|
IR-REM OBS G/G-J/COLO TUB
|
Facility
|
IP
|
$4,459.55
|
|
|
Service Code
|
HCPCS 49460
|
| Hospital Charge Code |
321049460
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$668.93 |
| Max. Negotiated Rate |
$668.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$668.93
|
|
|
IR-REM OBS G/G-J/COLO TUB
|
Facility
|
IP
|
$4,459.55
|
|
|
Service Code
|
HCPCS 49460
|
| Hospital Charge Code |
2690175
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$668.93 |
| Max. Negotiated Rate |
$668.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$668.93
|
|
|
IR-REM OBS G/G-J/COLO TUB
|
Facility
|
OP
|
$4,459.55
|
|
|
Service Code
|
HCPCS 49460
|
| Hospital Charge Code |
321049460
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$126.65 |
| Max. Negotiated Rate |
$5,347.00 |
| Rate for Payer: Aetna Commercial |
$2,930.85
|
| Rate for Payer: Aetna Medicare Advantage |
$3,491.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,908.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,908.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,077.52
|
| 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 |
$3,908.70
|
| Rate for Payer: Cigna Commercial |
$2,159.89
|
| Rate for Payer: Cigna Medicare Advantage |
$1,077.52
|
| Rate for Payer: Clover Medicare Advantage |
$1,023.64
|
| Rate for Payer: EmblemHealth Commercial |
$3,232.56
|
| Rate for Payer: Humana Medicare Advantage |
$1,109.85
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,077.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,159.48
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$668.93
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.92
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,077.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,077.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$126.65
|
|
|
IR-REM OBS G/G-J/COLO TUB
|
Facility
|
OP
|
$3,717.20
|
|
|
Service Code
|
HCPCS 49460
|
| Hospital Charge Code |
366849460
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$105.57 |
| Max. Negotiated Rate |
$5,347.00 |
| Rate for Payer: Aetna Commercial |
$2,930.85
|
| Rate for Payer: Aetna Medicare Advantage |
$3,491.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,908.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,908.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,077.52
|
| 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 |
$3,908.70
|
| Rate for Payer: Cigna Commercial |
$2,159.89
|
| Rate for Payer: Cigna Medicare Advantage |
$1,077.52
|
| Rate for Payer: Clover Medicare Advantage |
$1,023.64
|
| Rate for Payer: EmblemHealth Commercial |
$3,232.56
|
| Rate for Payer: Humana Medicare Advantage |
$1,109.85
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,077.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$966.47
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$557.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$117.46
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,077.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,077.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$105.57
|
|
|
IR-REM OBS G/G-J/COLO TUB
|
Facility
|
IP
|
$3,717.20
|
|
|
Service Code
|
HCPCS 49460
|
| Hospital Charge Code |
366849460
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$557.58 |
| Max. Negotiated Rate |
$557.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$557.58
|
|
|
IR-REM OBS G/G-J/COLO TUB
|
Facility
|
OP
|
$4,459.55
|
|
|
Service Code
|
HCPCS 49460
|
| Hospital Charge Code |
2690175
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$126.65 |
| Max. Negotiated Rate |
$5,347.00 |
| Rate for Payer: Aetna Commercial |
$2,930.85
|
| Rate for Payer: Aetna Medicare Advantage |
$3,491.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,908.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,908.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,077.52
|
| 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 |
$3,908.70
|
| Rate for Payer: Cigna Commercial |
$2,159.89
|
| Rate for Payer: Cigna Medicare Advantage |
$1,077.52
|
| Rate for Payer: Clover Medicare Advantage |
$1,023.64
|
| Rate for Payer: EmblemHealth Commercial |
$3,232.56
|
| Rate for Payer: Humana Medicare Advantage |
$1,109.85
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,077.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,159.48
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$668.93
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.92
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,077.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,077.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$126.65
|
|
|
IR REMOVE HEPATIC SHUNT (TIPS)
|
Facility
|
OP
|
$25,423.30
|
|
|
Service Code
|
HCPCS 37183
|
| Hospital Charge Code |
366837183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$722.02 |
| Max. Negotiated Rate |
$24,528.18 |
| Rate for Payer: Aetna Commercial |
$18,391.91
|
| Rate for Payer: Aetna Medicare Advantage |
$21,908.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24,528.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24,528.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,761.73
|
| 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 |
$24,528.18
|
| Rate for Payer: Cigna Commercial |
$13,553.85
|
| Rate for Payer: Cigna Medicare Advantage |
$6,761.73
|
| Rate for Payer: Clover Medicare Advantage |
$6,423.64
|
| Rate for Payer: EmblemHealth Commercial |
$20,285.19
|
| Rate for Payer: Humana Medicare Advantage |
$6,964.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,761.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,610.06
