|
IR CORPORA CAVERNOSOGRAPHY
|
Facility
|
OP
|
$1,046.00
|
|
|
Service Code
|
HCPCS 74445
|
| Hospital Charge Code |
7411681
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.71 |
| Max. Negotiated Rate |
$2,231.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$85.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$450.54
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$86.94
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.96
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$156.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$33.05
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.71
|
|
|
IR CORPORA CAVERNOSOGRAPHY
|
Facility
|
IP
|
$1,046.00
|
|
|
Service Code
|
HCPCS 74445
|
| Hospital Charge Code |
7411681
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$156.90 |
| Max. Negotiated Rate |
$156.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$156.90
|
|
|
IR CTA LOWER EXTREMITY W/WO CO
|
Facility
|
IP
|
$2,013.25
|
|
|
Service Code
|
HCPCS 73706
|
| Hospital Charge Code |
7411671
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$301.99 |
| Max. Negotiated Rate |
$301.99 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$301.99
|
|
|
IR CTA LOWER EXTREMITY W/WO CO
|
Facility
|
IP
|
$2,013.25
|
|
|
Service Code
|
HCPCS 73706
|
| Hospital Charge Code |
2680300
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$301.99 |
| Max. Negotiated Rate |
$301.99 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$301.99
|
|
|
IR CTA LOWER EXTREMITY W/WO CO
|
Facility
|
OP
|
$2,013.25
|
|
|
Service Code
|
HCPCS 73706
|
| Hospital Charge Code |
2680300
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$57.18 |
| Max. Negotiated Rate |
$3,916.00 |
| Rate for Payer: Aetna Commercial |
$566.79
|
| Rate for Payer: Aetna Medicare Advantage |
$675.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$755.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$755.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$208.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$308.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$755.90
|
| Rate for Payer: Cigna Commercial |
$417.70
|
| Rate for Payer: Cigna Medicare Advantage |
$145.87
|
| Rate for Payer: Clover Medicare Advantage |
$197.96
|
| Rate for Payer: EmblemHealth Commercial |
$625.14
|
| Rate for Payer: Humana Medicare Advantage |
$214.63
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$208.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$523.45
|
| Rate for Payer: Oxford Commercial |
$3,774.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$301.99
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,916.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$63.62
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$208.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$208.38
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$958.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$57.18
|
|
|
IR CTA LOWER EXTREMITY W/WO CO
|
Facility
|
OP
|
$2,013.25
|
|
|
Service Code
|
HCPCS 73706
|
| Hospital Charge Code |
7411671
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$57.18 |
| Max. Negotiated Rate |
$3,916.00 |
| Rate for Payer: Aetna Commercial |
$566.79
|
| Rate for Payer: Aetna Medicare Advantage |
$675.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$755.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$755.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$208.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$308.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$755.90
|
| Rate for Payer: Cigna Commercial |
$417.70
|
| Rate for Payer: Cigna Medicare Advantage |
$145.87
|
| Rate for Payer: Clover Medicare Advantage |
$197.96
|
| Rate for Payer: EmblemHealth Commercial |
$625.14
|
| Rate for Payer: Humana Medicare Advantage |
$214.63
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$208.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$523.45
|
| Rate for Payer: Oxford Commercial |
$3,774.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$301.99
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,916.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$63.62
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$208.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$208.38
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$958.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$57.18
|
|
|
IR CTA UPPER EXTRY W/WO CONTRA
|
Facility
|
OP
|
$2,013.25
|
|
|
Service Code
|
HCPCS 73206
|
| Hospital Charge Code |
2680280
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$57.18 |
| Max. Negotiated Rate |
$3,916.00 |
| Rate for Payer: Aetna Commercial |
$566.79
|
| Rate for Payer: Aetna Medicare Advantage |
$675.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$755.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$755.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$208.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$308.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$755.90
|
| Rate for Payer: Cigna Commercial |
$417.70
|
| Rate for Payer: Cigna Medicare Advantage |
$145.87
|
| Rate for Payer: Clover Medicare Advantage |
$197.96
|
| Rate for Payer: EmblemHealth Commercial |
$625.14
|
| Rate for Payer: Humana Medicare Advantage |
$214.63
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$208.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$523.45
|
| Rate for Payer: Oxford Commercial |
$3,774.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$301.99
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,916.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$63.62
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$208.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$208.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$57.18
|
|
|
