|
IR CYSTOSTOMY TUBE CHANGE SIMP
|
Facility
|
IP
|
$833.00
|
|
|
Service Code
|
HCPCS 51705
|
| Hospital Charge Code |
7411626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.95 |
| Max. Negotiated Rate |
$124.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$124.95
|
|
|
IR CYSTOSTOMY TUBE CHANGE SIMP
|
Facility
|
OP
|
$1,355.15
|
|
|
Service Code
|
HCPCS 51705
|
| Hospital Charge Code |
2670140
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$38.49 |
| 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 |
$352.34
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.27
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.49
|
|
|
IR CYSTOSTOMY TUBE CHANGE SIMP
|
Facility
|
IP
|
$1,355.15
|
|
|
Service Code
|
HCPCS 51705
|
| Hospital Charge Code |
2670140
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$203.27 |
| Max. Negotiated Rate |
$203.27 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.27
|
|
|
IR CYSTOSTOMY TUBE CHANGE SIMP
|
Facility
|
OP
|
$1,355.15
|
|
|
Service Code
|
HCPCS 51705
|
| Hospital Charge Code |
321051705
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$38.49 |
| 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 |
$352.34
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.27
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.49
|
|
|
IR CYSTOSTOMY TUBE CHANGE SIMP
|
Facility
|
IP
|
$1,355.15
|
|
|
Service Code
|
HCPCS 51705
|
| Hospital Charge Code |
321051705
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$203.27 |
| Max. Negotiated Rate |
$203.27 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.27
|
|
|
IR & D DEEP FOREARM OR WRIST
|
Facility
|
IP
|
$9,394.00
|
|
|
Service Code
|
HCPCS 25028
|
| Hospital Charge Code |
7411363
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,409.10 |
| Max. Negotiated Rate |
$1,409.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,409.10
|
|
|
IR & D DEEP FOREARM OR WRIST
|
Facility
|
OP
|
$9,394.00
|
|
|
Service Code
|
HCPCS 25028
|
| Hospital Charge Code |
7411363
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$266.79 |
| Max. Negotiated Rate |
$14,100.89 |
| Rate for Payer: Aetna Commercial |
$10,573.24
|
| Rate for Payer: Aetna Medicare Advantage |
$12,594.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14,100.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14,100.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,887.22
|
| 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 |
$14,100.89
|
| Rate for Payer: Cigna Commercial |
$7,791.93
|
| Rate for Payer: Cigna Medicare Advantage |
$3,887.22
|
| Rate for Payer: Clover Medicare Advantage |
$3,692.86
|
| Rate for Payer: EmblemHealth Commercial |
$11,661.66
|
| Rate for Payer: Humana Medicare Advantage |
$4,003.84
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,887.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,442.44
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,409.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$296.85
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,887.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,887.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$266.79
|
|
|
IR & D DEEP FOREARM OR WRIST
|
Facility
|
IP
|
$9,394.00
|
|
|
Service Code
|
HCPCS 25028
|
| Hospital Charge Code |
2680070
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,409.10 |
| Max. Negotiated Rate |
$1,409.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,409.10
|
|
|
IR & D DEEP FOREARM OR WRIST
|
Facility
|
OP
|
$9,394.00
|
|
|
Service Code
|
HCPCS 25028
|
| Hospital Charge Code |
2680070
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$266.79 |
| Max. Negotiated Rate |
$14,100.89 |
| Rate for Payer: Aetna Commercial |
$10,573.24
|
| Rate for Payer: Aetna Medicare Advantage |
$12,594.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14,100.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14,100.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,887.22
|
| 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 |
$14,100.89
|
| Rate for Payer: Cigna Commercial |
$7,791.93
|
| Rate for Payer: Cigna Medicare Advantage |
$3,887.22
|
| Rate for Payer: Clover Medicare Advantage |
$3,692.86
|
| Rate for Payer: EmblemHealth Commercial |
$11,661.66
|
| Rate for Payer: Humana Medicare Advantage |
$4,003.84
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,887.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,442.44
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,409.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$296.85
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,887.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,887.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$266.79
|
|
|
IR DILATE BILIARY DUCT/AMPULLA
|
Facility
|
IP
|
$732.00
|
|
|
Service Code
|
HCPCS 47542
|
| Hospital Charge Code |
321047542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$109.80 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$109.80
|
|
|
IR DILATE BILIARY DUCT/AMPULLA
|
Facility
|
OP
|
$732.00
|
|
|
Service Code
|
HCPCS 47542
|
| Hospital Charge Code |
7411570
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$20.79 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$278.16
|
| Rate for Payer: Aetna Medicare Advantage |
$219.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$186.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$186.66
|
