|
IR-DRAIN OF BREAST LES-LT
|
Facility
|
IP
|
$3,392.55
|
|
|
Service Code
|
HCPCS 19000LT
|
| Hospital Charge Code |
321019000L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$508.88 |
| Max. Negotiated Rate |
$508.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$508.88
|
|
|
IR-DRAIN OF BREAST LES-LT
|
Facility
|
OP
|
$3,392.55
|
|
|
Service Code
|
HCPCS 19000LT
|
| Hospital Charge Code |
2690870
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$441.03 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$1,017.76
|
| Rate for Payer: Aetna Medicare Advantage |
$1,017.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$865.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$865.10
|
| 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 |
$865.10
|
| Rate for Payer: Cigna Commercial |
$1,696.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$441.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$508.88
|
|
|
IR-DRAIN OF BREAST LES-RT
|
Facility
|
IP
|
$3,392.55
|
|
|
Service Code
|
HCPCS 19000RT
|
| Hospital Charge Code |
2690875
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$508.88 |
| Max. Negotiated Rate |
$508.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$508.88
|
|
|
IR-DRAIN OF BREAST LES-RT
|
Facility
|
IP
|
$5,305.00
|
|
|
Service Code
|
HCPCS 19000RT
|
| Hospital Charge Code |
7411860
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$795.75 |
| Max. Negotiated Rate |
$795.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$795.75
|
|
|
IR-DRAIN OF BREAST LES-RT
|
Facility
|
OP
|
$3,392.55
|
|
|
Service Code
|
HCPCS 19000RT
|
| Hospital Charge Code |
2690875
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$441.03 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$1,017.76
|
| Rate for Payer: Aetna Medicare Advantage |
$1,017.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$865.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$865.10
|
| 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 |
$865.10
|
| Rate for Payer: Cigna Commercial |
$1,696.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$441.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$508.88
|
|
|
IR-DRAIN OF BREAST LES-RT
|
Facility
|
OP
|
$3,392.55
|
|
|
Service Code
|
HCPCS 19000RT
|
| Hospital Charge Code |
321019000R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$441.03 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$1,017.76
|
| Rate for Payer: Aetna Medicare Advantage |
$1,017.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$865.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$865.10
|
| 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 |
$865.10
|
| Rate for Payer: Cigna Commercial |
$1,696.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$441.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$508.88
|
|
|
IR-DRAIN OF BREAST LES-RT
|
Facility
|
IP
|
$3,392.55
|
|
|
Service Code
|
HCPCS 19000RT
|
| Hospital Charge Code |
321019000R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$508.88 |
| Max. Negotiated Rate |
$508.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$508.88
|
|
|
IR-DRAIN OF BREAST LES-RT
|
Facility
|
OP
|
$5,305.00
|
|
|
Service Code
|
HCPCS 19000RT
|
| Hospital Charge Code |
7411860
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$689.65 |
| Max. Negotiated Rate |
$2,652.50 |
| Rate for Payer: Aetna Commercial |
$1,591.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,591.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,352.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,352.78
|
| 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 |
$1,352.78
|
| Rate for Payer: Cigna Commercial |
$2,652.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$689.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$795.75
|
|
|
IR DRAIN PELV ABS,TRANSVAG/TRA
|
Facility
|
OP
|
$8,582.36
|
|
|
Service Code
|
HCPCS 49407
|
| Hospital Charge Code |
7411587
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,115.71 |
| Max. Negotiated Rate |
$3,933.12 |
| Rate for Payer: Aetna Commercial |
$2,574.71
|
| Rate for Payer: Aetna Medicare Advantage |
$2,574.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,188.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,188.50
|
| 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 |
$2,188.50
|
| Rate for Payer: Cigna Commercial |
$3,933.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,115.71
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,287.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,687.00
|
|
|
IR DRAIN PELV ABS,TRANSVAG/TRA
|
Facility
|
IP
|
$8,054.80
|
|
|
Service Code
|
HCPCS 49407
|
| Hospital Charge Code |
2680225
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,208.22 |
| Max. Negotiated Rate |
$1,208.22 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,208.22
|
|
|
IR DRAIN PELV ABS,TRANSVAG/TRA
|
Facility
|
IP
|
$8,054.80
|
|
|
Service Code
|
HCPCS 49407
|
| Hospital Charge Code |
321049407
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,208.22 |
| Max. Negotiated Rate |
$1,208.22 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,208.22
|
|
|
IR DRAIN PELV ABS,TRANSVAG/TRA
|
Facility
|
OP
|
$8,054.80
|
|
|
Service Code
|
HCPCS 49407
|
| Hospital Charge Code |
2680225
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,047.12 |
| Max. Negotiated Rate |
$3,933.12 |
| Rate for Payer: Aetna Commercial |
$2,416.44
|
| Rate for Payer: Aetna Medicare Advantage |
$2,416.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,053.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,053.97
|
| 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 |
$2,053.97
|
| Rate for Payer: Cigna Commercial |
$3,933.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,047.12
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,208.22
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,687.00
|
|
|
IR DRAIN PELV ABS,TRANSVAG/TRA
|
Facility
|
IP
|
$8,582.36
|
|
|
Service Code
|
HCPCS 49407
|
| Hospital Charge Code |
7411587
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,287.35 |
| Max. Negotiated Rate |
$1,287.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,287.35
|
|
|
