|
LAP ENTEROLYSIS
|
Facility
|
IP
|
$58,549.97
|
|
|
Service Code
|
HCPCS 44180
|
| Hospital Charge Code |
16000586
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,782.50 |
| Max. Negotiated Rate |
$8,782.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8,782.50
|
|
|
LAP ENTEROLYSIS
|
Facility
|
OP
|
$58,549.97
|
|
|
Service Code
|
HCPCS 44180
|
| Hospital Charge Code |
16000586
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,662.82 |
| Max. Negotiated Rate |
$26,053.61 |
| Rate for Payer: Aetna Commercial |
$19,535.72
|
| Rate for Payer: Aetna Medicare Advantage |
$23,270.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$26,053.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$26,053.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7,182.25
|
| 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 |
$26,053.61
|
| Rate for Payer: Cigna Commercial |
$14,396.79
|
| Rate for Payer: Cigna Medicare Advantage |
$7,182.25
|
| Rate for Payer: Clover Medicare Advantage |
$6,823.14
|
| Rate for Payer: EmblemHealth Commercial |
$21,546.75
|
| Rate for Payer: Humana Medicare Advantage |
$7,397.72
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$7,182.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15,222.99
|
| Rate for Payer: Oxford Commercial |
$13,407.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8,782.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,869.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,850.18
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7,182.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$7,182.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,662.82
|
|
|
LAP GASTRIC BYPASS/ROUX-EN-Y
|
Facility
|
IP
|
$14,821.52
|
|
|
Service Code
|
HCPCS 43644
|
| Hospital Charge Code |
1600000388
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,223.23 |
| Max. Negotiated Rate |
$2,223.23 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,223.23
|
|
|
LAP GASTRIC BYPASS/ROUX-EN-Y
|
Facility
|
OP
|
$14,821.52
|
|
|
Service Code
|
HCPCS 43644
|
| Hospital Charge Code |
1600000388
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$420.93 |
| Max. Negotiated Rate |
$14,869.00 |
| Rate for Payer: Aetna Commercial |
$5,632.18
|
| Rate for Payer: Aetna Medicare Advantage |
$4,446.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,779.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,779.49
|
| 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 |
$3,779.49
|
| Rate for Payer: Cigna Commercial |
$7,410.76
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,853.60
|
| Rate for Payer: Oxford Commercial |
$13,407.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,223.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,869.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$468.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$420.93
|
|
|
LAP GYN KIT
|
Facility
|
IP
|
$347.00
|
|
| Hospital Charge Code |
270338738
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.05 |
| Max. Negotiated Rate |
$52.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.05
|
|
|
LAP GYN KIT
|
Facility
|
OP
|
$347.00
|
|
| Hospital Charge Code |
270338738
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$173.50 |
| Rate for Payer: Aetna Commercial |
$131.86
|
| Rate for Payer: Aetna Medicare Advantage |
$104.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$88.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$88.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$88.48
|
| Rate for Payer: Cigna Commercial |
$173.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$90.22
|
| Rate for Payer: Oxford Commercial |
$69.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$69.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.97
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.85
|
|
|
LAP HANDSWITCH ELECTRODE
|
Facility
|
OP
|
$600.00
|
|
| Hospital Charge Code |
270335111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$228.00
|
| Rate for Payer: Aetna Medicare Advantage |
$180.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$153.00
|
| Rate for Payer: Cigna Commercial |
$300.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$156.00
|
| Rate for Payer: Oxford Commercial |
$120.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$120.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.04
|
|
|
LAP HANDSWITCH ELECTRODE
|
Facility
|
IP
|
$600.00
|
|
| Hospital Charge Code |
270335111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.00
|
|
|
LAPIDUS 3.5MMX24MM SCREW
|
Facility
|
IP
|
$1,380.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688235
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$333.96 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$276.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$333.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$207.00
|
|
|
LAPIDUS 3.5MMX24MM SCREW
|
Facility
|
OP
|
$1,380.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688235
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.19 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: Aetna Commercial |
$524.40
