|
PERQ DEV BREAST 1ST US IMAG
|
Facility
|
IP
|
$1,167.00
|
|
|
Service Code
|
HCPCS 19285
|
| Hospital Charge Code |
16000195
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$175.05 |
| Max. Negotiated Rate |
$175.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$175.05
|
|
|
PERQ DEVICE BREAST 1ST IMAG
|
Facility
|
OP
|
$1,167.00
|
|
|
Service Code
|
HCPCS 19281
|
| Hospital Charge Code |
16000188
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$33.14 |
| 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 |
$303.42
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$175.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$36.88
|
| 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 |
$33.14
|
|
|
PERQ DEVICE BREAST 1ST IMAG
|
Facility
|
IP
|
$1,167.00
|
|
|
Service Code
|
HCPCS 19281
|
| Hospital Charge Code |
16000188
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$175.05 |
| Max. Negotiated Rate |
$175.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$175.05
|
|
|
PERQ LAMOT/LAM LUMBAR
|
Facility
|
OP
|
$33,651.56
|
|
|
Service Code
|
HCPCS 62330
|
| Hospital Charge Code |
1600000390
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$955.70 |
| Max. Negotiated Rate |
$31,271.12 |
| Rate for Payer: Aetna Commercial |
$23,447.95
|
| Rate for Payer: Aetna Medicare Advantage |
$27,930.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31,271.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31,271.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8,620.57
|
| 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 |
$31,271.12
|
| Rate for Payer: Cigna Commercial |
$17,279.91
|
| Rate for Payer: Cigna Medicare Advantage |
$8,620.57
|
| Rate for Payer: Clover Medicare Advantage |
$8,189.54
|
| Rate for Payer: EmblemHealth Commercial |
$25,861.71
|
| Rate for Payer: Humana Medicare Advantage |
$8,879.19
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$8,620.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,749.41
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,047.73
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,063.39
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8,620.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$8,620.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$955.70
|
|
|
PERQ LAMOT/LAM LUMBAR
|
Facility
|
IP
|
$33,651.56
|
|
|
Service Code
|
HCPCS 62330
|
| Hospital Charge Code |
1600000390
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,047.73 |
| Max. Negotiated Rate |
$5,047.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,047.73
|
|
|
PERQ LUMBOSACRAL INJECTION
|
Facility
|
OP
|
$15,447.21
|
|
|
Service Code
|
HCPCS 22511
|
| Hospital Charge Code |
321022511
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$438.70 |
| Max. Negotiated Rate |
$14,100.89 |
| Rate for Payer: Aetna Commercial |
$10,573.24
|
| Rate for Payer: Aetna Medicare Advantage |
$12,594.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14,100.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14,100.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,887.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,131.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14,100.89
|
| Rate for Payer: Cigna Commercial |
$7,791.93
|
| Rate for Payer: Cigna Medicare Advantage |
$2,721.05
|
| Rate for Payer: Clover Medicare Advantage |
$3,692.86
|
| Rate for Payer: EmblemHealth Commercial |
$11,661.66
|
| Rate for Payer: Humana Medicare Advantage |
$4,003.84
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,887.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,016.27
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,317.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$488.13
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,887.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,887.22
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$8,822.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$438.70
|
|
|
PERQ LUMBOSACRAL INJECTION
|
Facility
|
IP
|
$15,447.21
|
|
|
Service Code
|
HCPCS 22511
|
| Hospital Charge Code |
321022511
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,317.08 |
| Max. Negotiated Rate |
$2,317.08 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,317.08
|
|
|
PERQ LUMBOSACRAL INJECTION
|
Facility
|
OP
|
$15,447.21
|
|
|
Service Code
|
HCPCS 22511
|
| Hospital Charge Code |
7411353
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$438.70 |
| Max. Negotiated Rate |
$14,100.89 |
| Rate for Payer: Aetna Commercial |
$10,573.24
|
| Rate for Payer: Aetna Medicare Advantage |
$12,594.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14,100.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14,100.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,887.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,131.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14,100.89
