
IP
|
$1,270.55
|
|
|
Service Code
|
HCPCS 81235
|
| Hospital Charge Code |
401181235
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$190.58 |
| Max. Negotiated Rate |
$190.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$190.58
|
|
|
EGFR GENE COM VARIANTS
|
Facility
|
OP
|
$1,270.55
|
|
|
Service Code
|
HCPCS 81235
|
| Hospital Charge Code |
401181235
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$1,189.26 |
| Rate for Payer: Aetna Commercial |
$1,051.64
|
| Rate for Payer: Aetna Medicare Advantage |
$324.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,189.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,189.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$324.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,189.26
|
| Rate for Payer: Cigna Commercial |
$324.58
|
| Rate for Payer: Cigna Medicare Advantage |
$162.29
|
| Rate for Payer: Clover Medicare Advantage |
$308.35
|
| Rate for Payer: EmblemHealth Commercial |
$973.74
|
| Rate for Payer: Humana Medicare Advantage |
$334.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$165.17
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$190.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$324.58
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$344.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$324.58
|
|
|
EGGCRATE PAD
|
Facility
|
IP
|
$35.86
|
|
| Hospital Charge Code |
270665428
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.38 |
| Max. Negotiated Rate |
$5.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.38
|
|
|
EGGCRATE PAD
|
Facility
|
OP
|
$35.86
|
|
| Hospital Charge Code |
270665428
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.66 |
| Max. Negotiated Rate |
$17.93 |
| Rate for Payer: Aetna Commercial |
$10.76
|
| Rate for Payer: Aetna Medicare Advantage |
$10.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.14
|
| Rate for Payer: Cigna Commercial |
$17.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.66
|
| Rate for Payer: Oxford Commercial |
$17.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$17.93
|
|
|
EGGNOG
|
Facility
|
IP
|
$13.00
|
|
| Hospital Charge Code |
60634843
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.95
|
|
|
EGGNOG
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
60634843
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna Medicare Advantage |
$3.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.31
|
| Rate for Payer: Cigna Commercial |
$6.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.69
|
| Rate for Payer: Oxford Commercial |
$6.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.50
|
|
|
EGIA 45 ARTICULATING VASCULAR
|
Facility
|
OP
|
$594.35
|
|
| Hospital Charge Code |
270652090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.27 |
| Max. Negotiated Rate |
$297.18 |
| Rate for Payer: Aetna Commercial |
$178.31
|
| Rate for Payer: Aetna Medicare Advantage |
$178.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$151.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$151.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$151.56
|
| Rate for Payer: Cigna Commercial |
$297.18
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$77.27
|
| Rate for Payer: Oxford Commercial |
$297.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$297.18
|
|
|
EGIA 45 ARTICULATING VASCULAR
|
Facility
|
IP
|
$594.35
|
|
| Hospital Charge Code |
270652090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.15 |
| Max. Negotiated Rate |
$89.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.15
|
|
|
EG-OSCOPY W/REM FOREIGN BODY**
|
Facility
|
OP
|
$439.00
|
|
| Hospital Charge Code |
2300374
|
|
Hospital Revenue Code
|
759
|
| Min. Negotiated Rate |
$57.07 |
| Max. Negotiated Rate |
$219.50 |
| Rate for Payer: Aetna Commercial |
$131.70
|
| Rate for Payer: Aetna Medicare Advantage |
$131.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$111.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$111.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$111.94
|
| Rate for Payer: Cigna Commercial |
$219.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$57.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$65.85
|
|
|
EG-OSCOPY W/REM FOREIGN BODY**
|
Facility
|
IP
|
$439.00
|
|
| Hospital Charge Code |
2300374
|
|
Hospital Revenue Code
|
759
|
| Min. Negotiated Rate |
$65.85 |
| Max. Negotiated Rate |
$65.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$65.85
|
|
|
E HISTO AG
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 87449
|
| Hospital Charge Code |
3009741
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$38.82
|
| Rate for Payer: Aetna Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.89
|
| Rate for Payer: Cigna Commercial |
$11.98
|
| Rate for Payer: Cigna Medicare Advantage |
$5.99
|
| Rate for Payer: Clover Medicare Advantage |
$11.38
|
| Rate for Payer: EmblemHealth Commercial |
$35.94
|
| Rate for Payer: Humana Medicare Advantage |
$12.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.25
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.98
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$12.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.98
|
|
|
E HISTO AG
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS 87449
|
| Hospital Charge Code |
3009741
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
|
|
E. HISTOLYTICA AB
|
Facility
|
OP
|
$131.25
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
3006632
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$48.57
|
| Rate for Payer: Aetna Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$54.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$54.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$54.92
|
| Rate for Payer: Cigna Commercial |
$14.99
|
| Rate for Payer: Cigna Medicare Advantage |
$7.50
|
| Rate for Payer: Clover Medicare Advantage |
$14.24
|
| Rate for Payer: EmblemHealth Commercial |
$44.97
|
| Rate for Payer: Humana Medicare Advantage |
$15.44
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17.06
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.99
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$15.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.99
|
|