|
| Rate for Payer: Aetna Medicare Advantage |
$414.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$351.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$351.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$276.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$351.90
|
| Rate for Payer: Cigna Commercial |
$690.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$333.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$207.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$43.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$39.19
|
|
|
LAPIDUS PLATE LEFT
|
Facility
|
OP
|
$9,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.60 |
| Max. Negotiated Rate |
$4,500.00 |
| Rate for Payer: Aetna Commercial |
$3,420.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,700.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,295.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,295.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,295.00
|
| Rate for Payer: Cigna Commercial |
$4,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,178.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,350.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$284.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$255.60
|
|
|
LAPIDUS PLATE LEFT
|
Facility
|
IP
|
$9,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,350.00 |
| Max. Negotiated Rate |
$2,178.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,800.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,178.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,350.00
|
|
|
LAP ILEO/JEJUNO-STOMY
|
Facility
|
IP
|
$130,620.30
|
|
|
Service Code
|
HCPCS 44187
|
| Hospital Charge Code |
1600000266
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$19,593.04 |
| Max. Negotiated Rate |
$19,593.04 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19,593.04
|
|
|
LAP ILEO/JEJUNO-STOMY
|
Facility
|
OP
|
$130,620.30
|
|
|
Service Code
|
HCPCS 44187
|
| Hospital Charge Code |
1600000266
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,536.00 |
| Max. Negotiated Rate |
$65,310.15 |
| Rate for Payer: Aetna Commercial |
$49,635.71
|
| Rate for Payer: Aetna Medicare Advantage |
$39,186.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$33,308.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$33,308.18
|
| 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 |
$33,308.18
|
| Rate for Payer: Cigna Commercial |
$65,310.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33,961.28
|
| Rate for Payer: Oxford Commercial |
$9,354.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19,593.04
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,269.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4,127.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3,709.62
|
|
|
LAP INC HERNIA REPAIR RECUR
|
Facility
|
IP
|
$63,727.20
|
|
|
Service Code
|
HCPCS 49656
|
| Hospital Charge Code |
1600000445
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,559.08 |
| Max. Negotiated Rate |
$9,559.08 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9,559.08
|
|
|
LAP INC HERNIA REPAIR RECUR
|
Facility
|
OP
|
$63,727.20
|
|
|
Service Code
|
HCPCS 49656
|
| Hospital Charge Code |
1600000445
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,809.85 |
| Max. Negotiated Rate |
$31,863.60 |
| Rate for Payer: Aetna Commercial |
$24,216.34
|
| Rate for Payer: Aetna Medicare Advantage |
$19,118.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$16,250.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$16,250.44
|
| 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 |
$16,250.44
|
| Rate for Payer: Cigna Commercial |
$31,863.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16,569.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9,559.08
|
| Rate for Payer: UnitedHealthcare Community & State |
$2,013.78
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,809.85
|
|
|
LAP INC HERN RECUR COMP
|
Facility
|
OP
|
$39,439.32
|
|
|
Service Code
|
HCPCS 49657
|
| Hospital Charge Code |
16000994
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,120.08 |
| Max. Negotiated Rate |
$19,719.66 |
| Rate for Payer: Aetna Commercial |
$14,986.94
|
| Rate for Payer: Aetna Medicare Advantage |
$11,831.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10,057.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10,057.03
|
| 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 |
$10,057.03
|
| Rate for Payer: Cigna Commercial |
$19,719.66
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10,254.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,915.90
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,246.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,120.08
|
|
|
LAP INC HERN RECUR COMP
|
Facility
|
IP
|
$39,439.32
|
|
|
Service Code
|
HCPCS 49657
|
| Hospital Charge Code |
16000994
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,915.90 |
| Max. Negotiated Rate |
$5,915.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,915.90
|
|
|
LAP ING HERNIA REPAIR INIT--RT
|
Facility
|
OP
|
$43,334.60
|
|
|
Service Code
|
HCPCS 49650
|
