|
IR DISKOGRAPHY LUMBAR
|
Facility
|
OP
|
$9,928.00
|
|
|
Service Code
|
HCPCS 72295
|
| Hospital Charge Code |
411072295
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$8,415.40 |
| Rate for Payer: Aetna Commercial |
$6,310.10
|
| Rate for Payer: Aetna Medicare Advantage |
$7,516.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,415.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,415.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,319.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$82.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,415.40
|
| Rate for Payer: Cigna Commercial |
$4,650.22
|
| Rate for Payer: Cigna Medicare Advantage |
$1,623.92
|
| Rate for Payer: Clover Medicare Advantage |
$2,203.90
|
| Rate for Payer: EmblemHealth Commercial |
$6,959.67
|
| Rate for Payer: Humana Medicare Advantage |
$2,389.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,319.89
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,581.28
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,489.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$313.72
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,319.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,319.89
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$556.68
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$281.96
|
|
|
IR DISKOGRAPHY LUMBAR
|
Facility
|
IP
|
$9,928.00
|
|
|
Service Code
|
HCPCS 72295
|
| Hospital Charge Code |
321072295
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,489.20 |
| Max. Negotiated Rate |
$1,489.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,489.20
|
|
|
IR DISKOGRAPHY LUMBAR
|
Facility
|
OP
|
$9,928.00
|
|
|
Service Code
|
HCPCS 72295
|
| Hospital Charge Code |
321072295
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$8,415.40 |
| Rate for Payer: Aetna Commercial |
$6,310.10
|
| Rate for Payer: Aetna Medicare Advantage |
$7,516.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,415.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,415.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,319.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$82.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,415.40
|
| Rate for Payer: Cigna Commercial |
$4,650.22
|
| Rate for Payer: Cigna Medicare Advantage |
$1,623.92
|
| Rate for Payer: Clover Medicare Advantage |
$2,203.90
|
| Rate for Payer: EmblemHealth Commercial |
$6,959.67
|
| Rate for Payer: Humana Medicare Advantage |
$2,389.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,319.89
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,581.28
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,489.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$313.72
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,319.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,319.89
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$556.68
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$281.96
|
|
|
IR DISKOGRAPHY LUMBAR
|
Facility
|
OP
|
$9,928.00
|
|
|
Service Code
|
HCPCS 72295
|
| Hospital Charge Code |
2680260
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$8,415.40 |
| Rate for Payer: Aetna Commercial |
$6,310.10
|
| Rate for Payer: Aetna Medicare Advantage |
$7,516.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,415.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,415.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,319.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$82.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,415.40
|
| Rate for Payer: Cigna Commercial |
$4,650.22
|
| Rate for Payer: Cigna Medicare Advantage |
$1,623.92
|
| Rate for Payer: Clover Medicare Advantage |
$2,203.90
|
| Rate for Payer: EmblemHealth Commercial |
$6,959.67
|
| Rate for Payer: Humana Medicare Advantage |
$2,389.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,319.89
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,581.28
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,489.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$313.72
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,319.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,319.89
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$556.68
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$281.96
|
|
|
IR DISKOGRAPHY LUMBAR
|
Facility
|
OP
|
$9,928.00
|
|
|
Service Code
|
HCPCS 72295
|
| Hospital Charge Code |
366872295
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$8,415.40 |
| Rate for Payer: Aetna Commercial |
$6,310.10
|
| Rate for Payer: Aetna Medicare Advantage |
$7,516.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,415.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,415.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,319.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$82.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,415.40
|
| Rate for Payer: Cigna Commercial |
$4,650.22
|
| Rate for Payer: Cigna Medicare Advantage |
$1,623.92
|
| Rate for Payer: Clover Medicare Advantage |
$2,203.90
|
| Rate for Payer: EmblemHealth Commercial |
$6,959.67
|
| Rate for Payer: Humana Medicare Advantage |