|
| Rate for Payer: Cigna Commercial |
$7,791.93
|
| Rate for Payer: Cigna Medicare Advantage |
$2,721.05
|
| Rate for Payer: Clover Medicare Advantage |
$3,692.86
|
| Rate for Payer: EmblemHealth Commercial |
$11,661.66
|
| Rate for Payer: Humana Medicare Advantage |
$4,003.84
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,887.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,016.27
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,317.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$488.13
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,887.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,887.22
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$8,822.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$438.70
|
|
|
PERQ LUMBOSACRAL INJECTION
|
Facility
|
IP
|
$15,447.21
|
|
|
Service Code
|
HCPCS 22511
|
| Hospital Charge Code |
5701104
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,317.08 |
| Max. Negotiated Rate |
$2,317.08 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,317.08
|
|
|
PERQ LUMBOSACRAL INJECTION
|
Facility
|
IP
|
$15,447.21
|
|
|
Service Code
|
HCPCS 22511
|
| Hospital Charge Code |
7411353
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,317.08 |
| Max. Negotiated Rate |
$2,317.08 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,317.08
|
|
|
PERQ LUMBOSACRAL INJECTION
|
Facility
|
OP
|
$15,447.21
|
|
|
Service Code
|
HCPCS 22511
|
| Hospital Charge Code |
5701104
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$438.70 |
| Max. Negotiated Rate |
$14,100.89 |
| Rate for Payer: Aetna Commercial |
$10,573.24
|
| Rate for Payer: Aetna Medicare Advantage |
$12,594.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14,100.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14,100.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,887.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,131.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14,100.89
|
| Rate for Payer: Cigna Commercial |
$7,791.93
|
| Rate for Payer: Cigna Medicare Advantage |
$2,721.05
|
| Rate for Payer: Clover Medicare Advantage |
$3,692.86
|
| Rate for Payer: EmblemHealth Commercial |
$11,661.66
|
| Rate for Payer: Humana Medicare Advantage |
$4,003.84
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,887.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,016.27
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,317.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$488.13
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,887.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,887.22
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$8,822.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$438.70
|
|
|
PERQ NJX ALGC FLUOR LMBR 1ST
|
Facility
|
IP
|
$59,508.84
|
|
|
Service Code
|
HCPCS 0627T
|
| Hospital Charge Code |
1600000770
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,926.33 |
| Max. Negotiated Rate |
$8,926.33 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8,926.33
|
|
|
PERQ NJX ALGC FLUOR LMBR 1ST
|
Facility
|
OP
|
$59,508.84
|
|
|
Service Code
|
HCPCS 0627T
|
| Hospital Charge Code |
1600000770
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,690.05 |
| Max. Negotiated Rate |
$55,329.13 |
| Rate for Payer: Aetna Commercial |
$41,487.32
|
| Rate for Payer: Aetna Medicare Advantage |
$49,418.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$55,329.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$55,329.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15,252.69
|
| 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 |
$55,329.13
|
| Rate for Payer: Cigna Commercial |
$30,573.98
|
| Rate for Payer: Cigna Medicare Advantage |
$15,252.69
|
| Rate for Payer: Clover Medicare Advantage |
$14,490.06
|
| Rate for Payer: EmblemHealth Commercial |
$45,758.07
|
| Rate for Payer: Humana Medicare Advantage |
$15,710.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15,252.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15,472.30
|
| Rate for Payer: Oxford Commercial |
$13,407.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8,926.33
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,869.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,880.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15,252.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$15,252.69
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,690.05
|
|
|
PERQ PLMT BILE DUCT STENT
|
Facility
|
IP
|
$24,264.20
|
|
|
Service Code
|
HCPCS 47539
|
| Hospital Charge Code |
7411568
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,639.63 |
| Max. Negotiated Rate |
$3,639.63 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,639.63
|
