|
IR-PLACE CTH PLM ARTRY-RT
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
HCPCS 36013RT
|
| Hospital Charge Code |
321036013R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$24.44 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$56.40
|
| Rate for Payer: Aetna Medicare Advantage |
$56.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.94
|
| 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 |
$47.94
|
| Rate for Payer: Cigna Commercial |
$94.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.20
|
|
|
IR-PLACE CTH PLM ARTRY-RT
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
HCPCS 36013RT
|
| Hospital Charge Code |
7411901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$28.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.20
|
|
|
IR-PLACE CTH PLM ARTRY-RT
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
HCPCS 36013RT
|
| Hospital Charge Code |
7411901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$24.44 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$56.40
|
| Rate for Payer: Aetna Medicare Advantage |
$56.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.94
|
| 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 |
$47.94
|
| Rate for Payer: Cigna Commercial |
$94.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.20
|
|
|
IR-PLACE CTH PLM ARTRY-RT
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
HCPCS 36013RT
|
| Hospital Charge Code |
321036013R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$28.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.20
|
|
|
IR-PLACE CTH PLM ARTRY-RT
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
HCPCS 36013RT
|
| Hospital Charge Code |
2691165
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$28.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.20
|
|
|
IR-PLACE CTH PLM ARTRY-RT
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
HCPCS 36013RT
|
| Hospital Charge Code |
2691165
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$24.44 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$56.40
|
| Rate for Payer: Aetna Medicare Advantage |
$56.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.94
|
| 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 |
$47.94
|
| Rate for Payer: Cigna Commercial |
$94.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.20
|
|
|
IR PLACE GASTROSTOMY TUBE
|
Facility
|
IP
|
$3,929.65
|
|
|
Service Code
|
HCPCS 43246
|
| Hospital Charge Code |
7411545
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$589.45 |
| Max. Negotiated Rate |
$589.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$589.45
|
|
|
IR PLACE GASTROSTOMY TUBE
|
Facility
|
OP
|
$3,929.65
|
|
|
Service Code
|
HCPCS 43246
|
| Hospital Charge Code |
7411545
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$510.85 |
| Max. Negotiated Rate |
$4,829.61 |
| Rate for Payer: Aetna Better Health Medicaid |
$4,734.91
|
| Rate for Payer: Aetna Commercial |
$1,178.89
|
| Rate for Payer: Aetna Medicare Advantage |
$1,178.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,002.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,002.06
|
| 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 |
$1,002.06
|
| Rate for Payer: Cigna Commercial |
$4,569.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$510.85
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$589.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,687.00
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$4,829.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4,734.91
|
|
|
IR PLACE GASTROSTOMY TUBE
|
Facility
|
IP
|
$3,929.65
|
|
|
Service Code
|
HCPCS 43246
|
| Hospital Charge Code |
5600187
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$589.45 |
| Max. Negotiated Rate |
$589.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$589.45
|
|
|
IR PLACE GASTROSTOMY TUBE
|
Facility
|
OP
|
$3,929.65
|
|
|
Service Code
|
HCPCS 43246
|
| Hospital Charge Code |
5600187
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$510.85 |
| Max. Negotiated Rate |
$4,829.61 |
| Rate for Payer: Aetna Better Health Medicaid |
$4,734.91
|
| Rate for Payer: Aetna Commercial |
$1,178.89
|
| Rate for Payer: Aetna Medicare Advantage |
$1,178.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,002.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,002.06
|
| 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 |
$1,002.06
|
| Rate for Payer: Cigna Commercial |
$4,569.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$510.85
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$589.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,687.00
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$4,829.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4,734.91
|
|
|
IR PLACE GASTROSTOMY TUBE PERC
|
Facility
|
IP
|
$6,674.15
|
|
|
Service Code
|
HCPCS 49440
|
| Hospital Charge Code |
366849440
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,001.12 |
| Max. Negotiated Rate |
$1,001.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,001.12
|
|
|
IR PLACE GASTROSTOMY TUBE PERC
|
Facility
|
OP
|
$6,674.15
|
|
|
Service Code
|
HCPCS 49440
|
| Hospital Charge Code |
7411593
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$867.64 |
| Max. Negotiated Rate |
$4,569.67 |
| Rate for Payer: Aetna Commercial |
$2,002.24
|
| Rate for Payer: Aetna Medicare Advantage |
$2,002.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,701.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,701.91
|
| 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 |
$1,701.91
|
| Rate for Payer: Cigna Commercial |
$4,569.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$867.64
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,001.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,687.00
|
|
|
IR PLACE GASTROSTOMY TUBE PERC
|
Facility
|
OP
|
$6,674.15
|
|
|
Service Code
|
HCPCS 49440
|
| Hospital Charge Code |
366849440
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$867.64 |
| Max. Negotiated Rate |
$4,569.67 |
| Rate for Payer: Aetna Commercial |
$2,002.24
|
| Rate for Payer: Aetna Medicare Advantage |
$2,002.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,701.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,701.91
