|
IC MOLDABLE STRIP 90MM FZ
|
Facility
|
IP
|
$7,000.00
|
|
| Hospital Charge Code |
270671275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$1,694.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,694.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,050.00
|
|
|
IC MOLDABLE STRIP 90MM FZ
|
Facility
|
OP
|
$7,000.00
|
|
| Hospital Charge Code |
270671275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$3,500.00 |
| Rate for Payer: Aetna Commercial |
$2,660.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,785.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,785.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,785.00
|
| Rate for Payer: Cigna Commercial |
$3,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,694.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,050.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$221.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$198.80
|
|
|
ICONIX 2.3 GUIDE
|
Facility
|
IP
|
$1,750.00
|
|
| Hospital Charge Code |
270680690
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$262.50
|
|
|
ICONIX 2.3 GUIDE
|
Facility
|
OP
|
$1,750.00
|
|
| Hospital Charge Code |
270680690
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna Commercial |
$665.00
|
| Rate for Payer: Aetna Medicare Advantage |
$525.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$446.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$446.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$446.25
|
| Rate for Payer: Cigna Commercial |
$875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$455.00
|
| Rate for Payer: Oxford Commercial |
$350.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$262.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$350.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$55.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$49.70
|
|
|
ICONIX NEEDLE iNTELLIBRIAN TEC
|
Facility
|
OP
|
$2,447.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.52 |
| Max. Negotiated Rate |
$1,223.90 |
| Rate for Payer: Aetna Commercial |
$930.16
|
| Rate for Payer: Aetna Medicare Advantage |
$734.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$624.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$624.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$489.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$624.19
|
| Rate for Payer: Cigna Commercial |
$1,223.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$592.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$367.17
|
| Rate for Payer: UnitedHealthcare Community & State |
$77.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$69.52
|
|
|
ICONIX NEEDLE iNTELLIBRIAN TEC
|
Facility
|
IP
|
$2,447.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$367.17 |
| Max. Negotiated Rate |
$592.37 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$489.56
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$592.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$367.17
|
|
|
I & D ABSCESS COMP MULTIPLE
|
Facility
|
OP
|
$2,352.55
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
1600000566
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$66.81 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$1,313.62
|
| Rate for Payer: Aetna Medicare Advantage |
$1,564.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,751.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,751.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$482.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,751.90
|
| Rate for Payer: Cigna Commercial |
$968.07
|
| Rate for Payer: Cigna Medicare Advantage |
$482.95
|
| Rate for Payer: Clover Medicare Advantage |
$458.80
|
| Rate for Payer: EmblemHealth Commercial |
$1,448.85
|
| Rate for Payer: Humana Medicare Advantage |
$497.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$482.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$611.66
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$352.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$74.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$66.81
|
|
|
I & D ABSCESS COMP MULTIPLE
|
Facility
|
IP
|
$2,352.55
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
1600000566
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$352.88 |
| Max. Negotiated Rate |
$352.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$352.88
|
|
|
I&D ABSCESS/CYST COMPL/MULTI
|
Facility
|
IP
|
$1,872.25
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
412310061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$280.84 |
| Max. Negotiated Rate |
$280.84 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$280.84
|
|
|
I&D ABSCESS/CYST COMPL/MULTI
|
Facility
|
OP
|
$1,872.25
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
412310061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.17 |
| Max. Negotiated Rate |
$1,751.90 |
| Rate for Payer: Aetna Commercial |
$1,313.62
|
| Rate for Payer: Aetna Medicare Advantage |
$1,564.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,751.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,751.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$482.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$121.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,751.90
|
| Rate for Payer: Cigna Commercial |
$968.07
|
| Rate for Payer: Cigna Medicare Advantage |
$482.95
|
| Rate for Payer: Clover Medicare Advantage |
$458.80
|
| Rate for Payer: EmblemHealth Commercial |
$1,448.85
|
| Rate for Payer: Humana Medicare Advantage |
$497.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$482.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$486.79
|
| Rate for Payer: Oxford Commercial |
$374.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$280.84