IR DRAIN PELV ABS,TRANSVAG/TRA
|
Facility
|
OP
|
$8,054.80
|
|
|
Service Code
|
HCPCS 49407
|
| Hospital Charge Code |
321049407
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,047.12 |
| Max. Negotiated Rate |
$3,933.12 |
| Rate for Payer: Aetna Commercial |
$2,416.44
|
| Rate for Payer: Aetna Medicare Advantage |
$2,416.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,053.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,053.97
|
| 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 |
$2,053.97
|
| Rate for Payer: Cigna Commercial |
$3,933.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,047.12
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,208.22
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,687.00
|
|
|
IR-DRAIN PERIU ABSCE DEEP
|
Facility
|
IP
|
$7,145.00
|
|
|
Service Code
|
HCPCS 53040
|
| Hospital Charge Code |
2690200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,071.75 |
| Max. Negotiated Rate |
$1,071.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,071.75
|
|
|
IR-DRAIN PERIU ABSCE DEEP
|
Facility
|
IP
|
$7,145.00
|
|
|
Service Code
|
HCPCS 53040
|
| Hospital Charge Code |
7411630
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,071.75 |
| Max. Negotiated Rate |
$1,071.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,071.75
|
|
|
IR-DRAIN PERIU ABSCE DEEP
|
Facility
|
OP
|
$7,145.00
|
|
|
Service Code
|
HCPCS 53040
|
| Hospital Charge Code |
2690200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$928.85 |
| Max. Negotiated Rate |
$8,394.37 |
| Rate for Payer: Aetna Commercial |
$2,143.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,143.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,821.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,821.97
|
| 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 |
$1,821.97
|
| Rate for Payer: Cigna Commercial |
$8,394.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$928.85
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,071.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,529.00
|
|
|
IR-DRAIN PERIU ABSCE DEEP
|
Facility
|
OP
|
$7,145.00
|
|
|
Service Code
|
HCPCS 53040
|
| Hospital Charge Code |
7411630
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$928.85 |
| Max. Negotiated Rate |
$8,394.37 |
| Rate for Payer: Aetna Commercial |
$2,143.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,143.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,821.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,821.97
|
| 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 |
$1,821.97
|
| Rate for Payer: Cigna Commercial |
$8,394.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$928.85
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,071.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,529.00
|
|
|
IR-DRAIN PROSTATE ABSCESS
|
Facility
|
OP
|
$5,784.00
|
|
|
Service Code
|
HCPCS 52700
|
| Hospital Charge Code |
7411629
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$751.92 |
| Max. Negotiated Rate |
$8,394.37 |
| Rate for Payer: Aetna Commercial |
$1,735.20
|
| Rate for Payer: Aetna Medicare Advantage |
$1,735.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,474.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,474.92
|
| 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 |
$1,474.92
|
| Rate for Payer: Cigna Commercial |
$8,394.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$751.92
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$867.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,529.00
|
|
|
IR-DRAIN PROSTATE ABSCESS
|
Facility
|
IP
|
$5,784.00
|
|
|
Service Code
|
HCPCS 52700
|
| Hospital Charge Code |
2690195
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$867.60 |
| Max. Negotiated Rate |
$867.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$867.60
|
|
|
IR-DRAIN PROSTATE ABSCESS
|
Facility
|
OP
|
$5,784.00
|
|
|
Service Code
|
HCPCS 52700
|
| Hospital Charge Code |
2690195
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$751.92 |
| Max. Negotiated Rate |
$8,394.37 |
| Rate for Payer: Aetna Commercial |
$1,735.20
|
| Rate for Payer: Aetna Medicare Advantage |
$1,735.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,474.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,474.92
|
| 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 |
$1,474.92
|
| Rate for Payer: Cigna Commercial |
$8,394.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$751.92
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$867.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,529.00
|
|
|
IR-DRAIN PROSTATE ABSCESS
|
Facility
|
IP
|
$5,784.00
|
|
|
Service Code
|
HCPCS 52700
|
| Hospital Charge Code |
7411629
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$867.60 |
| Max. Negotiated Rate |
$867.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$867.60
|
|
|
IR DRAIN RETROPERITONEAL ABCSS
|
Facility
|
OP
|
$3,407.60
|
|
|
Service Code
|
HCPCS 75989
|
| Hospital Charge Code |
7411749
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.54 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna Commercial |
$1,022.28
|
| Rate for Payer: Aetna Medicare Advantage |
$1,022.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$868.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$868.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$244.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$868.94
|
| Rate for Payer: Cigna Commercial |
$126.54
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$442.99
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$511.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
IR DRAIN RETROPERITONEAL ABCSS
|
Facility
|
IP
|
$3,407.60
|
|
|
Service Code
|
HCPCS 75989
|
| Hospital Charge Code |
2600070
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$511.14 |
| Max. Negotiated Rate |
$511.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$511.14
|
|
|
IR DRAIN RETROPERITONEAL ABCSS
|
Facility
|
IP
|
$3,407.60
|
|
|
Service Code
|
HCPCS 75989
|
| Hospital Charge Code |
7411749
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$511.14 |
| Max. Negotiated Rate |
$511.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$511.14
|
|