|
| 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 |
$1,701.91
|
| Rate for Payer: Cigna Commercial |
$4,569.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$867.64
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,001.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,687.00
|
|
|
IR PLACE GASTROSTOMY TUBE PERC
|
Facility
|
IP
|
$8,686.35
|
|
|
Service Code
|
HCPCS 49440
|
| Hospital Charge Code |
5600159
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,302.95 |
| Max. Negotiated Rate |
$1,302.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,302.95
|
|
|
IR PLACE GASTROSTOMY TUBE PERC
|
Facility
|
IP
|
$6,674.15
|
|
|
Service Code
|
HCPCS 49440
|
| Hospital Charge Code |
7411593
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,001.12 |
| Max. Negotiated Rate |
$1,001.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,001.12
|
|
|
IR PLACE GASTROSTOMY TUBE PERC
|
Facility
|
IP
|
$8,686.35
|
|
|
Service Code
|
HCPCS 49440
|
| Hospital Charge Code |
321049440
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,302.95 |
| Max. Negotiated Rate |
$1,302.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,302.95
|
|
|
IR PLACE GASTROSTOMY TUBE PERC
|
Facility
|
OP
|
$8,686.35
|
|
|
Service Code
|
HCPCS 49440
|
| Hospital Charge Code |
321049440
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,129.23 |
| Max. Negotiated Rate |
$4,569.67 |
| Rate for Payer: Aetna Commercial |
$2,605.91
|
| Rate for Payer: Aetna Medicare Advantage |
$2,605.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,215.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,215.02
|
| 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 |
$2,215.02
|
| Rate for Payer: Cigna Commercial |
$4,569.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,129.23
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,302.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,687.00
|
|
|
IR PLACE GASTROSTOMY TUBE PERC
|
Facility
|
OP
|
$8,686.35
|
|
|
Service Code
|
HCPCS 49440
|
| Hospital Charge Code |
5600159
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,129.23 |
| Max. Negotiated Rate |
$4,569.67 |
| Rate for Payer: Aetna Commercial |
$2,605.91
|
| Rate for Payer: Aetna Medicare Advantage |
$2,605.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,215.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,215.02
|
| 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 |
$2,215.02
|
| Rate for Payer: Cigna Commercial |
$4,569.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,129.23
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,302.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,687.00
|
|
|
IR-PLACEMENT OF MARKER
|
Facility
|
OP
|
$1,023.00
|
|
| Hospital Charge Code |
2680020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$132.99 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Medicare Advantage |
$306.90
|
| Rate for Payer: Aetna Commercial |
$306.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$260.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$260.87
|
| 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 |
$260.87
|
| Rate for Payer: Cigna Commercial |
$511.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$132.99
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.45
|
|
|
IR-PLACEMENT OF MARKER
|
Facility
|
IP
|
$1,023.00
|
|
| Hospital Charge Code |
2680020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$153.45 |
| Max. Negotiated Rate |
$153.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.45
|
|
|
IR PLACEMNT CENTRL VENOUS CATH
|
Facility
|
IP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 36561
|
| Hospital Charge Code |
2011168
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,320.28 |
| Max. Negotiated Rate |
$2,320.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,320.28
|
|
|
IR PLACEMNT CENTRL VENOUS CATH
|
Facility
|
OP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 36561
|
| Hospital Charge Code |
2011168
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$7,519.21 |
| Rate for Payer: Aetna Commercial |
$4,640.55
|
| Rate for Payer: Aetna Medicare Advantage |
$4,640.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,944.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,944.47
|
| 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 |
$3,944.47
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,010.90
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,320.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,873.00
|
|
|
IR PLACEMNT CENTRL VENOUS CATH
|
Facility
|
IP
|
$8,696.85
|
|
|
Service Code
|
HCPCS 36561
|
| Hospital Charge Code |
366836561
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,304.53 |
| Max. Negotiated Rate |
$1,304.53 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,304.53
|
|
|
IR PLACEMNT CENTRL VENOUS CATH
|
Facility
|
OP
|
$8,696.85
|
|
|
Service Code
|
HCPCS 36561
|
| Hospital Charge Code |
7411454
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,130.59 |
| Max. Negotiated Rate |
$7,519.21 |
| Rate for Payer: Aetna Commercial |
$2,609.05
|
| Rate for Payer: Aetna Medicare Advantage |
$2,609.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,217.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,217.70
|
| 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 |
$2,217.70
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,130.59
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,304.53
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,873.00
|
|
|
IR PLACEMNT CENTRL VENOUS CATH
|
Facility
|
OP
|
$8,696.85
|
|
|
Service Code
|
HCPCS 36561
|
| Hospital Charge Code |
366836561
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,130.59 |
| Max. Negotiated Rate |
$7,519.21 |
| Rate for Payer: Aetna Commercial |
$2,609.05
|
| Rate for Payer: Aetna Medicare Advantage |
$2,609.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,217.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,217.70
|
| 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 |
$2,217.70
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,130.59
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,304.53
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,873.00
|
|
