|
INTMD WND REPAIR S/A/T/EXT
|
Facility
|
IP
|
$1,497.80
|
|
|
Service Code
|
HCPCS 12035
|
| Hospital Charge Code |
16000406
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$224.67 |
| Max. Negotiated Rate |
$224.67 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$224.67
|
|
|
INTMD WND R S/TR/EXT7.6-12.5CM
|
Facility
|
IP
|
$2,482.20
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
1600149
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$372.33 |
| Max. Negotiated Rate |
$372.33 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$372.33
|
|
|
INTMD WND R S/TR/EXT7.6-12.5CM
|
Facility
|
OP
|
$2,482.20
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
1600149
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$322.69 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Better Health Medicaid |
$1,037.98
|
| Rate for Payer: Aetna Commercial |
$744.66
|
| Rate for Payer: Aetna Medicare Advantage |
$744.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$632.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$632.96
|
| 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 |
$632.96
|
| Rate for Payer: Cigna Commercial |
$968.07
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$322.69
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$372.33
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$1,058.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,037.98
|
|
|
INTM EVAL MD AD/15MIN PH MCAID
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4822621
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
INTM EVAL MD AD/15MIN PH MCAID
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4509621
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
INTM EVAL MD AD/15MIN PH MCAID
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4509621
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$71.39 |
| Max. Negotiated Rate |
$422.69 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| Rate for Payer: Aetna Medicare Advantage |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$97.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$71.39
|
|
|
INTM EVAL MD AD/15MIN PH MCAID
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4822621
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$71.39 |
| Max. Negotiated Rate |
$422.69 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| Rate for Payer: Aetna Medicare Advantage |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$97.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$71.39
|
|
|
INTM EVAL MD CH/15MIN PH MCAID
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4824627
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
INTM EVAL MD CH/15MIN PH MCAID
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4510627
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
INTM EVAL MD CH/15MIN PH MCAID
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4822627
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$71.39 |
| Max. Negotiated Rate |
$422.69 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| Rate for Payer: Aetna Medicare Advantage |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$97.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$71.39
|
|
|
INTM EVAL MD CH/15MIN PH MCAID
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4824627
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$71.39 |
| Max. Negotiated Rate |
$422.69 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| Rate for Payer: Aetna Medicare Advantage |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$97.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$71.39
|
|
|
INTM EVAL MD CH/15MIN PH MCAID
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4509627
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
INTM EVAL MD CH/15MIN PH MCAID
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4510627
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$71.39 |
| Max. Negotiated Rate |
$422.69 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| Rate for Payer: Aetna Medicare Advantage |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$97.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$71.39
|
|
|
INTM EVAL MD CH/15MIN PH MCAID
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4822627
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
INTM EVAL MD CH/15MIN PH MCAID
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4509627
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$71.39 |
| Max. Negotiated Rate |
$422.69 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| Rate for Payer: Aetna Medicare Advantage |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$97.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$71.39
|
|
|
INTRA-ABD OMENTAL FLAP
|
Facility
|
IP
|
$1,439.84
|
|
|
Service Code
|
HCPCS 49905
|
| Hospital Charge Code |
1600000499
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$215.98 |
| Max. Negotiated Rate |
$215.98 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$215.98
|
|
|
INTRA-ABD OMENTAL FLAP
|
Facility
|
IP
|
$1,439.84
|
|
|
Service Code
|
HCPCS 49905
|
| Hospital Charge Code |
1600000436
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$215.98 |
| Max. Negotiated Rate |
$215.98 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$215.98
|
|
|
INTRA-ABD OMENTAL FLAP
|
Facility
|
OP
|
$1,439.84
|
|
|
Service Code
|
HCPCS 49905
|
| Hospital Charge Code |
1600000499
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$187.18 |
| Max. Negotiated Rate |
$6,873.00 |
| Rate for Payer: Aetna Commercial |
$431.95
|
| Rate for Payer: Aetna Medicare Advantage |
$431.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$367.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$367.16
|
| 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 |
$367.16
|
| Rate for Payer: Cigna Commercial |
$340.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.18
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$215.98
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,873.00
|
|
|
INTRA-ABD OMENTAL FLAP
|
Facility
|
OP
|
$1,439.84
|
|
|
Service Code
|
HCPCS 49905
|
| Hospital Charge Code |
1600000436
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$187.18 |
| Max. Negotiated Rate |
$6,873.00 |
| Rate for Payer: Aetna Commercial |
$431.95
|
| Rate for Payer: Aetna Medicare Advantage |
$431.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$367.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$367.16
|
| 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 |
$367.16
|
| Rate for Payer: Cigna Commercial |
$340.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.18
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$215.98
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,873.00
|
|
|
INTRACARDIAC ECG
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 93662
|
| Hospital Charge Code |
7411251
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
INTRACARDIAC ECG
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 93662
|
| Hospital Charge Code |
7411251
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$1,793.00 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| Rate for Payer: Aetna Medicare Advantage |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$202.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$97.50
|
| Rate for Payer: Oxford Commercial |
$1,580.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,793.00
|
|
|
INTRACATH 16GX8 YELLOW
|
Facility
|
OP
|
$38.00
|
|
| Hospital Charge Code |
270331478
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Aetna Commercial |
$11.40
|
| Rate for Payer: Aetna Medicare Advantage |
$11.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.69
|
| Rate for Payer: Cigna Commercial |
$19.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.94
|
| Rate for Payer: Oxford Commercial |
$19.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$19.00
|
|
|
INTRACATH 16GX8 YELLOW
|
Facility
|
IP
|
$38.00
|
|
| Hospital Charge Code |
270331478
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.70 |
| Max. Negotiated Rate |
$5.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.70
|
|
|
INTRACRAN ANGIOPLASTY W STENT
|
Facility
|
IP
|
$58,920.00
|
|
|
Service Code
|
HCPCS 61635
|
| Hospital Charge Code |
411061635
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,838.00 |
| Max. Negotiated Rate |
$8,838.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8,838.00
|
|
|
INTRACRAN ANGIOPLASTY W STENT
|
Facility
|
OP
|
$58,920.00
|
|
|
Service Code
|
HCPCS 61635
|
| Hospital Charge Code |
411061635
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,474.38 |
| Max. Negotiated Rate |
$17,676.00 |
| Rate for Payer: Aetna Commercial |
$17,676.00
|
| Rate for Payer: Aetna Medicare Advantage |
$17,676.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15,024.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15,024.60
|
| 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 |
$15,024.60
|
| Rate for Payer: Cigna Commercial |
$1,474.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,659.60
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8,838.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,873.00
|
|