|
| Rate for Payer: Oxford Commercial |
$14,968.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,813.49
|
| Rate for Payer: UnitedHealthcare Commercial |
$16,639.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$803.38
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$722.02
|
|
|
IR REMOVE HEPATIC SHUNT (TIPS)
|
Facility
|
OP
|
$27,397.00
|
|
|
Service Code
|
HCPCS 37183
|
| Hospital Charge Code |
321037183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$778.07 |
| Max. Negotiated Rate |
$24,528.18 |
| Rate for Payer: Aetna Commercial |
$18,391.91
|
| Rate for Payer: Aetna Medicare Advantage |
$21,908.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24,528.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24,528.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,761.73
|
| 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 |
$24,528.18
|
| Rate for Payer: Cigna Commercial |
$13,553.85
|
| Rate for Payer: Cigna Medicare Advantage |
$6,761.73
|
| Rate for Payer: Clover Medicare Advantage |
$6,423.64
|
| Rate for Payer: EmblemHealth Commercial |
$20,285.19
|
| Rate for Payer: Humana Medicare Advantage |
$6,964.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,761.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,123.22
|
| Rate for Payer: Oxford Commercial |
$14,968.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,109.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$16,639.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$865.75
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$778.07
|
|
|
IR REMOVE HEPATIC SHUNT (TIPS)
|
Facility
|
IP
|
$27,397.00
|
|
|
Service Code
|
HCPCS 37183
|
| Hospital Charge Code |
321037183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,109.55 |
| Max. Negotiated Rate |
$4,109.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,109.55
|
|
|
IR REMOVE HEPATIC SHUNT (TIPS)
|
Facility
|
IP
|
$25,423.30
|
|
|
Service Code
|
HCPCS 37183
|
| Hospital Charge Code |
366837183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,813.49 |
| Max. Negotiated Rate |
$3,813.49 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,813.49
|
|
|
IR REMOVE HEPATIC SHUNT (TIPS)
|
Facility
|
OP
|
$27,397.00
|
|
|
Service Code
|
HCPCS 37183
|
| Hospital Charge Code |
2011298
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$778.07 |
| Max. Negotiated Rate |
$24,528.18 |
| Rate for Payer: Aetna Commercial |
$18,391.91
|
| Rate for Payer: Aetna Medicare Advantage |
$21,908.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24,528.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24,528.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,761.73
|
| 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 |
$24,528.18
|
| Rate for Payer: Cigna Commercial |
$13,553.85
|
| Rate for Payer: Cigna Medicare Advantage |
$6,761.73
|
| Rate for Payer: Clover Medicare Advantage |
$6,423.64
|
| Rate for Payer: EmblemHealth Commercial |
$20,285.19
|
| Rate for Payer: Humana Medicare Advantage |
$6,964.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,761.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,123.22
|
| Rate for Payer: Oxford Commercial |
$14,968.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,109.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$16,639.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$865.75
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$778.07
|
|
|
IR REMOVE HEPATIC SHUNT (TIPS)
|
Facility
|
IP
|
$27,397.00
|
|
|
Service Code
|
HCPCS 37183
|
| Hospital Charge Code |
2011298
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,109.55 |
| Max. Negotiated Rate |
$4,109.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,109.55
|
|
|
IR REMOVE HEPATIC SHUNT (TIPS)
|
Facility
|
IP
|
$25,423.30
|
|
|
Service Code
|
HCPCS 37183
|
| Hospital Charge Code |
411037183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,813.49 |
| Max. Negotiated Rate |
$3,813.49 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,813.49
|
|
|
IR REMOVE HEPATIC SHUNT (TIPS)
|
Facility
|
OP
|
$25,423.30
|
|
|
Service Code
|
HCPCS 37183
|
| Hospital Charge Code |
411037183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$722.02 |
| Max. Negotiated Rate |
$24,528.18 |
| Rate for Payer: Aetna Commercial |
$18,391.91
|
| Rate for Payer: Aetna Medicare Advantage |
$21,908.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24,528.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24,528.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,761.73
|
| 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 |
$24,528.18
|
| Rate for Payer: Cigna Commercial |
$13,553.85
|
| Rate for Payer: Cigna Medicare Advantage |
$6,761.73
|
| Rate for Payer: Clover Medicare Advantage |
$6,423.64
|
| Rate for Payer: EmblemHealth Commercial |
$20,285.19
|
| Rate for Payer: Humana Medicare Advantage |
$6,964.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,761.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,610.06
|
| Rate for Payer: Oxford Commercial |
$14,968.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,813.49
|
| Rate for Payer: UnitedHealthcare Commercial |
$16,639.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$803.38
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$722.02
|
|
|
IR-REM/REPL URET STNT-LT
|
Facility
|
IP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50382LT
|
| Hospital Charge Code |
321050382L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,528.17 |
| Max. Negotiated Rate |
$1,528.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,528.17
|
|
|