|
| Rate for Payer: UnitedHealthcare Commercial |
$374.45
|
| Rate for Payer: UnitedHealthcare Community & State |
$59.16
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$53.17
|
|
|
I&D ABSC, SMPL OR SGL
|
Facility
|
IP
|
$1,896.30
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
1600000462
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$284.44 |
| Max. Negotiated Rate |
$284.44 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$284.44
|
|
|
I&D ABSC, SMPL OR SGL
|
Facility
|
OP
|
$1,896.30
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
1600000462
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$59.92 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$648.34
|
| Rate for Payer: Aetna Medicare Advantage |
$772.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$864.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$864.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$238.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$864.65
|
| Rate for Payer: Cigna Commercial |
$477.79
|
| Rate for Payer: Cigna Medicare Advantage |
$238.36
|
| Rate for Payer: Clover Medicare Advantage |
$226.44
|
| Rate for Payer: EmblemHealth Commercial |
$715.08
|
| Rate for Payer: Humana Medicare Advantage |
$245.51
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$238.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$493.04
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$284.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$59.92
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$962.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$943.15
|
|
|
IDARUCIZUMAB 50MG/ML INJ 50ML
|
Facility
|
OP
|
$14,070.00
|
|
|
Service Code
|
HCPCS C9399
|
| Hospital Charge Code |
606380034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$399.59 |
| Max. Negotiated Rate |
$7,035.00 |
| Rate for Payer: Aetna Commercial |
$5,346.60
|
| Rate for Payer: Aetna Medicare Advantage |
$4,221.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,587.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,587.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,587.85
|
| Rate for Payer: Cigna Commercial |
$7,035.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,404.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,110.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$444.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$399.59
|
|
|
IDARUCIZUMAB 50MG/ML INJ 50ML
|
Facility
|
IP
|
$14,070.00
|
|
|
Service Code
|
HCPCS C9399
|
| Hospital Charge Code |
606380034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,110.50 |
| Max. Negotiated Rate |
$3,404.94 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,404.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,110.50
|
|
|
I&D BARTHOLIN GLAND
|
Facility
|
IP
|
$942.15
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
412356420
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$141.32 |
| Max. Negotiated Rate |
$141.32 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$141.32
|
|
|
I&D BARTHOLIN GLAND
|
Facility
|
OP
|
$942.15
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
412356420
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$26.76 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$653.29
|
| Rate for Payer: Aetna Medicare Advantage |
$778.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$871.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$871.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$240.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$871.25
|
| Rate for Payer: Cigna Commercial |
$481.45
|
| Rate for Payer: Cigna Medicare Advantage |
$240.18
|
| Rate for Payer: Clover Medicare Advantage |
$228.17
|
| Rate for Payer: EmblemHealth Commercial |
$720.54
|
| Rate for Payer: Humana Medicare Advantage |
$247.39
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$240.18
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$244.96
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$141.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$29.77
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$240.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$240.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.76
|
|
|
I&D BARTHOLIN'S GLND ABSCESS
|
Facility
|
IP
|
$1,872.73
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
1600000705
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$280.91 |
| Max. Negotiated Rate |
$280.91 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$280.91
|
|
|
I&D BARTHOLIN'S GLND ABSCESS
|
Facility
|
OP
|
$1,872.73
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
1600000705
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$53.19 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$653.29
|
| Rate for Payer: Aetna Medicare Advantage |
$778.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$871.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$871.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$240.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$871.25
|
| Rate for Payer: Cigna Commercial |
$481.45
|
| Rate for Payer: Cigna Medicare Advantage |
$240.18
|
| Rate for Payer: Clover Medicare Advantage |
$228.17
|
| Rate for Payer: EmblemHealth Commercial |
$720.54
|
| Rate for Payer: Humana Medicare Advantage |
$247.39
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$240.18
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$486.91
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$280.91
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$59.18
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$240.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$240.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$53.19