$2,389.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,319.89
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,581.28
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,489.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$313.72
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,319.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,319.89
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$556.68
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$281.96
|
|
|
IR DISKOGRAPHY LUMBAR
|
Facility
|
IP
|
$9,928.00
|
|
|
Service Code
|
HCPCS 72295
|
| Hospital Charge Code |
2680260
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,489.20 |
| Max. Negotiated Rate |
$1,489.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,489.20
|
|
|
IR-DRAINAGE SUBDIAPH OR SUBPHR
|
Facility
|
IP
|
$6,420.00
|
|
|
Service Code
|
HCPCS 49406
|
| Hospital Charge Code |
7411586
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$963.00 |
| Max. Negotiated Rate |
$963.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$963.00
|
|
|
IR-DRAINAGE SUBDIAPH OR SUBPHR
|
Facility
|
IP
|
$8,054.80
|
|
|
Service Code
|
HCPCS 49406
|
| Hospital Charge Code |
2670205
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,208.22 |
| Max. Negotiated Rate |
$1,208.22 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,208.22
|
|
|
IR-DRAINAGE SUBDIAPH OR SUBPHR
|
Facility
|
OP
|
$6,420.00
|
|
|
Service Code
|
HCPCS 49406
|
| Hospital Charge Code |
7411586
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$182.33 |
| 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 |
$3,536.00
|
| 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 |
$1,669.20
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$963.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$202.87
|
| 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 |
$182.33
|
|
|
IR-DRAINAGE SUBDIAPH OR SUBPHR
|
Facility
|
OP
|
$8,054.80
|
|
|
Service Code
|
HCPCS 49406
|
| Hospital Charge Code |
2670205
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$228.76 |
| 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 |
$3,536.00
|
| 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 |
$2,094.25
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,208.22
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$254.53
|
| 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 |
$228.76
|
|
|
IR-DRAIN OF BREAST LES-LT
|
Facility
|
IP
|
$3,392.55
|
|
|
Service Code
|
HCPCS 19000LT
|
| Hospital Charge Code |
2690870
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$508.88 |
| Max. Negotiated Rate |
$508.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$508.88
|
|
|
IR-DRAIN OF BREAST LES-LT
|
Facility
|
OP
|
$3,392.55
|
|
|
Service Code
|
HCPCS 19000LT
|
| Hospital Charge Code |
2690870
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$96.35 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$1,289.17
|
| Rate for Payer: Aetna Medicare Advantage |
$1,017.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$865.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$865.10
|
| 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 |
$865.10
|
| Rate for Payer: Cigna Commercial |
$1,696.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$882.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$508.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$107.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$96.35
|
|
|
IR-DRAIN OF BREAST LES-LT
|
Facility
|
IP
|
$3,392.55
|
|
|
Service Code
|
HCPCS 19000LT
|
| Hospital Charge Code |
321019000L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$508.88 |
| Max. Negotiated Rate |
$508.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$508.88
|
|
|
IR-DRAIN OF BREAST LES-LT
|
Facility
|
OP
|
$3,392.55
|
|
|
Service Code
|
HCPCS 19000LT
|
| Hospital Charge Code |
321019000L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$96.35 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$1,289.17
|
| Rate for Payer: Aetna Medicare Advantage |
$1,017.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$865.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$865.10
|
| 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 |
$865.10
|
| Rate for Payer: Cigna Commercial |
$1,696.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$882.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$508.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$107.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$96.35
|
|
|
IR-DRAIN OF BREAST LES-RT
|
Facility
|
IP
|
$3,392.55
|
|
|
Service Code
|
HCPCS 19000RT
|
| Hospital Charge Code |
321019000R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$508.88 |
| Max. Negotiated Rate |
$508.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$508.88
|
|
|
IR-DRAIN OF BREAST LES-RT
|
Facility
|
OP
|
$3,392.55
|
|
|
Service Code
|
HCPCS 19000RT
|
| Hospital Charge Code |
321019000R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$96.35 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$1,289.17
|
| Rate for Payer: Aetna Medicare Advantage |
$1,017.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$865.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$865.10
