|
REPLACE G TUBE WO REV G TRACT
|
Facility
|
OP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
411043762
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$38.53 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$807.38
|
| Rate for Payer: Aetna Medicare Advantage |
$961.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,076.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,076.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$296.83
|
| 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 |
$1,076.75
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: Cigna Medicare Advantage |
$296.83
|
| Rate for Payer: Clover Medicare Advantage |
$281.99
|
| Rate for Payer: EmblemHealth Commercial |
$890.49
|
| Rate for Payer: Humana Medicare Advantage |
$305.73
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$296.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$352.76
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.87
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.53
|
|
|
REPLACE G TUBE WO REV G TRACT
|
Facility
|
OP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
404643762
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$38.53 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$807.38
|
| Rate for Payer: Aetna Medicare Advantage |
$961.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,076.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,076.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$296.83
|
| 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 |
$1,076.75
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: Cigna Medicare Advantage |
$296.83
|
| Rate for Payer: Clover Medicare Advantage |
$281.99
|
| Rate for Payer: EmblemHealth Commercial |
$890.49
|
| Rate for Payer: Humana Medicare Advantage |
$305.73
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$296.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$352.76
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.87
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.53
|
|
|
REPLACE G TUBE WO REV G TRACT
|
Facility
|
IP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
404643762
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$203.52 |
| Max. Negotiated Rate |
$203.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.52
|
|
|
REPLACE G TUBE WO REV G TRACT
|
Facility
|
IP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
411043762
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$203.52 |
| Max. Negotiated Rate |
$203.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.52
|
|
|
REPLACE G TUBE WO REV G TRACT
|
Facility
|
OP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
321043762
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$38.53 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$807.38
|
| Rate for Payer: Aetna Medicare Advantage |
$961.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,076.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,076.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$296.83
|
| 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 |
$1,076.75
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: Cigna Medicare Advantage |
$296.83
|
| Rate for Payer: Clover Medicare Advantage |
$281.99
|
| Rate for Payer: EmblemHealth Commercial |
$890.49
|
| Rate for Payer: Humana Medicare Advantage |
$305.73
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$296.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$352.76
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.87
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.53
|
|
|
REPLACE G TUBE WO REV G TRACT
|
Facility
|
OP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
323043762
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$38.53 |
| Max. Negotiated Rate |
$1,076.75 |
| Rate for Payer: Aetna Commercial |
$807.38
|
| Rate for Payer: Aetna Medicare Advantage |
$961.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,076.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,076.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$296.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$144.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,076.75
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: Cigna Medicare Advantage |
$296.83
|
| Rate for Payer: Clover Medicare Advantage |
$281.99
|
| Rate for Payer: EmblemHealth Commercial |
$890.49
|
| Rate for Payer: Humana Medicare Advantage |
$305.73
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$296.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$352.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.52
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.53
|
|
|
REPLACE G TUBE WO REV G TRACT
|
Facility
|
IP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
323043762
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$203.52 |
| Max. Negotiated Rate |
$203.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.52
|
|
|
REPLACE G TUBE WO REV G TRACT
|
Facility
|
IP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
366843762
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$203.52 |
| Max. Negotiated Rate |
$203.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.52
|
|
|
REPLACE G TUBE WO REV G TRACT
|
Facility
|
OP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
366843762
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$38.53 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$807.38
|
| Rate for Payer: Aetna Medicare Advantage |
$961.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,076.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,076.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$296.83
|
| 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 |
$1,076.75
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: Cigna Medicare Advantage |
$296.83
|
| Rate for Payer: Clover Medicare Advantage |
$281.99
|
| Rate for Payer: EmblemHealth Commercial |
