|
IR DRAIN RETROPERITONEAL ABCSS
|
Facility
|
OP
|
$3,407.60
|
|
|
Service Code
|
HCPCS 75989
|
| Hospital Charge Code |
2600070
|
|
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 SKENES ABSCESS
|
Facility
|
OP
|
$4,467.00
|
|
|
Service Code
|
HCPCS 53060
|
| Hospital Charge Code |
7411631
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$580.71 |
| Max. Negotiated Rate |
$5,529.00 |
| Rate for Payer: Aetna Commercial |
$1,340.10
|
| Rate for Payer: Aetna Medicare Advantage |
$1,340.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,139.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,139.09
|
| 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 |
$1,139.09
|
| Rate for Payer: Cigna Commercial |
$4,978.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$580.71
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$670.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,529.00
|
|
|
IR-DRAIN SKENES ABSCESS
|
Facility
|
IP
|
$4,467.00
|
|
|
Service Code
|
HCPCS 53060
|
| Hospital Charge Code |
2690205
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$670.05 |
| Max. Negotiated Rate |
$670.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$670.05
|
|
|
IR-DRAIN SKENES ABSCESS
|
Facility
|
IP
|
$4,467.00
|
|
|
Service Code
|
HCPCS 53060
|
| Hospital Charge Code |
7411631
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$670.05 |
| Max. Negotiated Rate |
$670.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$670.05
|
|
|
IR-DRAIN SKENES ABSCESS
|
Facility
|
OP
|
$4,467.00
|
|
|
Service Code
|
HCPCS 53060
|
| Hospital Charge Code |
2690205
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$580.71 |
| Max. Negotiated Rate |
$5,529.00 |
| Rate for Payer: Aetna Commercial |
$1,340.10
|
| Rate for Payer: Aetna Medicare Advantage |
$1,340.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,139.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,139.09
|
| 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 |
$1,139.09
|
| Rate for Payer: Cigna Commercial |
$4,978.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$580.71
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$670.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,529.00
|
|
|
IR-DRAIN SPINAL CORD CYST
|
Facility
|
OP
|
$741.00
|
|
|
Service Code
|
HCPCS 62268
|
| Hospital Charge Code |
7411648
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$96.33 |
| Max. Negotiated Rate |
$2,575.00 |
| Rate for Payer: Aetna Commercial |
$222.30
|
| Rate for Payer: Aetna Medicare Advantage |
$222.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$188.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$188.96
|
| 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 |
$188.96
|
| Rate for Payer: Cigna Commercial |
$2,106.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$96.33
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,575.00
|
|
|
IR-DRAIN SPINAL CORD CYST
|
Facility
|
OP
|
$741.00
|
|
|
Service Code
|
HCPCS 62268
|
| Hospital Charge Code |
2690230
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$96.33 |
| Max. Negotiated Rate |
$2,575.00 |
| Rate for Payer: Aetna Commercial |
$222.30
|
| Rate for Payer: Aetna Medicare Advantage |
$222.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$188.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$188.96
|
| 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 |
$188.96
|
| Rate for Payer: Cigna Commercial |
$2,106.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$96.33
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,575.00
|
|
|
IR-DRAIN SPINAL CORD CYST
|
Facility
|
IP
|
$741.00
|
|
|
Service Code
|
HCPCS 62268
|
| Hospital Charge Code |
2690230
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$111.15 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.15
|
|
|
IR-DRAIN SPINAL CORD CYST
|
Facility
|
IP
|
$741.00
|
|
|
Service Code
|
HCPCS 62268
|
| Hospital Charge Code |
7411648
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$111.15 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.15
|
|
|
IR DRAIN SUBDIAPHRAGM/SUBPHRNC
|
Facility
|
IP
|
$6,139.10
|
|
| Hospital Charge Code |
2600071
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$920.87 |
| Max. Negotiated Rate |
$920.87 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$920.87
|
|
|
IR DRAIN SUBDIAPHRAGM/SUBPHRNC
|
Facility
|
OP
|
$6,139.10
|
|
| Hospital Charge Code |
2600071
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$798.08 |
| Max. Negotiated Rate |
$3,069.55 |
| Rate for Payer: Aetna Commercial |
$1,841.73
|
| Rate for Payer: Aetna Medicare Advantage |
$1,841.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,565.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,565.47
|
| 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 |
$1,565.47
|
| Rate for Payer: Cigna Commercial |
$3,069.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$798.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$920.87
|
|
|
IR-DRAN CEREB SPINAL FLUD
|
Facility
|
OP
|
$548.00
|
|
|
Service Code
|
HCPCS 62272
|
| Hospital Charge Code |
7411651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$71.24 |
| Max. Negotiated Rate |
$2,575.00 |
| Rate for Payer: Aetna Commercial |
$164.40
|
| Rate for Payer: Aetna Medicare Advantage |
$164.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$139.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$139.74
|
| 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 |
$139.74
|
| Rate for Payer: Cigna Commercial |
$1,680.99
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$71.24