| Hospital Charge Code |
16000646
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,230.70 |
| Max. Negotiated Rate |
$26,053.61 |
| Rate for Payer: Aetna Commercial |
$19,535.72
|
| Rate for Payer: Aetna Medicare Advantage |
$23,270.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$26,053.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$26,053.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7,182.25
|
| 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 |
$26,053.61
|
| Rate for Payer: Cigna Commercial |
$14,396.79
|
| Rate for Payer: Cigna Medicare Advantage |
$7,182.25
|
| Rate for Payer: Clover Medicare Advantage |
$6,823.14
|
| Rate for Payer: EmblemHealth Commercial |
$21,546.75
|
| Rate for Payer: Humana Medicare Advantage |
$7,397.72
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$7,182.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11,267.00
|
| Rate for Payer: Oxford Commercial |
$13,407.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,500.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,869.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,369.37
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7,182.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$7,182.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,230.70
|
|
|
LAP ING HERNIA REPAIR INIT--RT
|
Facility
|
IP
|
$43,334.60
|
|
|
Service Code
|
HCPCS 49650
|
| Hospital Charge Code |
16000646
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,500.19 |
| Max. Negotiated Rate |
$6,500.19 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,500.19
|
|
|
LAP ING HERNIA REPAIR RECUR RT
|
Facility
|
OP
|
$44,604.55
|
|
|
Service Code
|
HCPCS 49651
|
| Hospital Charge Code |
1600000328
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,266.77 |
| Max. Negotiated Rate |
$26,053.61 |
| Rate for Payer: Aetna Commercial |
$19,535.72
|
| Rate for Payer: Aetna Medicare Advantage |
$23,270.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$26,053.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$26,053.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7,182.25
|
| 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 |
$26,053.61
|
| Rate for Payer: Cigna Commercial |
$14,396.79
|
| Rate for Payer: Cigna Medicare Advantage |
$7,182.25
|
| Rate for Payer: Clover Medicare Advantage |
$6,823.14
|
| Rate for Payer: EmblemHealth Commercial |
$21,546.75
|
| Rate for Payer: Humana Medicare Advantage |
$7,397.72
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$7,182.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11,597.18
|
| Rate for Payer: Oxford Commercial |
$13,407.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,690.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,869.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,409.50
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7,182.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$7,182.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,266.77
|
|
|
LAP ING HERNIA REPAIR RECUR RT
|
Facility
|
IP
|
$44,604.55
|
|
|
Service Code
|
HCPCS 49651
|
| Hospital Charge Code |
1600000328
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,690.68 |
| Max. Negotiated Rate |
$6,690.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,690.68
|
|
|
LAP INSERTION PERM IP CATH
|
Facility
|
OP
|
$34,812.50
|
|
|
Service Code
|
HCPCS 49324
|
| Hospital Charge Code |
16000988
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$988.67 |
| Max. Negotiated Rate |
$26,053.61 |
| Rate for Payer: Aetna Commercial |
$19,535.72
|
| Rate for Payer: Aetna Medicare Advantage |
$23,270.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$26,053.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$26,053.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7,182.25
|
| 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 |
$26,053.61
|
| Rate for Payer: Cigna Commercial |
$14,396.79
|
| Rate for Payer: Cigna Medicare Advantage |
$7,182.25
|
| Rate for Payer: Clover Medicare Advantage |
$6,823.14
|
| Rate for Payer: EmblemHealth Commercial |
$21,546.75
|
| Rate for Payer: Humana Medicare Advantage |
$7,397.72
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$7,182.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,051.25
|
| Rate for Payer: Oxford Commercial |
$11,677.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,221.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$12,906.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,100.08
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7,182.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$7,182.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$988.67
|
|
|
LAP INSERTION PERM IP CATH
|
Facility
|
IP
|
$34,812.50
|
|
|
Service Code
|
HCPCS 49324
|
| Hospital Charge Code |
16000988
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,221.88 |
| Max. Negotiated Rate |
$5,221.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,221.88
|
|
|
LAP INSUFFLATOR TUBE/FILTER
|
Facility
|
IP
|
$300.00
|
|
| Hospital Charge Code |
270335094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
|