$890.49
|
| Rate for Payer: Humana Medicare Advantage |
$305.73
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$296.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$352.76
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.87
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.53
|
|
|
REPLACE G TUBE W REV G TRACT
|
Facility
|
IP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43763
|
| Hospital Charge Code |
366843763
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$203.52 |
| Max. Negotiated Rate |
$203.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.52
|
|
|
REPLACE G TUBE W REV G TRACT
|
Facility
|
OP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43763
|
| Hospital Charge Code |
323043763
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$38.53 |
| Max. Negotiated Rate |
$1,076.75 |
| Rate for Payer: Aetna Commercial |
$807.38
|
| Rate for Payer: Aetna Medicare Advantage |
$961.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,076.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,076.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$296.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$214.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,076.75
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: Cigna Medicare Advantage |
$296.83
|
| Rate for Payer: Clover Medicare Advantage |
$281.99
|
| Rate for Payer: EmblemHealth Commercial |
$890.49
|
| Rate for Payer: Humana Medicare Advantage |
$305.73
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$296.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$352.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.52
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.53
|
|
|
REPLACE G TUBE W REV G TRACT
|
Facility
|
IP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43763
|
| Hospital Charge Code |
411043763
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$203.52 |
| Max. Negotiated Rate |
$203.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.52
|
|
|
REPLACE G TUBE W REV G TRACT
|
Facility
|
IP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43763
|
| Hospital Charge Code |
323043763
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$203.52 |
| Max. Negotiated Rate |
$203.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.52
|
|
|
REPLACE G TUBE W REV G TRACT
|
Facility
|
IP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43763
|
| Hospital Charge Code |
321043763
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$203.52 |
| Max. Negotiated Rate |
$203.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.52
|
|
|
REPLACE G TUBE W REV G TRACT
|
Facility
|
OP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43763
|
| Hospital Charge Code |
321043763
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$38.53 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$807.38
|
| Rate for Payer: Aetna Medicare Advantage |
$961.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,076.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,076.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$296.83
|
| 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 |
$1,076.75
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: Cigna Medicare Advantage |
$296.83
|
| Rate for Payer: Clover Medicare Advantage |
$281.99
|
| Rate for Payer: EmblemHealth Commercial |
$890.49
|
| Rate for Payer: Humana Medicare Advantage |
$305.73
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$296.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$352.76
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.87
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.53
|
|
|
REPLACE G TUBE W REV G TRACT
|
Facility
|
OP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43763
|
| Hospital Charge Code |
411043763
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$38.53 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$807.38
|
| Rate for Payer: Aetna Medicare Advantage |
$961.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,076.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,076.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$296.83
|
| 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 |
$1,076.75
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: Cigna Medicare Advantage |
$296.83
|
| Rate for Payer: Clover Medicare Advantage |
$281.99
|
| Rate for Payer: EmblemHealth Commercial |
$890.49
|
| Rate for Payer: Humana Medicare Advantage |
$305.73
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$296.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$352.76
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.87
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.53
|
|
|
REPLACE G TUBE W REV G TRACT
|
Facility
|
OP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43763
|
| Hospital Charge Code |
404643763
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$38.53 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$807.38
|
| Rate for Payer: Aetna Medicare Advantage |
$961.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,076.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,076.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$296.83
|
| 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 |
$1,076.75
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: Cigna Medicare Advantage |
$296.83
|
| Rate for Payer: Clover Medicare Advantage |
$281.99
|
| Rate for Payer: EmblemHealth Commercial |
$890.49
|
| Rate for Payer: Humana Medicare Advantage |
$305.73
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$296.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$352.76
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.87
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.53
|
|
|
REPLACE G TUBE W REV G TRACT
|
Facility
|
IP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43763
|
| Hospital Charge Code |
404643763