IR CTA UPPER EXTRY W/WO CONTRA
|
Facility
|
IP
|
$2,013.25
|
|
|
Service Code
|
HCPCS 73206
|
| Hospital Charge Code |
7411667
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$301.99 |
| Max. Negotiated Rate |
$301.99 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$301.99
|
|
|
IR CTA UPPER EXTRY W/WO CONTRA
|
Facility
|
IP
|
$2,013.25
|
|
|
Service Code
|
HCPCS 73206
|
| Hospital Charge Code |
2680280
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$301.99 |
| Max. Negotiated Rate |
$301.99 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$301.99
|
|
|
IR CTA UPPER EXTRY W/WO CONTRA
|
Facility
|
OP
|
$2,013.25
|
|
|
Service Code
|
HCPCS 73206
|
| Hospital Charge Code |
7411667
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$57.18 |
| Max. Negotiated Rate |
$3,916.00 |
| Rate for Payer: Aetna Commercial |
$566.79
|
| Rate for Payer: Aetna Medicare Advantage |
$675.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$755.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$755.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$208.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$308.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$755.90
|
| Rate for Payer: Cigna Commercial |
$417.70
|
| Rate for Payer: Cigna Medicare Advantage |
$145.87
|
| Rate for Payer: Clover Medicare Advantage |
$197.96
|
| Rate for Payer: EmblemHealth Commercial |
$625.14
|
| Rate for Payer: Humana Medicare Advantage |
$214.63
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$208.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$523.45
|
| Rate for Payer: Oxford Commercial |
$3,774.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$301.99
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,916.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$63.62
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$208.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$208.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$57.18
|
|
|
IR-CTN INJ ABSCS/CYST VIA CATH
|
Facility
|
OP
|
$599.00
|
|
|
Service Code
|
HCPCS 49424
|
| Hospital Charge Code |
7411591
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$227.62
|
| Rate for Payer: Aetna Medicare Advantage |
$179.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$152.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$152.75
|
| 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 |
$152.75
|
| Rate for Payer: Cigna Commercial |
$299.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$155.74
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.93
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.01
|
|
|
IR-CTN INJ ABSCS/CYST VIA CATH
|
Facility
|
OP
|
$599.00
|
|
|
Service Code
|
HCPCS 49424
|
| Hospital Charge Code |
321049424
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$227.62
|
| Rate for Payer: Aetna Medicare Advantage |
$179.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$152.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$152.75
|
| 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 |
$152.75
|
| Rate for Payer: Cigna Commercial |
$299.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$155.74
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.93
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.01
|
|
|
IR-CTN INJ ABSCS/CYST VIA CATH
|
Facility
|
IP
|
$599.00
|
|
|
Service Code
|
HCPCS 49424
|
| Hospital Charge Code |
7411591
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.85 |
| Max. Negotiated Rate |
$89.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.85
|
|
|
IR-CTN INJ ABSCS/CYST VIA CATH
|
Facility
|
IP
|
$599.00
|
|
|
Service Code
|
HCPCS 49424
|
| Hospital Charge Code |
2670150
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.85 |
| Max. Negotiated Rate |
$89.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.85
|
|
|
IR-CTN INJ ABSCS/CYST VIA CATH
|
Facility
|
OP
|
$599.00
|
|
|
Service Code
|
HCPCS 49424
|
| Hospital Charge Code |
2670150
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$227.62
|
| Rate for Payer: Aetna Medicare Advantage |
$179.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$152.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$152.75
|
| 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 |
$152.75
|
| Rate for Payer: Cigna Commercial |
$299.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$155.74
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.93
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.01
|
|
|
IR-CTN INJ ABSCS/CYST VIA CATH
|
Facility
|
IP
|
$599.00
|
|
|
Service Code
|
HCPCS 49424
|
| Hospital Charge Code |
321049424
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.85 |
| Max. Negotiated Rate |
$89.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.85
|
|
|
IR CYST ASP BREAST
|
Facility
|
OP
|
$1,874.00
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
2680005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$53.22 |
| Max. Negotiated Rate |
$3,629.00 |
| Rate for Payer: Aetna Commercial |
$2,288.28
|
| Rate for Payer: Aetna Medicare Advantage |
$2,725.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,051.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,051.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$841.28
|
| 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 |
$3,051.74
|
| Rate for Payer: Cigna Commercial |
$1,686.34
|
| Rate for Payer: Cigna Medicare Advantage |
$841.28
|
| Rate for Payer: Clover Medicare Advantage |
$799.22
|
| Rate for Payer: EmblemHealth Commercial |
$2,523.84
|
| Rate for Payer: Humana Medicare Advantage |
$866.52
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$841.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$487.24
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$281.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$59.22