|
|
PERQ PLMT BILE DUCT STENT
|
Facility
|
IP
|
$24,264.20
|
|
|
Service Code
|
HCPCS 47540
|
| Hospital Charge Code |
7411569
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,639.63 |
| Max. Negotiated Rate |
$3,639.63 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,639.63
|
|
|
PERQ PLMT BILE DUCT STENT
|
Facility
|
OP
|
$24,264.20
|
|
|
Service Code
|
HCPCS 47540
|
| Hospital Charge Code |
7411569
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$689.10 |
| 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 |
$6,308.69
|
| Rate for Payer: Oxford Commercial |
$13,407.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,639.63
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,869.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$766.75
|
| 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 |
$689.10
|
|
|
PERQ PLMT BILE DUCT STENT
|
Facility
|
OP
|
$24,264.20
|
|
|
Service Code
|
HCPCS 47539
|
| Hospital Charge Code |
7411568
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$689.10 |
| 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 |
$6,308.69
|
| Rate for Payer: Oxford Commercial |
$13,407.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,639.63
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,869.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$766.75
|
| 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 |
$689.10
|
|
|
PERQ PLMT BILE DUCT STENT(S)
|
Facility
|
OP
|
$24,264.20
|
|
|
Service Code
|
HCPCS 47540
|
| Hospital Charge Code |
366847540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$689.10 |
| 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 |
$6,308.69
|
| Rate for Payer: Oxford Commercial |
$13,407.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,639.63
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,869.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$766.75
|
| 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 |
$689.10
|
|
|
PERQ PLMT BILE DUCT STENT(S)
|
Facility
|
IP
|
$24,264.20
|
|
|
Service Code
|
HCPCS 47538
|
| Hospital Charge Code |
366847538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,639.63 |
| Max. Negotiated Rate |
$3,639.63 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,639.63
|
|
|
PERQ PLMT BILE DUCT STENT(S)
|
Facility
|
IP
|
$24,264.20
|
|
|
Service Code
|
HCPCS 47540
|
| Hospital Charge Code |
366847540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,639.63 |
| Max. Negotiated Rate |
$3,639.63 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,639.63
|
|
|
PERQ PLMT BILE DUCT STENT(S)
|
Facility
|
OP
|
$26,912.85
|
|
|
Service Code
|
HCPCS 47539
|
| Hospital Charge Code |
2600233
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$764.32 |
| 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 |
$6,997.34
|
| Rate for Payer: Oxford Commercial |
$13,407.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,036.93
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,869.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$850.45
|
| 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 |
$764.32
|
|
|
PERQ PLMT BILE DUCT STENT(S)
|
Facility
|
OP
|
$24,264.20
|
|
|
Service Code
|
HCPCS 47538
|
| Hospital Charge Code |
366847538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$689.10 |
| 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 |
$6,308.69
|
| Rate for Payer: Oxford Commercial |
$13,407.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,639.63
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,869.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$766.75
|
| 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 |
$689.10
|
|
|
PERQ PLMT BILE DUCT STENT(S)
|
Facility
|
IP
|
$24,264.20
|
|
|
Service Code
|
HCPCS 47538
|
| Hospital Charge Code |
7411567
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,639.63 |
| Max. Negotiated Rate |
$3,639.63 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,639.63
|
|
|
PERQ PLMT BILE DUCT STENT(S)
|
Facility
|
OP
|
$24,264.20
|
|
|
Service Code
|
HCPCS 47540
|
| Hospital Charge Code |
411047540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$689.10 |
| 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 |
$6,308.69
|
| Rate for Payer: Oxford Commercial |
$13,407.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,639.63
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,869.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$766.75
|
| 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 |
$689.10
|
|
|
PERQ PLMT BILE DUCT STENT(S)
|
Facility
|
IP
|
$24,264.20
|
|
|
Service Code
|
HCPCS 47540
|
| Hospital Charge Code |
411047540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,639.63 |
| Max. Negotiated Rate |
$3,639.63 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,639.63
|
|