| 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 |
$186.66
|
| Rate for Payer: Cigna Commercial |
$366.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$190.32
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$109.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.13
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20.79
|
|
|
IR DILATE BILIARY DUCT/AMPULLA
|
Facility
|
OP
|
$732.00
|
|
|
Service Code
|
HCPCS 47542
|
| Hospital Charge Code |
2692121
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$20.79 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$278.16
|
| Rate for Payer: Aetna Medicare Advantage |
$219.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$186.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$186.66
|
| 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 |
$186.66
|
| Rate for Payer: Cigna Commercial |
$366.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$190.32
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$109.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.13
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20.79
|
|
|
IR DILATE BILIARY DUCT/AMPULLA
|
Facility
|
IP
|
$732.00
|
|
|
Service Code
|
HCPCS 47542
|
| Hospital Charge Code |
7411570
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$109.80 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$109.80
|
|
|
IR DILATE BILIARY DUCT/AMPULLA
|
Facility
|
IP
|
$732.00
|
|
|
Service Code
|
HCPCS 47542
|
| Hospital Charge Code |
2692121
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$109.80 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$109.80
|
|
|
IR DILATE BILIARY DUCT/AMPULLA
|
Facility
|
OP
|
$732.00
|
|
|
Service Code
|
HCPCS 47542
|
| Hospital Charge Code |
321047542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$20.79 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$278.16
|
| Rate for Payer: Aetna Medicare Advantage |
$219.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$186.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$186.66
|
| 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 |
$186.66
|
| Rate for Payer: Cigna Commercial |
$366.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$190.32
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$109.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.13
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20.79
|
|
|
IR DIL BILIARY DUCT W/ STENT
|
Facility
|
OP
|
$12,976.00
|
|
|
Service Code
|
HCPCS 47556
|
| Hospital Charge Code |
7411573
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$368.52 |
| Max. Negotiated Rate |
$45,809.96 |
| Rate for Payer: Aetna Commercial |
$34,349.57
|
| Rate for Payer: Aetna Medicare Advantage |
$40,916.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$45,809.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$45,809.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12,628.52
|
| 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 |
$45,809.96
|
| Rate for Payer: Cigna Commercial |
$25,313.84
|
| Rate for Payer: Cigna Medicare Advantage |
$12,628.52
|
| Rate for Payer: Clover Medicare Advantage |
$11,997.09
|
| Rate for Payer: EmblemHealth Commercial |
$37,885.56
|
| Rate for Payer: Humana Medicare Advantage |
$13,007.38
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12,628.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,373.76
|
| Rate for Payer: Oxford Commercial |
$13,407.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,946.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,869.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$410.04
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12,628.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$12,628.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$368.52
|
|
|
IR DIL BILIARY DUCT W/ STENT
|
Facility
|
IP
|
$24,264.20
|
|
|
Service Code
|
HCPCS 47556
|
| Hospital Charge Code |
366847556
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,639.63 |
| Max. Negotiated Rate |
$3,639.63 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,639.63
|
|
|
IR DIL BILIARY DUCT W/ STENT
|
Facility
|
IP
|
$26,912.85
|
|
|
Service Code
|
HCPCS 47556
|
| Hospital Charge Code |
2000940
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,036.93 |
| Max. Negotiated Rate |
$4,036.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,036.93
|
|
|
IR DIL BILIARY DUCT W/ STENT
|
Facility
|
OP
|
$24,264.20
|
|
|
Service Code
|
HCPCS 47556
|
| Hospital Charge Code |
366847556
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$689.10 |
| Max. Negotiated Rate |
$45,809.96 |
| Rate for Payer: Aetna Commercial |
$34,349.57
|
| Rate for Payer: Aetna Medicare Advantage |
$40,916.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$45,809.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$45,809.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12,628.52
|
| 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 |
$45,809.96
|
| Rate for Payer: Cigna Commercial |
$25,313.84
|
| Rate for Payer: Cigna Medicare Advantage |
$12,628.52
|
| Rate for Payer: Clover Medicare Advantage |
$11,997.09
|
| Rate for Payer: EmblemHealth Commercial |
$37,885.56
|
| Rate for Payer: Humana Medicare Advantage |
$13,007.38
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12,628.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,308.69
|
| Rate for Payer: Oxford Commercial |