|
|
|
I&D BARTHOLOINS CYST
|
Facility
|
OP
|
$1,068.55
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
87502585
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$30.35 |
| Max. Negotiated Rate |
$871.25 |
| Rate for Payer: Aetna Commercial |
$653.29
|
| Rate for Payer: Aetna Medicare Advantage |
$778.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$871.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$871.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$240.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$871.25
|
| Rate for Payer: Cigna Commercial |
$481.45
|
| Rate for Payer: Cigna Medicare Advantage |
$240.18
|
| Rate for Payer: Clover Medicare Advantage |
$228.17
|
| Rate for Payer: EmblemHealth Commercial |
$720.54
|
| Rate for Payer: Humana Medicare Advantage |
$247.39
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$240.18
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$277.82
|
| Rate for Payer: Oxford Commercial |
$213.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$160.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$213.71
|
| Rate for Payer: UnitedHealthcare Community & State |
$33.77
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$240.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$240.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$30.35
|
|
|
I&D BARTHOLOINS CYST
|
Facility
|
IP
|
$1,068.55
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
87502585
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$160.28 |
| Max. Negotiated Rate |
$160.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$160.28
|
|
|
ID BY PROBE
|
Facility
|
OP
|
$137.85
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
39900273
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$54.54
|
| Rate for Payer: Aetna Medicare Advantage |
$64.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$72.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$72.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$20.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$36.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$72.73
|
| Rate for Payer: Cigna Commercial |
$68.92
|
| Rate for Payer: Cigna Medicare Advantage |
$20.05
|
| Rate for Payer: Clover Medicare Advantage |
$19.05
|
| Rate for Payer: EmblemHealth Commercial |
$60.15
|
| Rate for Payer: Humana Medicare Advantage |
$20.65
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$20.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.84
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.04
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$20.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$20.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.91
|
|
|
ID BY PROBE
|
Facility
|
IP
|
$137.85
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
39900273
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$20.68 |
| Max. Negotiated Rate |
$20.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.68
|
|
|
I&D CPLX POSTOP WND INF
|
Facility
|
IP
|
$9,748.92
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
16000463
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,462.34 |
| Max. Negotiated Rate |
$1,462.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,462.34
|
|
|
I&D CPLX POSTOP WND INF
|
Facility
|
OP
|
$9,748.92
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
16000463
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$308.07 |
| Max. Negotiated Rate |
$12,518.07 |
| Rate for Payer: Aetna Commercial |
$9,386.39
|
| Rate for Payer: Aetna Medicare Advantage |
$11,180.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12,518.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12,518.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,450.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12,518.07
|
| Rate for Payer: Cigna Commercial |
$6,917.28
|
| Rate for Payer: Cigna Medicare Advantage |
$3,450.88
|
| Rate for Payer: Clover Medicare Advantage |
$3,278.34
|
| Rate for Payer: EmblemHealth Commercial |
$10,352.64
|
| Rate for Payer: Humana Medicare Advantage |
$3,554.41
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,450.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,534.72
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,462.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$308.07
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$635.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$622.61
|
|
|
I&D EAR ABSCESS COMPLICATED
|
Facility
|
OP
|
$8,259.00
|
|
|
Service Code
|
HCPCS 69005
|
| Hospital Charge Code |
5780255
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$67.10 |
| Max. Negotiated Rate |
$7,117.66 |
| Rate for Payer: Aetna Commercial |
$5,337.02
|
| Rate for Payer: Aetna Medicare Advantage |
$6,357.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,117.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,117.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,962.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$67.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,117.66
|
| Rate for Payer: Cigna Commercial |
$3,933.12
|
| Rate for Payer: Cigna Medicare Advantage |
$1,962.14
|
| Rate for Payer: Clover Medicare Advantage |
$1,864.03
|
| Rate for Payer: EmblemHealth Commercial |
$5,886.42
|
| Rate for Payer: Humana Medicare Advantage |
$2,021.00
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,962.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,147.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,238.85
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,962.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,962.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$234.56
|
|