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$53.22
|
|
|
IR CYST ASP BREAST
|
Facility
|
OP
|
$1,874.00
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
7411337
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$53.22 |
| Max. Negotiated Rate |
$3,629.00 |
| Rate for Payer: Aetna Commercial |
$2,288.28
|
| Rate for Payer: Aetna Medicare Advantage |
$2,725.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,051.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,051.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$841.28
|
| 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 |
$3,051.74
|
| Rate for Payer: Cigna Commercial |
$1,686.34
|
| Rate for Payer: Cigna Medicare Advantage |
$841.28
|
| Rate for Payer: Clover Medicare Advantage |
$799.22
|
| Rate for Payer: EmblemHealth Commercial |
$2,523.84
|
| Rate for Payer: Humana Medicare Advantage |
$866.52
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$841.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$487.24
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$281.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$59.22
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$53.22
|
|
|
IR CYST ASP BREAST
|
Facility
|
IP
|
$1,874.00
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
2680005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$281.10 |
| Max. Negotiated Rate |
$281.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$281.10
|
|
|
IR CYST ASP BREAST
|
Facility
|
IP
|
$1,874.00
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
7411337
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$281.10 |
| Max. Negotiated Rate |
$281.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$281.10
|
|
|
IR CYSTOSTOMY TUBE CHANGE COMP
|
Facility
|
OP
|
$2,588.00
|
|
|
Service Code
|
HCPCS 51710
|
| Hospital Charge Code |
7411627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$3,629.00 |
| Rate for Payer: Aetna Commercial |
$2,253.28
|
| Rate for Payer: Aetna Medicare Advantage |
$2,684.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,005.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,005.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$828.41
|
| 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 |
$3,005.06
|
| Rate for Payer: Cigna Commercial |
$1,660.53
|
| Rate for Payer: Cigna Medicare Advantage |
$828.41
|
| Rate for Payer: Clover Medicare Advantage |
$786.99
|
| Rate for Payer: EmblemHealth Commercial |
$2,485.23
|
| Rate for Payer: Humana Medicare Advantage |
$853.26
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$828.41
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$672.88
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$388.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$81.78
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$828.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$828.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$73.50
|
|
|
IR CYSTOSTOMY TUBE CHANGE COMP
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
HCPCS 51710
|
| Hospital Charge Code |
7411627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$388.20 |
| Max. Negotiated Rate |
$388.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$388.20
|
|
|
IR CYSTOSTOMY TUBE CHANGE COMP
|
Facility
|
OP
|
$2,588.00
|
|
|
Service Code
|
HCPCS 51710
|
| Hospital Charge Code |
2670135
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$3,629.00 |
| Rate for Payer: Aetna Commercial |
$2,253.28
|
| Rate for Payer: Aetna Medicare Advantage |
$2,684.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,005.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,005.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$828.41
|
| 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 |
$3,005.06
|
| Rate for Payer: Cigna Commercial |
$1,660.53
|
| Rate for Payer: Cigna Medicare Advantage |
$828.41
|
| Rate for Payer: Clover Medicare Advantage |
$786.99
|
| Rate for Payer: EmblemHealth Commercial |
$2,485.23
|
| Rate for Payer: Humana Medicare Advantage |
$853.26
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$828.41
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$672.88
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$388.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$81.78
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$828.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$828.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$73.50
|
|
|
IR CYSTOSTOMY TUBE CHANGE COMP
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
HCPCS 51710
|
| Hospital Charge Code |
2670135
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$388.20 |
| Max. Negotiated Rate |
$388.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$388.20
|
|
|
IR CYSTOSTOMY TUBE CHANGE SIMP
|
Facility
|
OP
|
$833.00
|
|
|
Service Code
|
HCPCS 51705
|
| Hospital Charge Code |
7411626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$23.66 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$807.38
|
| Rate for Payer: Aetna Medicare Advantage |
$961.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,076.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,076.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$296.83
|
| 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 |
$1,076.75
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: Cigna Medicare Advantage |
$296.83
|
| Rate for Payer: Clover Medicare Advantage |
$281.99
|
| Rate for Payer: EmblemHealth Commercial |
$890.49
|
| Rate for Payer: Humana Medicare Advantage |
$305.73
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$296.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$216.58
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$124.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.32
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.66
|
|
