|
IR TRLUML PERIP ATHRC RENAL AR
|
Facility
|
IP
|
$22,749.00
|
|
|
Service Code
|
HCPCS 0234T
|
| Hospital Charge Code |
7411848A
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,412.35 |
| Max. Negotiated Rate |
$3,412.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,412.35
|
|
|
IR TRLUML PERIP ATHRC RENAL AR
|
Facility
|
IP
|
$22,749.00
|
|
|
Service Code
|
HCPCS 0234T
|
| Hospital Charge Code |
5600218
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,412.35 |
| Max. Negotiated Rate |
$3,412.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,412.35
|
|
|
IR TRLUML PERIP ATHRC RENAL AR
|
Facility
|
OP
|
$22,749.00
|
|
|
Service Code
|
HCPCS 0234T
|
| Hospital Charge Code |
7411848
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$646.07 |
| Max. Negotiated Rate |
$49,750.44 |
| Rate for Payer: Aetna Commercial |
$37,304.26
|
| Rate for Payer: Aetna Medicare Advantage |
$44,435.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49,750.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49,750.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13,714.80
|
| 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 |
$49,750.44
|
| Rate for Payer: Cigna Commercial |
$27,491.26
|
| Rate for Payer: Cigna Medicare Advantage |
$13,714.80
|
| Rate for Payer: Clover Medicare Advantage |
$13,029.06
|
| Rate for Payer: EmblemHealth Commercial |
$41,144.40
|
| Rate for Payer: Humana Medicare Advantage |
$14,126.24
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13,714.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,914.74
|
| Rate for Payer: Oxford Commercial |
$14,968.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,412.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$16,639.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$718.87
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13,714.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$13,714.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$646.07
|
|
|
IR TRLUML PERIP ATHRC RENAL AR
|
Facility
|
IP
|
$22,749.00
|
|
|
Service Code
|
HCPCS 0234T
|
| Hospital Charge Code |
7411848
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,412.35 |
| Max. Negotiated Rate |
$3,412.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,412.35
|
|
|
IR TRNSHPTC PRTGRPHY W/HMO EVL
|
Facility
|
IP
|
$15,254.51
|
|
|
Service Code
|
HCPCS 75885
|
| Hospital Charge Code |
2600114
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,288.18 |
| Max. Negotiated Rate |
$2,288.18 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,288.18
|
|
|
IR TRNSHPTC PRTGRPHY W/HMO EVL
|
Facility
|
IP
|
$12,031.00
|
|
|
Service Code
|
HCPCS 75885
|
| Hospital Charge Code |
7411723
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,804.65 |
| Max. Negotiated Rate |
$1,804.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,804.65
|
|
|
IR TRNSHPTC PRTGRPHY W/HMO EVL
|
Facility
|
OP
|
$15,254.51
|
|
|
Service Code
|
HCPCS 75885
|
| Hospital Charge Code |
2600114
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$235.62 |
| 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 |
$235.62
|
| 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 |
$2,625.82
|
| 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 |
$3,966.17
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,288.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$482.04
|
| 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 |
$433.23
|
|
|
IR TRNSHPTC PRTGRPHY W/HMO EVL
|
Facility
|
OP
|
$12,031.00
|
|
|
Service Code
|
HCPCS 75885
|
| Hospital Charge Code |
7411723
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$235.62 |
| 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 |
$235.62
|
| 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 |
$2,625.82
|
| 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 |
$3,128.06
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,804.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$380.18
|
| 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 |
$341.68
|
|
|
IR TRNSLMNAL BALN ANGIO VENOUS
|
Facility
|
OP
|
$14,919.00
|
|
|
Service Code
|
HCPCS 75978
|
| Hospital Charge Code |
2600116
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$423.70 |
| Max. Negotiated Rate |
$7,459.50 |
| Rate for Payer: Aetna Commercial |
$5,669.22
|
| Rate for Payer: Aetna Medicare Advantage |
$4,475.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,804.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,804.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,804.34
|
| Rate for Payer: Cigna Commercial |
$7,459.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,878.94
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,237.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$471.44
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$423.70
|
|
|
IR TRNSLMNAL BALN ANGIO VENOUS
|
Facility
|
IP
|
$14,919.00
|
|
|
Service Code
|
HCPCS 75978
|
| Hospital Charge Code |
2600116
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,237.85 |
| Max. Negotiated Rate |
$2,237.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,237.85
|
|
|
IR TRNSLMNAL BALN ANGIO VENOUS
|
Facility
|
OP
|
$14,919.00
|
|
|
Service Code
|
HCPCS 75978
|
| Hospital Charge Code |
7411742
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$423.70 |
| Max. Negotiated Rate |
$7,459.50 |
| Rate for Payer: Aetna Commercial |
$5,669.22
|
| Rate for Payer: Aetna Medicare Advantage |
$4,475.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,804.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,804.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,804.34
|
| Rate for Payer: Cigna Commercial |
$7,459.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,878.94
