|
IR I&D ABSCESS DEEP LEG OR ANK
|
Facility
|
OP
|
$8,259.00
|
|
|
Service Code
|
HCPCS 27603
|
| Hospital Charge Code |
2680100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$234.56 |
| 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 |
$2,147.34
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,238.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$260.98
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$234.56
|
|
|
IR I&D ABSCESS DEEP LEG OR ANK
|
Facility
|
IP
|
$8,259.00
|
|
|
Service Code
|
HCPCS 27603
|
| Hospital Charge Code |
7411371
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,238.85 |
| Max. Negotiated Rate |
$1,238.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,238.85
|
|
|
IR I&D ABSCESS DEEP LEG OR ANK
|
Facility
|
IP
|
$8,259.00
|
|
|
Service Code
|
HCPCS 27603
|
| Hospital Charge Code |
2680100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,238.85 |
| Max. Negotiated Rate |
$1,238.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,238.85
|
|
|
IR I&D DEEP ABSCESS NECK/THORA
|
Facility
|
OP
|
$8,259.00
|
|
|
Service Code
|
HCPCS 20501
|
| Hospital Charge Code |
7411350
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$234.56 |
| Max. Negotiated Rate |
$4,129.50 |
| Rate for Payer: Aetna Commercial |
$3,138.42
|
| Rate for Payer: Aetna Medicare Advantage |
$2,477.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,106.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,106.05
|
| 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 |
$2,106.05
|
| Rate for Payer: Cigna Commercial |
$4,129.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,147.34
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,238.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$260.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$234.56
|
|
|
IR I&D DEEP ABSCESS NECK/THORA
|
Facility
|
OP
|
$8,259.00
|
|
|
Service Code
|
HCPCS 21501
|
| Hospital Charge Code |
2680045
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$234.56 |
| 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 |
$2,147.34
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,238.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$260.98
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$234.56
|
|
|
IR I&D DEEP ABSCESS NECK/THORA
|
Facility
|
IP
|
$8,259.00
|
|
|
Service Code
|
HCPCS 21501
|
| Hospital Charge Code |
2680045
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,238.85 |
| Max. Negotiated Rate |
$1,238.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,238.85
|
|
|
IR I&D DEEP ABSCESS NECK/THORA
|
Facility
|
IP
|
$8,259.00
|
|
|
Service Code
|
HCPCS 20501
|
| Hospital Charge Code |
7411350
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,238.85 |
| Max. Negotiated Rate |
$1,238.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,238.85
|
|
|
IR I&D DEEP ABSCESS UP ARM/ELB
|
Facility
|
OP
|
$8,259.00
|
|
|
Service Code
|
HCPCS 23930
|
| Hospital Charge Code |
7411361
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$234.56 |
| 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 |
$2,147.34
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,238.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$260.98
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$234.56
|
|
|
IR I&D DEEP ABSCESS UP ARM/ELB
|
Facility
|
IP
|
$8,259.00
|
|
|
Service Code
|
HCPCS 23930
|
| Hospital Charge Code |
7411361
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,238.85 |
| Max. Negotiated Rate |
$1,238.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,238.85
|
|
|
IR I&D DEEP ABSCESS UP ARM/ELB
|
Facility
|
OP
|
$8,259.00
|
|
|
Service Code
|
HCPCS 23930
|
| Hospital Charge Code |
2680060
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$234.56 |
| 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 |
$2,147.34
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,238.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$260.98
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$234.56
|
|
|
IR I&D DEEP ABSCESS UP ARM/ELB
|
Facility
|
IP
|
$8,259.00
|
|
|
Service Code
|
HCPCS 23930
|
| Hospital Charge Code |
2680060
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,238.85 |
| Max. Negotiated Rate |
$1,238.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,238.85
|
|
|
IR I&D DEEP THIGH OR KNEE
|
Facility
|
IP
|
$8,259.00
|
|
|
Service Code
|
HCPCS 27301
|
| Hospital Charge Code |
2680090
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,238.85 |
| Max. Negotiated Rate |
$1,238.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,238.85
|
|
|
IR I&D DEEP THIGH OR KNEE
|
Facility
|
OP
|
$8,259.00
|
|
|
Service Code
|
HCPCS 27301
|
| Hospital Charge Code |
7411369
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$234.56 |
| 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 |
$2,147.34
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,238.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$260.98