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$203.52 |
| Max. Negotiated Rate |
$203.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.52
|
|
|
REPLACE G TUBE W REV G TRACT
|
Facility
|
OP
|
$1,356.77
|
|
|
Service Code
|
HCPCS 43763
|
| Hospital Charge Code |
366843763
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$38.53 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$807.38
|
| Rate for Payer: Aetna Medicare Advantage |
$961.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,076.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,076.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$296.83
|
| 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 |
$1,076.75
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: Cigna Medicare Advantage |
$296.83
|
| Rate for Payer: Clover Medicare Advantage |
$281.99
|
| Rate for Payer: EmblemHealth Commercial |
$890.49
|
| Rate for Payer: Humana Medicare Advantage |
$305.73
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$296.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$352.76
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.87
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.53
|
|
|
REPLACE PICC CATH
|
Facility
|
OP
|
$3,931.88
|
|
|
Service Code
|
HCPCS 36584
|
| Hospital Charge Code |
16000737
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$111.67 |
| Max. Negotiated Rate |
$6,783.93 |
| Rate for Payer: Aetna Commercial |
$5,086.78
|
| Rate for Payer: Aetna Medicare Advantage |
$6,059.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,783.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,783.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,870.14
|
| 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 |
$6,783.93
|
| Rate for Payer: Cigna Commercial |
$3,748.67
|
| Rate for Payer: Cigna Medicare Advantage |
$1,870.14
|
| Rate for Payer: Clover Medicare Advantage |
$1,776.63
|
| Rate for Payer: EmblemHealth Commercial |
$5,610.42
|
| Rate for Payer: Humana Medicare Advantage |
$1,926.24
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,870.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,022.29
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$589.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$124.25
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,870.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,870.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$111.67
|
|
|
REPLACE PICC CATH
|
Facility
|
IP
|
$3,931.88
|
|
|
Service Code
|
HCPCS 36584
|
| Hospital Charge Code |
16000737
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$589.78 |
| Max. Negotiated Rate |
$589.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$589.78
|
|
|
REP LACERAT 2.5 CM/<; FLR-MOUT
|
Facility
|
OP
|
$511.12
|
|
|
Service Code
|
HCPCS 41250
|
| Hospital Charge Code |
16000960
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$14.52 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$1,443.56
|
| Rate for Payer: Aetna Medicare Advantage |
$1,719.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,925.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,925.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$530.72
|
| 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 |
$1,925.19
|
| Rate for Payer: Cigna Commercial |
$1,063.82
|
| Rate for Payer: Cigna Medicare Advantage |
$530.72
|
| Rate for Payer: Clover Medicare Advantage |
$504.18
|
| Rate for Payer: EmblemHealth Commercial |
$1,592.16
|
| Rate for Payer: Humana Medicare Advantage |
$546.64
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$530.72
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$132.89
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$76.67
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.15
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$530.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$530.72
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.52
|
|
|
REP LACERAT 2.5 CM/<; FLR-MOUT
|
Facility
|
IP
|
$511.12
|
|
|
Service Code
|
HCPCS 41250
|
| Hospital Charge Code |
16000960
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$76.67 |
| Max. Negotiated Rate |
$76.67 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$76.67
|
|
|
REPLACE REVISE BRAIN SHUNT
|
Facility
|
OP
|
$30,813.76
|
|
|
Service Code
|
HCPCS 62230
|
| Hospital Charge Code |
1600000545
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$875.11 |
| Max. Negotiated Rate |
$37,820.10 |
| Rate for Payer: Aetna Commercial |
$28,358.56
|
| Rate for Payer: Aetna Medicare Advantage |
$33,780.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$37,820.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$37,820.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$10,425.94
|
| 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 |
$37,820.10
|
| Rate for Payer: Cigna Commercial |
$20,898.76
|
| Rate for Payer: Cigna Medicare Advantage |
$10,425.94
|
| Rate for Payer: Clover Medicare Advantage |
$9,904.64
|
| Rate for Payer: EmblemHealth Commercial |
$31,277.82
|
| Rate for Payer: Humana Medicare Advantage |
$10,738.72
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$10,425.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,011.58
|
| Rate for Payer: Oxford Commercial |
$11,677.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,622.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$12,906.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$973.71
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$10,425.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$10,425.94
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$875.11
|
|
|
REPLACE REVISE BRAIN SHUNT
|
Facility
|
IP
|
$30,813.76
|
|
|
Service Code
|
HCPCS 62230
|
| Hospital Charge Code |
1600000545
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,622.06 |
| Max. Negotiated Rate |
$4,622.06 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,622.06
|
|
