|
IR PLACE GASTROSTOMY TUBE PERC
|
Facility
|
OP
|
$6,674.15
|
|
|
Service Code
|
HCPCS 49440
|
| Hospital Charge Code |
7411593
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$189.55 |
| Max. Negotiated Rate |
$8,269.65 |
| Rate for Payer: Aetna Commercial |
$6,200.81
|
| Rate for Payer: Aetna Medicare Advantage |
$7,386.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,269.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,269.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,279.71
|
| 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 |
$8,269.65
|
| Rate for Payer: Cigna Commercial |
$4,569.67
|
| Rate for Payer: Cigna Medicare Advantage |
$2,279.71
|
| Rate for Payer: Clover Medicare Advantage |
$2,165.72
|
| Rate for Payer: EmblemHealth Commercial |
$6,839.13
|
| Rate for Payer: Humana Medicare Advantage |
$2,348.10
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,279.71
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,735.28
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,001.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$210.90
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,279.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,279.71
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$189.55
|
|
|
IR PLACE GASTROSTOMY TUBE PERC
|
Facility
|
OP
|
$8,686.35
|
|
|
Service Code
|
HCPCS 49440
|
| Hospital Charge Code |
5600159
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$246.69 |
| Max. Negotiated Rate |
$8,269.65 |
| Rate for Payer: Aetna Commercial |
$6,200.81
|
| Rate for Payer: Aetna Medicare Advantage |
$7,386.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,269.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,269.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,279.71
|
| 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 |
$8,269.65
|
| Rate for Payer: Cigna Commercial |
$4,569.67
|
| Rate for Payer: Cigna Medicare Advantage |
$2,279.71
|
| Rate for Payer: Clover Medicare Advantage |
$2,165.72
|
| Rate for Payer: EmblemHealth Commercial |
$6,839.13
|
| Rate for Payer: Humana Medicare Advantage |
$2,348.10
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,279.71
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,258.45
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,302.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$274.49
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,279.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,279.71
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$246.69
|
|
|
IR PLACE GASTROSTOMY TUBE PERC
|
Facility
|
IP
|
$8,686.35
|
|
|
Service Code
|
HCPCS 49440
|
| Hospital Charge Code |
321049440
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,302.95 |
| Max. Negotiated Rate |
$1,302.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,302.95
|
|
|
IR PLACE GASTROSTOMY TUBE PERC
|
Facility
|
OP
|
$8,686.35
|
|
|
Service Code
|
HCPCS 49440
|
| Hospital Charge Code |
321049440
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$246.69 |
| Max. Negotiated Rate |
$8,269.65 |
| Rate for Payer: Aetna Commercial |
$6,200.81
|
| Rate for Payer: Aetna Medicare Advantage |
$7,386.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,269.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,269.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,279.71
|
| 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 |
$8,269.65
|
| Rate for Payer: Cigna Commercial |
$4,569.67
|
| Rate for Payer: Cigna Medicare Advantage |
$2,279.71
|
| Rate for Payer: Clover Medicare Advantage |
$2,165.72
|
| Rate for Payer: EmblemHealth Commercial |
$6,839.13
|
| Rate for Payer: Humana Medicare Advantage |
$2,348.10
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,279.71
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,258.45
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,302.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$274.49
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,279.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,279.71
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$246.69
|
|
|
IR-PLACEMENT OF MARKER
|
Facility
|
OP
|
$1,023.00
|
|
| Hospital Charge Code |
2680020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$29.05 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$388.74
|
| Rate for Payer: Aetna Medicare Advantage |
$306.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$260.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$260.87
|
| 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 |
$260.87
|
| Rate for Payer: Cigna Commercial |
$511.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$265.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.45
|
| Rate for Payer: UnitedHealthcare Community & State |
$32.33
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.05
|
|
|
IR-PLACEMENT OF MARKER
|
Facility
|
IP
|
$1,023.00
|
|
| Hospital Charge Code |
2680020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$153.45 |
| Max. Negotiated Rate |
$153.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.45
|
|
|
IR PLACEMNT CENTRL VENOUS CATH
|
Facility
|
OP
|
$12,584.00
|
|
|
Service Code
|
HCPCS 36561
|
| Hospital Charge Code |
7411454
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$357.39 |
| Max. Negotiated Rate |
$13,607.37 |
| Rate for Payer: Aetna Commercial |
$10,203.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12,153.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,751.17
|
| 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 |
$13,607.37
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$3,751.17
|
| Rate for Payer: Clover Medicare Advantage |
$3,563.61
|
| Rate for Payer: EmblemHealth Commercial |
$11,253.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,863.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,751.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,271.84
|
| Rate for Payer: Oxford Commercial |
$9,354.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,887.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,269.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$397.65
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$357.39
|
|
|
IR PLACEMNT CENTRL VENOUS CATH
|
Facility
|
IP
|
$12,584.00
|
|
|
Service Code
|
HCPCS 36561
|
| Hospital Charge Code |
7411454
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,887.60 |
| Max. Negotiated Rate |
$1,887.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,887.60
|
|
|
IR PLACEMNT CENTRL VENOUS CATH
|
Facility
|
IP
|
$8,696.85
|
|
|
Service Code
|
HCPCS 36561
|
| Hospital Charge Code |
366836561
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,304.53 |
| Max. Negotiated Rate |
$1,304.53 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,304.53
|
|
|
IR PLACEMNT CENTRL VENOUS CATH
|
Facility
|
OP
|
$8,696.85
|
|
|
Service Code
|
HCPCS 36561
|
| Hospital Charge Code |
366836561
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$246.99 |
| Max. Negotiated Rate |
$13,607.37 |
| Rate for Payer: Aetna Commercial |
$10,203.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12,153.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,751.17
|
| 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 |