IR-REM/REPL URET STNT-LT
|
Facility
|
IP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50382RT
|
| Hospital Charge Code |
366850382R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,528.17 |
| Max. Negotiated Rate |
$1,528.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,528.17
|
|
|
IR-REM/REPL URET STNT-LT
|
Facility
|
OP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50382LT
|
| Hospital Charge Code |
321050382L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$289.33 |
| Max. Negotiated Rate |
$5,093.90 |
| Rate for Payer: Aetna Commercial |
$3,871.36
|
| Rate for Payer: Aetna Medicare Advantage |
$3,056.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,597.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,597.89
|
| 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 |
$2,597.89
|
| Rate for Payer: Cigna Commercial |
$5,093.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,648.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,528.17
|
| Rate for Payer: UnitedHealthcare Community & State |
$321.93
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$289.33
|
|
|
IR-REM/REPL URET STNT-LT
|
Facility
|
OP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50382RT
|
| Hospital Charge Code |
366850382R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$289.33 |
| Max. Negotiated Rate |
$5,093.90 |
| Rate for Payer: Aetna Commercial |
$3,871.36
|
| Rate for Payer: Aetna Medicare Advantage |
$3,056.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,597.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,597.89
|
| 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 |
$2,597.89
|
| Rate for Payer: Cigna Commercial |
$5,093.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,648.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,528.17
|
| Rate for Payer: UnitedHealthcare Community & State |
$321.93
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$289.33
|
|
|
IR-REM/REPL URET STNT-LT
|
Facility
|
IP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50382LT
|
| Hospital Charge Code |
366850382L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,528.17 |
| Max. Negotiated Rate |
$1,528.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,528.17
|
|
|
IR-REM/REPL URET STNT-LT
|
Facility
|
OP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50382RT
|
| Hospital Charge Code |
411050382L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$289.33 |
| Max. Negotiated Rate |
$5,093.90 |
| Rate for Payer: Aetna Commercial |
$3,871.36
|
| Rate for Payer: Aetna Medicare Advantage |
$3,056.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,597.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,597.89
|
| 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 |
$2,597.89
|
| Rate for Payer: Cigna Commercial |
$5,093.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,648.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,528.17
|
| Rate for Payer: UnitedHealthcare Community & State |
$321.93
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$289.33
|
|
|
IR-REM/REPL URET STNT-LT
|
Facility
|
IP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50382LT
|
| Hospital Charge Code |
2691550
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,528.17 |
| Max. Negotiated Rate |
$1,528.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,528.17
|
|
|
IR-REM/REPL URET STNT-LT
|
Facility
|
IP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50382RT
|
| Hospital Charge Code |
411050382L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,528.17 |
| Max. Negotiated Rate |
$1,528.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,528.17
|
|
|
IR-REM/REPL URET STNT-LT
|
Facility
|
OP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50382LT
|
| Hospital Charge Code |
366850382L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$289.33 |
| Max. Negotiated Rate |
$5,093.90 |
| Rate for Payer: Aetna Commercial |
$3,871.36
|
| Rate for Payer: Aetna Medicare Advantage |
$3,056.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,597.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,597.89
|
| 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 |
$2,597.89
|
| Rate for Payer: Cigna Commercial |
$5,093.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,648.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,528.17
|
| Rate for Payer: UnitedHealthcare Community & State |
$321.93
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$289.33
|
|
|
IR-REM/REPL URET STNT-LT
|
Facility
|
OP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50382LT
|
| Hospital Charge Code |
2691550
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$289.33 |
| Max. Negotiated Rate |
$5,093.90 |
| Rate for Payer: Aetna Commercial |
$3,871.36
|
| Rate for Payer: Aetna Medicare Advantage |
$3,056.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,597.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,597.89
|
| 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 |
$2,597.89
|
| Rate for Payer: Cigna Commercial |
$5,093.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,648.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,528.17
|
| Rate for Payer: UnitedHealthcare Community & State |
$321.93
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$289.33
|
|
|
IR-REM/REPL URET STNT-RT
|
Facility
|
IP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50382RT
|
| Hospital Charge Code |
2691555
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,528.17 |
| Max. Negotiated Rate |
$1,528.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,528.17
|
|
