|
IR NEPHROSTOGRAM
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 74425
|
| Hospital Charge Code |
2600104
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.36 |
| 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 |
$52.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$830.80
|
| 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 NEPHROSTOGRAM
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 74425
|
| Hospital Charge Code |
411074425
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.36 |
| 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 |
$52.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$830.80
|
| 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 NEPHROSTOGRAM
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 74425
|
| Hospital Charge Code |
411074425
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
IR NEPHROSTOGRAM
|
Facility
|
IP
|
$906.25
|
|
|
Service Code
|
HCPCS 74425
|
| Hospital Charge Code |
7411678
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$135.94 |
| Max. Negotiated Rate |
$135.94 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.94
|
|
|
IR NEPHROSTOGRAM
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 74425
|
| Hospital Charge Code |
366874425
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
IR NEPHROSTOGRAM
|
Facility
|
OP
|
$906.25
|
|
|
Service Code
|
HCPCS 74425
|
| Hospital Charge Code |
7411678
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.36 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna Commercial |
$271.88
|
| Rate for Payer: Aetna Medicare Advantage |
$271.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$231.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$231.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$52.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$231.09
|
| Rate for Payer: Cigna Commercial |
$830.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.81
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
IR NEPHROSTOGRAM
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 74425
|
| Hospital Charge Code |
321074425
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.36 |
| 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 |
$52.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$830.80
|
| 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 NEPHROSTOGRAM
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 74425
|
| Hospital Charge Code |
2600104
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
IR NEPHROSTOGRAM
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 74425
|
| Hospital Charge Code |
321074425
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
IR NEPHROSTOGRAM
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 74425
|
| Hospital Charge Code |
366874425
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.36 |
| 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 |
$52.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$830.80
|
| 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 NEPHROSTOMY
|
Facility
|
IP
|
$3,730.45
|
|
| Hospital Charge Code |
5600012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$559.57 |
| Max. Negotiated Rate |
$559.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$559.57
|
|
|
IR NEPHROSTOMY
|
Facility
|
OP
|
$3,730.45
|
|
| Hospital Charge Code |
5600012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$484.96 |
| Max. Negotiated Rate |
$1,865.22 |
| Rate for Payer: Aetna Commercial |
$1,119.13
|
| Rate for Payer: Aetna Medicare Advantage |
$1,119.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$951.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$951.26
|
| 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 |
$951.26
|
| Rate for Payer: Cigna Commercial |
$1,865.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$484.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$559.57
|
|
|
IR NEPHROSTOMY CATHETER CHANGE
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
366875984
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
IR NEPHROSTOMY CATHETER CHANGE
|
Facility
|
IP
|
$1,608.85
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
7411743
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$241.33 |
| Max. Negotiated Rate |
$241.33 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$241.33
|
|
|
IR NEPHROSTOMY CATHETER CHANGE
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
2002111
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$96.21 |
| 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 |
$96.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$106.03
|
| 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 NEPHROSTOMY CATHETER CHANGE
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
366875984
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$96.21 |
| 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 |
$96.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$106.03
|
| 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 NEPHROSTOMY CATHETER CHANGE
|
Facility
|
OP
|
$1,608.85
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
7411743
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$96.21 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna Commercial |
$482.65
|
| Rate for Payer: Aetna Medicare Advantage |
$482.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$410.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$410.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$96.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$410.26
|
| Rate for Payer: Cigna Commercial |
$106.03
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$209.15
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$241.33
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
IR NEPHROSTOMY CATHETER CHANGE
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
2002111
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
IR NEPHROSTOMY CATHETER CHANGE
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
411075984
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
IR NEPHROSTOMY CATHETER CHANGE
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
411075984
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$96.21 |
| 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 |
$96.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$106.03
|
| 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 NEPHROSTOMY DILATION
|
Facility
|
OP
|
$1,780.85
|
|
|
Service Code
|
HCPCS 74485
|
| Hospital Charge Code |
7411682
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$231.51 |
| Max. Negotiated Rate |
$4,978.04 |
| Rate for Payer: Aetna Commercial |
$534.25
|
| Rate for Payer: Aetna Medicare Advantage |
$534.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$454.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$454.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$454.12
|
| Rate for Payer: Cigna Commercial |
$4,978.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$231.51
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$267.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
IR NEPHROSTOMY DILATION
|
Facility
|
OP
|
$1,780.85
|
|
|
Service Code
|
HCPCS 74485
|
| Hospital Charge Code |
2004935
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$231.51 |
| Max. Negotiated Rate |
$4,978.04 |
| Rate for Payer: Aetna Commercial |
$534.25
|
| Rate for Payer: Aetna Medicare Advantage |
$534.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$454.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$454.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$454.12
|
| Rate for Payer: Cigna Commercial |
$4,978.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$231.51
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$267.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
IR NEPHROSTOMY DILATION
|
Facility
|
IP
|
$1,780.85
|
|
|
Service Code
|
HCPCS 74485
|
| Hospital Charge Code |
2004935
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$267.13 |
| Max. Negotiated Rate |
$267.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$267.13
|
|
|
IR NEPHROSTOMY DILATION
|
Facility
|
IP
|
$1,780.85
|
|
|
Service Code
|
HCPCS 74485
|
| Hospital Charge Code |
7411682
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$267.13 |
| Max. Negotiated Rate |
$267.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$267.13
|
|
|
IR NEPHROSTOMY DILATION LEFT
|
Facility
|
IP
|
$1,780.85
|
|
|
Service Code
|
HCPCS 74485
|
| Hospital Charge Code |
2600105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$267.13 |
| Max. Negotiated Rate |
$267.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$267.13
|
|