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$234.56
|
|
|
IR I&D DEEP THIGH OR KNEE
|
Facility
|
IP
|
$8,259.00
|
|
|
Service Code
|
HCPCS 27301
|
| Hospital Charge Code |
7411369
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,238.85 |
| Max. Negotiated Rate |
$1,238.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,238.85
|
|
|
IR I&D DEEP THIGH OR KNEE
|
Facility
|
OP
|
$8,259.00
|
|
|
Service Code
|
HCPCS 27301
|
| Hospital Charge Code |
2680090
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$234.56 |
| 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 |
$2,147.34
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,238.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$260.98
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$234.56
|
|
|
IR I&D HEMATOMA, SEROMA OR FLU
|
Facility
|
IP
|
$5,321.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
7411335
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$798.15 |
| Max. Negotiated Rate |
$798.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$798.15
|
|
|
IR I&D HEMATOMA, SEROMA OR FLU
|
Facility
|
IP
|
$8,036.95
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
2680001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,205.54 |
| Max. Negotiated Rate |
$1,205.54 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,205.54
|
|
|
IR I&D HEMATOMA, SEROMA OR FLU
|
Facility
|
IP
|
$8,036.95
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
403410140
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,205.54 |
| Max. Negotiated Rate |
$1,205.54 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,205.54
|
|
|
IR I&D HEMATOMA, SEROMA OR FLU
|
Facility
|
OP
|
$5,321.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
7411335
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$151.12 |
| 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 |
$1,383.46
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$798.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$168.14
|
| 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 |
$151.12
|
|
|
IR I&D HEMATOMA, SEROMA OR FLU
|
Facility
|
OP
|
$8,036.95
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
403410140
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$228.25 |
| 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 |
$4,213.00
|
| 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 |
$2,089.61
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,205.54
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$253.97
|
| 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 |
$228.25
|
|
|
IR I&D HEMATOMA, SEROMA OR FLU
|
Facility
|
OP
|
$8,036.95
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
2680001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$228.25 |
| 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 |
$2,089.61
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,205.54
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$253.97
|
| 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 |
$228.25
|
|
|
IR ILIAC ANEURISM ENDOVAS RPR
|
Facility
|
OP
|
$4,000.00
|
|
|
Service Code
|
HCPCS 75954
|
| Hospital Charge Code |
2011300
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.60 |
| Max. Negotiated Rate |
$2,231.00 |
| Rate for Payer: Aetna Commercial |
$1,520.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,020.00
|
| Rate for Payer: Cigna Commercial |
$2,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,040.00
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$600.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$126.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$113.60
|
|
|
IR ILIAC ANEURISM ENDOVAS RPR
|
Facility
|
IP
|
$4,000.00
|
|
|
Service Code
|
HCPCS 75954
|
| Hospital Charge Code |
2011300
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$600.00
|
|
|
IR ILIAC ANEURISM ENDOVAS RPR
|
Facility
|
OP
|
$9,489.90
|
|
|
Service Code
|
HCPCS 75954
|
| Hospital Charge Code |
7411734
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$269.51 |
| Max. Negotiated Rate |
$4,744.95 |
| Rate for Payer: Aetna Commercial |
$3,606.16
|
| Rate for Payer: Aetna Medicare Advantage |
$2,846.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,419.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,419.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,419.92
|
| Rate for Payer: Cigna Commercial |
$4,744.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,467.37
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,423.48
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$299.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$269.51
|
|
|
IR ILIAC ANEURISM ENDOVAS RPR
|
Facility
|
IP
|
$9,489.90
|
|
|
Service Code
|
HCPCS 75954
|
| Hospital Charge Code |
7411734
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,423.48 |
| Max. Negotiated Rate |
$1,423.48 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,423.48
|
|