$13,607.37
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$3,751.17
|
| Rate for Payer: Clover Medicare Advantage |
$3,563.61
|
| Rate for Payer: EmblemHealth Commercial |
$11,253.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,863.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,751.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,261.18
|
| Rate for Payer: Oxford Commercial |
$9,354.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,304.53
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,269.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$274.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$246.99
|
|
|
IR PLACEMNT CENTRL VENOUS CATH
|
Facility
|
IP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 36561
|
| Hospital Charge Code |
2011168
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,320.28 |
| Max. Negotiated Rate |
$2,320.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,320.28
|
|
|
IR PLACEMNT CENTRL VENOUS CATH
|
Facility
|
OP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 36561
|
| Hospital Charge Code |
2011168
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$439.31 |
| Max. Negotiated Rate |
$13,607.37 |
| Rate for Payer: Aetna Commercial |
$10,203.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12,153.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,751.17
|
| 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 |
$13,607.37
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$3,751.17
|
| Rate for Payer: Clover Medicare Advantage |
$3,563.61
|
| Rate for Payer: EmblemHealth Commercial |
$11,253.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,863.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,751.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,021.81
|
| Rate for Payer: Oxford Commercial |
$9,354.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,320.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,269.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$488.80
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$439.31
|
|
|
IR=PL CATH ART 1ST A/P-BI
|
Facility
|
OP
|
$364.00
|
|
|
Service Code
|
HCPCS 3624550
|
| Hospital Charge Code |
411036245
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$138.32
|
| Rate for Payer: Aetna Medicare Advantage |
$109.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$92.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$92.82
|
| 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 |
$92.82
|
| Rate for Payer: Cigna Commercial |
$182.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$94.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
IR=PL CATH ART 1ST A/P-BI
|
Facility
|
IP
|
$364.00
|
|
|
Service Code
|
HCPCS 3624550
|
| Hospital Charge Code |
411036245
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$54.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.60
|
|
|
IR=PL CATH ART 1ST A/P-BI
|
Facility
|
OP
|
$364.00
|
|
|
Service Code
|
HCPCS 3624550
|
| Hospital Charge Code |
3668362455
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$138.32
|
| Rate for Payer: Aetna Medicare Advantage |
$109.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$92.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$92.82
|
| 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 |
$92.82
|
| Rate for Payer: Cigna Commercial |
$182.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$94.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
IR=PL CATH ART 1ST A/P-BI
|
Facility
|
IP
|
$364.00
|
|
|
Service Code
|
HCPCS 3624550
|
| Hospital Charge Code |
3668362455
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$54.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.60
|
|
|
IR=PL CATH ART 1ST A/P-BI
|
Facility
|
IP
|
$364.00
|
|
|
Service Code
|
HCPCS 3624550
|
| Hospital Charge Code |
2690475
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$54.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.60
|
|
|
IR=PL CATH ART 1ST A/P-BI
|
Facility
|
OP
|
$364.00
|
|
|
Service Code
|
HCPCS 3624550
|
| Hospital Charge Code |
2690475
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$138.32
|
| Rate for Payer: Aetna Medicare Advantage |
$109.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$92.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$92.82
|
| 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 |
$92.82
|
| Rate for Payer: Cigna Commercial |
$182.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$94.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
IR=PL CATH ART 1ST A/P-BI
|
Facility
|
OP
|
$364.00
|
|
|
Service Code
|
HCPCS 3624550
|
| Hospital Charge Code |
321036245B
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$138.32
|
| Rate for Payer: Aetna Medicare Advantage |
$109.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$92.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$92.82
|
| 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 |
$92.82
|
| Rate for Payer: Cigna Commercial |
$182.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$94.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
IR=PL CATH ART 1ST A/P-BI
|
Facility
|
IP
|
$364.00
|
|
|
Service Code
|
HCPCS 3624550
|
| Hospital Charge Code |
321036245B
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$54.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.60
|
|
|
IR-PL CATH ART 1ST A/P-LT
|
Facility
|
IP
|
$364.00
|
|
|
Service Code
|
HCPCS 36245LT
|
| Hospital Charge Code |
2691260
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$54.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.60
|
|
|
IR-PL CATH ART 1ST A/P-LT
|
Facility
|
IP
|
$364.00
|
|
|
Service Code
|
HCPCS 36245LT
|
| Hospital Charge Code |
321036245L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$54.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.60
|
|
|
IR-PL CATH ART 1ST A/P-LT
|
Facility
|
OP
|
$364.00
|
|
|
Service Code
|
HCPCS 36245LT
|
| Hospital Charge Code |
321036245L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$138.32
|
| Rate for Payer: Aetna Medicare Advantage |
$109.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$92.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$92.82
|
| 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 |
$92.82
|
| Rate for Payer: Cigna Commercial |
$182.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$94.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
IR-PL CATH ART 1ST A/P-LT
|
Facility
|
OP
|
$364.00
|
|
|
Service Code
|
HCPCS 36245LT
|
| Hospital Charge Code |
2691260
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$138.32
|
| Rate for Payer: Aetna Medicare Advantage |
$109.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$92.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$92.82
|
| 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 |
$92.82
|
| Rate for Payer: Cigna Commercial |
$182.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$94.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
IR-PL CATH ART 1ST A/P-RT
|
Facility
|
IP
|
$364.00
|
|
|
Service Code
|
HCPCS 36245RT
|
| Hospital Charge Code |
2691265
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$54.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.60
|
|