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,575.00
|
|
|
IR-DRAN CEREB SPINAL FLUD
|
Facility
|
OP
|
$3,506.55
|
|
|
Service Code
|
HCPCS 62272
|
| Hospital Charge Code |
321062272
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$455.85 |
| Max. Negotiated Rate |
$2,575.00 |
| Rate for Payer: Aetna Commercial |
$1,051.96
|
| Rate for Payer: Aetna Medicare Advantage |
$1,051.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$894.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$894.17
|
| 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 |
$894.17
|
| Rate for Payer: Cigna Commercial |
$1,680.99
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$455.85
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$525.98
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,575.00
|
|
|
IR-DRAN CEREB SPINAL FLUD
|
Facility
|
IP
|
$3,506.55
|
|
|
Service Code
|
HCPCS 62272
|
| Hospital Charge Code |
321062272
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$525.98 |
| Max. Negotiated Rate |
$525.98 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$525.98
|
|
|
IR-DRAN CEREB SPINAL FLUD
|
Facility
|
IP
|
$3,506.55
|
|
|
Service Code
|
HCPCS 62272
|
| Hospital Charge Code |
2690235
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$525.98 |
| Max. Negotiated Rate |
$525.98 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$525.98
|
|
|
IR-DRAN CEREB SPINAL FLUD
|
Facility
|
IP
|
$548.00
|
|
|
Service Code
|
HCPCS 62272
|
| Hospital Charge Code |
7411651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$82.20 |
| Max. Negotiated Rate |
$82.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.20
|
|
|
IR-DRAN CEREB SPINAL FLUD
|
Facility
|
OP
|
$3,506.55
|
|
|
Service Code
|
HCPCS 62272
|
| Hospital Charge Code |
2690235
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$455.85 |
| Max. Negotiated Rate |
$2,575.00 |
| Rate for Payer: Aetna Commercial |
$1,051.96
|
| Rate for Payer: Aetna Medicare Advantage |
$1,051.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$894.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$894.17
|
| 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 |
$894.17
|
| Rate for Payer: Cigna Commercial |
$1,680.99
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$455.85
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$525.98
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,575.00
|
|
|
IR DX-FLUORO GUIDANCE/LOC NEED
|
Facility
|
IP
|
$1,508.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
7411755
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$226.20 |
| Max. Negotiated Rate |
$226.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$226.20
|
|
|
IR DX-FLUORO GUIDANCE/LOC NEED
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
366877002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
IR DX-FLUORO GUIDANCE/LOC NEED
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
366877002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.56 |
| Max. Negotiated Rate |
$1,530.00 |
| Rate for Payer: Aetna Commercial |
$1,530.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,300.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,300.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$53.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$138.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$663.00
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
IR DX-FLUORO GUIDANCE/LOC NEED
|
Facility
|
OP
|
$1,508.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
7411755
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.56 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna Commercial |
$452.40
|
| Rate for Payer: Aetna Medicare Advantage |
$452.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$384.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$384.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$53.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$384.54
|
| Rate for Payer: Cigna Commercial |
$138.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$196.04
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$226.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
IR DX-FLUORO GUIDANCE/LOC NEED
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
321077002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.56 |
| Max. Negotiated Rate |
$1,530.00 |
| Rate for Payer: Aetna Commercial |
$1,530.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,300.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,300.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$53.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$138.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$663.00
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
IR DX-FLUORO GUIDANCE/LOC NEED
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
321077002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
IR DX-FLUORO GUIDANCE/LOC NEED
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
411077002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
IR DX-FLUORO GUIDANCE/LOC NEED
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
2670020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.56 |
| Max. Negotiated Rate |
$1,530.00 |
| Rate for Payer: Aetna Commercial |
$1,530.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,300.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,300.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$53.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$138.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$663.00
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