|
| 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 |
$865.10
|
| Rate for Payer: Cigna Commercial |
$1,696.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$882.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$508.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$107.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$96.35
|
|
|
IR-DRAIN OF BREAST LES-RT
|
Facility
|
IP
|
$3,392.55
|
|
|
Service Code
|
HCPCS 19000RT
|
| Hospital Charge Code |
2690875
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$508.88 |
| Max. Negotiated Rate |
$508.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$508.88
|
|
|
IR-DRAIN OF BREAST LES-RT
|
Facility
|
OP
|
$3,392.55
|
|
|
Service Code
|
HCPCS 19000RT
|
| Hospital Charge Code |
2690875
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$96.35 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$1,289.17
|
| Rate for Payer: Aetna Medicare Advantage |
$1,017.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$865.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$865.10
|
| 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 |
$865.10
|
| Rate for Payer: Cigna Commercial |
$1,696.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$882.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$508.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$107.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$96.35
|
|
|
IR DRAIN PELV ABS,TRANSVAG/TRA
|
Facility
|
IP
|
$8,054.80
|
|
|
Service Code
|
HCPCS 49407
|
| Hospital Charge Code |
321049407
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,208.22 |
| Max. Negotiated Rate |
$1,208.22 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,208.22
|
|
|
IR DRAIN PELV ABS,TRANSVAG/TRA
|
Facility
|
OP
|
$8,054.80
|
|
|
Service Code
|
HCPCS 49407
|
| Hospital Charge Code |
321049407
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$228.76 |
| 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 |
$3,536.00
|
| 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 |
$2,094.25
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,208.22
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$254.53
|
| 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 |
$228.76
|
|
|
IR DRAIN PELV ABS,TRANSVAG/TRA
|
Facility
|
IP
|
$8,054.80
|
|
|
Service Code
|
HCPCS 49407
|
| Hospital Charge Code |
2680225
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,208.22 |
| Max. Negotiated Rate |
$1,208.22 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,208.22
|
|
|
IR DRAIN PELV ABS,TRANSVAG/TRA
|
Facility
|
IP
|
$8,455.00
|
|
|
Service Code
|
HCPCS 49407
|
| Hospital Charge Code |
7411587
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,268.25 |
| Max. Negotiated Rate |
$1,268.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,268.25
|
|
|
IR DRAIN PELV ABS,TRANSVAG/TRA
|
Facility
|
OP
|
$8,455.00
|
|
|
Service Code
|
HCPCS 49407
|
| Hospital Charge Code |
7411587
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$240.12 |
| 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 |
$3,536.00
|
| 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 |
$2,198.30
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,268.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$267.18
|
| 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 |
$240.12
|
|
|
IR DRAIN PELV ABS,TRANSVAG/TRA
|
Facility
|
OP
|
$8,054.80
|
|
|
Service Code
|
HCPCS 49407
|
| Hospital Charge Code |
2680225
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$228.76 |
| 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 |
$3,536.00
|
| 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 |
$2,094.25
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,208.22
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$254.53
|
| 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 |
$228.76
|
|
|
IR-DRAN CEREB SPINAL FLUD
|
Facility
|
OP
|
$3,506.55
|
|
|
Service Code
|
HCPCS 62272
|
| Hospital Charge Code |
2690235
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$99.59 |
| Max. Negotiated Rate |
$3,629.00 |
| Rate for Payer: Aetna Commercial |
$2,281.02
|
| Rate for Payer: Aetna Medicare Advantage |
$2,717.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,042.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,042.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$838.61
|
| 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 |
$3,042.06
|
| Rate for Payer: Cigna Commercial |
$1,680.99
|
| Rate for Payer: Cigna Medicare Advantage |
$838.61
|
| Rate for Payer: Clover Medicare Advantage |
$796.68
|
| Rate for Payer: EmblemHealth Commercial |
$2,515.83
|
| Rate for Payer: Humana Medicare Advantage |
$863.77
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$838.61
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$911.70
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$525.98
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$110.81
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$838.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$838.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$99.59
|
|
