|
IR CTA LOWER EXTREMITY W/WO CO
|
Facility
|
OP
|
$2,013.25
|
|
|
Service Code
|
HCPCS 73706
|
| Hospital Charge Code |
2680300
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$261.72 |
| Max. Negotiated Rate |
$2,773.00 |
| Rate for Payer: Aetna Better Health Medicaid |
$940.08
|
| Rate for Payer: Aetna Commercial |
$603.98
|
| Rate for Payer: Aetna Medicare Advantage |
$603.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$513.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$513.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$349.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$513.38
|
| Rate for Payer: Cigna Commercial |
$417.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$261.72
|
| Rate for Payer: Oxford Commercial |
$2,443.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$301.99
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,773.00
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$958.88
|
|
|
IR CT ANGIO ABD AORTA BI ILIO
|
Facility
|
OP
|
$2,010.00
|
|
|
Service Code
|
HCPCS 75635
|
| Hospital Charge Code |
2600155
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$261.30 |
| Max. Negotiated Rate |
$2,773.00 |
| Rate for Payer: Aetna Commercial |
$603.00
|
| Rate for Payer: Aetna Medicare Advantage |
$603.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$512.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$512.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$344.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$512.55
|
| Rate for Payer: Cigna Commercial |
$417.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$261.30
|
| Rate for Payer: Oxford Commercial |
$2,443.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$301.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,773.00
|
|
|
IR CT ANGIO ABD AORTA BI ILIO
|
Facility
|
IP
|
$2,010.00
|
|
|
Service Code
|
HCPCS 75635
|
| Hospital Charge Code |
2600155
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$301.50 |
| Max. Negotiated Rate |
$301.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$301.50
|
|
|
IR CTA UPPER EXTRY W/WO CONTRA
|
Facility
|
OP
|
$2,013.25
|
|
|
Service Code
|
HCPCS 73206
|
| Hospital Charge Code |
2680280
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$261.72 |
| Max. Negotiated Rate |
$2,773.00 |
| Rate for Payer: Aetna Commercial |
$603.98
|
| Rate for Payer: Aetna Medicare Advantage |
$603.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$513.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$513.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$349.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$513.38
|
| Rate for Payer: Cigna Commercial |
$417.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$261.72
|
| Rate for Payer: Oxford Commercial |
$2,443.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$301.99
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,773.00
|
|
|
IR CTA UPPER EXTRY W/WO CONTRA
|
Facility
|
IP
|
$2,013.25
|
|
|
Service Code
|
HCPCS 73206
|
| Hospital Charge Code |
7411667
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$301.99 |
| Max. Negotiated Rate |
$301.99 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$301.99
|
|
|
IR CTA UPPER EXTRY W/WO CONTRA
|
Facility
|
IP
|
$2,013.25
|
|
|
Service Code
|
HCPCS 73206
|
| Hospital Charge Code |
2680280
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$301.99 |
| Max. Negotiated Rate |
$301.99 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$301.99
|
|
|
IR CTA UPPER EXTRY W/WO CONTRA
|
Facility
|
OP
|
$2,013.25
|
|
|
Service Code
|
HCPCS 73206
|
| Hospital Charge Code |
7411667
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$261.72 |
| Max. Negotiated Rate |
$2,773.00 |
| Rate for Payer: Aetna Commercial |
$603.98
|
| Rate for Payer: Aetna Medicare Advantage |
$603.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$513.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$513.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$349.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$513.38
|
| Rate for Payer: Cigna Commercial |
$417.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$261.72
|
| Rate for Payer: Oxford Commercial |
$2,443.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$301.99
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,773.00
|
|
|
IR-CTN INJ ABSCS/CYST VIA CATH
|
Facility
|
IP
|
$599.00
|
|
|
Service Code
|
HCPCS 49424
|
| Hospital Charge Code |
2670150
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.85 |
| Max. Negotiated Rate |
$89.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.85
|
|
|
IR-CTN INJ ABSCS/CYST VIA CATH
|
Facility
|
IP
|
$599.00
|
|
|
Service Code
|
HCPCS 49424
|
| Hospital Charge Code |
7411591
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.85 |
| Max. Negotiated Rate |
$89.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.85
|
|
|
IR-CTN INJ ABSCS/CYST VIA CATH
|
Facility
|
IP
|
$599.00
|
|
|
Service Code
|
HCPCS 49424
|
| Hospital Charge Code |
321049424
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.85 |
| Max. Negotiated Rate |
$89.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.85
|
|
|
IR-CTN INJ ABSCS/CYST VIA CATH
|
Facility
|
OP
|
$599.00
|
|
|
Service Code
|
HCPCS 49424
|
| Hospital Charge Code |
321049424
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$34.58 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$179.70
|
| Rate for Payer: Aetna Medicare Advantage |
$179.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$152.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$152.75
|
| 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 |
$152.75
|
| Rate for Payer: Cigna Commercial |
$34.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$77.87
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
IR-CTN INJ ABSCS/CYST VIA CATH
|
Facility
|
OP
|
$599.00
|
|
|
Service Code
|
HCPCS 49424
|
| Hospital Charge Code |
7411591
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$34.58 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$179.70
|
| Rate for Payer: Aetna Medicare Advantage |
$179.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$152.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$152.75
|
| 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 |
$152.75
|
| Rate for Payer: Cigna Commercial |
$34.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$77.87
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
IR-CTN INJ ABSCS/CYST VIA CATH
|
Facility
|
OP
|
$599.00
|
|
|