$13,407.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,639.63
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,869.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$766.75
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12,628.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$12,628.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$689.10
|
|
|
IR DIL BILIARY DUCT W/ STENT
|
Facility
|
OP
|
$26,912.85
|
|
|
Service Code
|
HCPCS 47556
|
| Hospital Charge Code |
2000940
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$764.32 |
| Max. Negotiated Rate |
$45,809.96 |
| Rate for Payer: Aetna Commercial |
$34,349.57
|
| Rate for Payer: Aetna Medicare Advantage |
$40,916.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$45,809.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$45,809.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12,628.52
|
| 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 |
$45,809.96
|
| Rate for Payer: Cigna Commercial |
$25,313.84
|
| Rate for Payer: Cigna Medicare Advantage |
$12,628.52
|
| Rate for Payer: Clover Medicare Advantage |
$11,997.09
|
| Rate for Payer: EmblemHealth Commercial |
$37,885.56
|
| Rate for Payer: Humana Medicare Advantage |
$13,007.38
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12,628.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,997.34
|
| Rate for Payer: Oxford Commercial |
$13,407.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,036.93
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,869.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$850.45
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12,628.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$12,628.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$764.32
|
|
|
IR DIL BILIARY DUCT W/ STENT
|
Facility
|
OP
|
$26,912.85
|
|
|
Service Code
|
HCPCS 47556
|
| Hospital Charge Code |
321047556
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$764.32 |
| Max. Negotiated Rate |
$45,809.96 |
| Rate for Payer: Aetna Commercial |
$34,349.57
|
| Rate for Payer: Aetna Medicare Advantage |
$40,916.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$45,809.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$45,809.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12,628.52
|
| 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 |
$45,809.96
|
| Rate for Payer: Cigna Commercial |
$25,313.84
|
| Rate for Payer: Cigna Medicare Advantage |
$12,628.52
|
| Rate for Payer: Clover Medicare Advantage |
$11,997.09
|
| Rate for Payer: EmblemHealth Commercial |
$37,885.56
|
| Rate for Payer: Humana Medicare Advantage |
$13,007.38
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12,628.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,997.34
|
| Rate for Payer: Oxford Commercial |
$13,407.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,036.93
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,869.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$850.45
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12,628.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$12,628.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$764.32
|
|
|
IR DIL BILIARY DUCT W/ STENT
|
Facility
|
OP
|
$24,264.20
|
|
|
Service Code
|
HCPCS 47556
|
| Hospital Charge Code |
411047556
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$689.10 |
| Max. Negotiated Rate |
$45,809.96 |
| Rate for Payer: Aetna Commercial |
$34,349.57
|
| Rate for Payer: Aetna Medicare Advantage |
$40,916.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$45,809.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$45,809.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12,628.52
|
| 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 |
$45,809.96
|
| Rate for Payer: Cigna Commercial |
$25,313.84
|
| Rate for Payer: Cigna Medicare Advantage |
$12,628.52
|
| Rate for Payer: Clover Medicare Advantage |
$11,997.09
|
| Rate for Payer: EmblemHealth Commercial |
$37,885.56
|
| Rate for Payer: Humana Medicare Advantage |
$13,007.38
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12,628.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,308.69
|
| Rate for Payer: Oxford Commercial |
$13,407.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,639.63
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,869.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$766.75
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12,628.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$12,628.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$689.10
|
|
|
IR DIL BILIARY DUCT W/ STENT
|
Facility
|
IP
|
$24,264.20
|
|
|
Service Code
|
HCPCS 47556
|
| Hospital Charge Code |
411047556
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,639.63 |
| Max. Negotiated Rate |
$3,639.63 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,639.63
|
|
|
IR DIL BILIARY DUCT W/ STENT
|
Facility
|
IP
|
$26,912.85
|
|
|
Service Code
|
HCPCS 47556
|
| Hospital Charge Code |
321047556
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,036.93 |
| Max. Negotiated Rate |
$4,036.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,036.93
|
|
|
IR DIL BILIARY DUCT W/ STENT
|
Facility
|
IP
|
$12,976.00
|
|
|
Service Code
|
HCPCS 47556
|
| Hospital Charge Code |
7411573
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,946.40 |
| Max. Negotiated Rate |
$1,946.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,946.40
|
|