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,237.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$471.44
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$423.70
|
|
|
IR TRNSLMNAL BALN ANGIO VENOUS
|
Facility
|
IP
|
$14,919.00
|
|
|
Service Code
|
HCPCS 75978
|
| Hospital Charge Code |
7411742
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,237.85 |
| Max. Negotiated Rate |
$2,237.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,237.85
|
|
|
IR TRSHPTC PRTGRPY W/O HMO EVL
|
Facility
|
OP
|
$3,084.40
|
|
|
Service Code
|
HCPCS 75887
|
| Hospital Charge Code |
366875887
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$87.60 |
| 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 |
$299.48
|
| 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 |
$2,625.82
|
| 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 |
$801.94
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$462.66
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$97.47
|
| 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 |
$87.60
|
|
|
IR TRSHPTC PRTGRPY W/O HMO EVL
|
Facility
|
IP
|
$6,404.20
|
|
|
Service Code
|
HCPCS 75887
|
| Hospital Charge Code |
2600115
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$960.63 |
| Max. Negotiated Rate |
$960.63 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$960.63
|
|
|
IR TRSHPTC PRTGRPY W/O HMO EVL
|
Facility
|
OP
|
$6,404.20
|
|
|
Service Code
|
HCPCS 75887
|
| Hospital Charge Code |
2600115
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$181.88 |
| 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 |
$299.48
|
| 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 |
$2,625.82
|
| 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 |
$1,665.09
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$960.63
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$202.37
|
| 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 |
$181.88
|
|
|
IR TRSHPTC PRTGRPY W/O HMO EVL
|
Facility
|
IP
|
$4,267.00
|
|
|
Service Code
|
HCPCS 75887
|
| Hospital Charge Code |
7411724
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$640.05 |
| Max. Negotiated Rate |
$640.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$640.05
|
|
|
IR TRSHPTC PRTGRPY W/O HMO EVL
|
Facility
|
IP
|
$3,084.40
|
|
|
Service Code
|
HCPCS 75887
|
| Hospital Charge Code |
366875887
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$462.66 |
| Max. Negotiated Rate |
$462.66 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$462.66
|
|
|
IR TRSHPTC PRTGRPY W/O HMO EVL
|
Facility
|
OP
|
$4,267.00
|
|
|
Service Code
|
HCPCS 75887
|
| Hospital Charge Code |
7411724
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$121.18 |
| 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 |
$299.48
|
| 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 |
$2,625.82
|
| 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 |
$1,109.42
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$640.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$134.84
|
| 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 |
$121.18
|
|
|
IR TUBE OR CATH CHANGE
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
321075984
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$84.89 |
| Max. Negotiated Rate |
$2,550.00 |
| Rate for Payer: Aetna Commercial |
$1,938.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,300.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,300.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$84.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$2,550.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,326.00
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$161.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$144.84
|
|
|
IR TUBE OR CATH CHANGE
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
321075984
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
IR TUBE OR CATH CHANGE
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
2600117
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
IR TUBE OR CATH CHANGE
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
2600117
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$84.89 |
| Max. Negotiated Rate |
$2,550.00 |
| Rate for Payer: Aetna Commercial |
$1,938.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,300.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,300.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$84.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$2,550.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,326.00
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$161.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$144.84
|
|
|
IR-TX COLLAPSED LUNG-LT
|
Facility
|
OP
|
$838.00
|
|
| Hospital Charge Code |
2691050
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$318.44
|
| Rate for Payer: Aetna Medicare Advantage |
$251.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$213.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$213.69
|
| 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 |
$213.69
|
| Rate for Payer: Cigna Commercial |
$419.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$217.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.70
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.80
|
|
|
IR-TX COLLAPSED LUNG-LT
|
Facility
|
IP
|
$838.00
|
|
| Hospital Charge Code |
2691050
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$125.70 |
| Max. Negotiated Rate |
$125.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.70
|
|
|
IR UNLISTED PROCEDURE - LIVER
|
Facility
|
IP
|
$2,864.05
|
|
|
Service Code
|
HCPCS 47399
|
| Hospital Charge Code |
366847399
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$429.61 |
| Max. Negotiated Rate |
$429.61 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$429.61
|
|