Service Code
|
HCPCS 49424
|
| Hospital Charge Code |
2670150
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$34.58 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$179.70
|
| Rate for Payer: Aetna Medicare Advantage |
$179.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$152.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$152.75
|
| 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 |
$152.75
|
| Rate for Payer: Cigna Commercial |
$34.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$77.87
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
IR CYST ASP BREAST
|
Facility
|
IP
|
$1,901.69
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
2680005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$285.25 |
| Max. Negotiated Rate |
$285.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$285.25
|
|
|
IR CYST ASP BREAST
|
Facility
|
OP
|
$1,901.69
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
7411337
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$247.22 |
| Max. Negotiated Rate |
$2,575.00 |
| Rate for Payer: Aetna Commercial |
$570.51
|
| Rate for Payer: Aetna Medicare Advantage |
$570.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$484.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$484.93
|
| 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 |
$484.93
|
| Rate for Payer: Cigna Commercial |
$1,686.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$247.22
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$285.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,575.00
|
|
|
IR CYST ASP BREAST
|
Facility
|
IP
|
$1,901.69
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
7411337
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$285.25 |
| Max. Negotiated Rate |
$285.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$285.25
|
|
|
IR CYST ASP BREAST
|
Facility
|
OP
|
$1,901.69
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
2680005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$247.22 |
| Max. Negotiated Rate |
$2,575.00 |
| Rate for Payer: Aetna Commercial |
$570.51
|
| Rate for Payer: Aetna Medicare Advantage |
$570.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$484.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$484.93
|
| 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 |
$484.93
|
| Rate for Payer: Cigna Commercial |
$1,686.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$247.22
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$285.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,575.00
|
|
|
IR CYSTOSTOMY TUBE CHANGE COMP
|
Facility
|
OP
|
$2,588.00
|
|
|
Service Code
|
HCPCS 51710
|
| Hospital Charge Code |
7411627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$336.44 |
| Max. Negotiated Rate |
$2,575.00 |
| Rate for Payer: Aetna Commercial |
$776.40
|
| Rate for Payer: Aetna Medicare Advantage |
$776.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$659.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$659.94
|
| 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 |
$659.94
|
| Rate for Payer: Cigna Commercial |
$1,660.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$336.44
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$388.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,575.00
|
|
|
IR CYSTOSTOMY TUBE CHANGE COMP
|
Facility
|
OP
|
$2,588.00
|
|
|
Service Code
|
HCPCS 51710
|
| Hospital Charge Code |
2670135
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$336.44 |
| Max. Negotiated Rate |
$2,575.00 |
| Rate for Payer: Aetna Commercial |
$776.40
|
| Rate for Payer: Aetna Medicare Advantage |
$776.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$659.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$659.94
|
| 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 |
$659.94
|
| Rate for Payer: Cigna Commercial |
$1,660.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$336.44
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$388.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,575.00
|
|
|
IR CYSTOSTOMY TUBE CHANGE COMP
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
HCPCS 51710
|
| Hospital Charge Code |
2670135
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$388.20 |
| Max. Negotiated Rate |
$388.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$388.20
|
|
|
IR CYSTOSTOMY TUBE CHANGE COMP
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
HCPCS 51710
|
| Hospital Charge Code |
7411627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$388.20 |
| Max. Negotiated Rate |
$388.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$388.20
|
|
|
IR CYSTOSTOMY TUBE CHANGE SIMP
|
Facility
|
OP
|
$833.00
|
|
|
Service Code
|
HCPCS 51705
|
| Hospital Charge Code |
7411626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$108.29 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$249.90
|
| Rate for Payer: Aetna Medicare Advantage |
$249.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$212.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$212.41
|
| 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 |
$212.41
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$108.29
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$124.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
IR CYSTOSTOMY TUBE CHANGE SIMP
|
Facility
|
IP
|
$1,355.15
|
|
|
Service Code
|
HCPCS 51705
|
| Hospital Charge Code |
321051705
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$203.27 |
| Max. Negotiated Rate |
$203.27 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.27
|
|
|
IR CYSTOSTOMY TUBE CHANGE SIMP
|
Facility
|
OP
|
$1,355.15
|
|
|
Service Code
|
HCPCS 51705
|
| Hospital Charge Code |
321051705
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$176.17 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$406.55
|
| Rate for Payer: Aetna Medicare Advantage |
$406.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$345.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$345.56
|
| 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 |
$345.56
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$176.17
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.27
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
IR CYSTOSTOMY TUBE CHANGE SIMP
|
Facility
|
IP
|
$833.00
|
|
|
Service Code
|
HCPCS 51705
|
| Hospital Charge Code |
7411626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.95 |
| Max. Negotiated Rate |
$124.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$124.95
|
|
