|
TRANSPLT AUTOL HCT/DONOR
|
Facility
|
OP
|
$6,717.80
|
|
|
Service Code
|
HCPCS 38241
|
| Hospital Charge Code |
16000956
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$190.79 |
| Max. Negotiated Rate |
$6,711.82 |
| Rate for Payer: Aetna Commercial |
$5,032.71
|
| Rate for Payer: Aetna Medicare Advantage |
$5,994.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,711.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,711.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,850.26
|
| 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 |
$6,711.82
|
| Rate for Payer: Cigna Commercial |
$3,708.85
|
| Rate for Payer: Cigna Medicare Advantage |
$1,850.26
|
| Rate for Payer: Clover Medicare Advantage |
$1,757.75
|
| Rate for Payer: EmblemHealth Commercial |
$5,550.78
|
| Rate for Payer: Humana Medicare Advantage |
$1,905.77
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,850.26
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,746.63
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,007.67
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$212.28
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,850.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,850.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$190.79
|
|
|
TRANSPLT AUTOL HCT/DONOR
|
Facility
|
IP
|
$6,717.80
|
|
|
Service Code
|
HCPCS 38241
|
| Hospital Charge Code |
16000956
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,007.67 |
| Max. Negotiated Rate |
$1,007.67 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,007.67
|
|
|
TRANSTELEPHONIC PACE CK D/S
|
Facility
|
IP
|
$649.00
|
|
|
Service Code
|
HCPCS 93293
|
| Hospital Charge Code |
5300120
|
|
Hospital Revenue Code
|
732
|
| Min. Negotiated Rate |
$97.35 |
| Max. Negotiated Rate |
$97.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$97.35
|
|
|
TRANSTELEPHONIC PACE CK D/S
|
Facility
|
OP
|
$649.00
|
|
|
Service Code
|
HCPCS 93293
|
| Hospital Charge Code |
5300120
|
|
Hospital Revenue Code
|
732
|
| Min. Negotiated Rate |
$18.43 |
| Max. Negotiated Rate |
$2,460.00 |
| Rate for Payer: Aetna Commercial |
$120.60
|
| Rate for Payer: Aetna Medicare Advantage |
$143.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$160.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$160.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$44.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$36.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$160.84
|
| Rate for Payer: Cigna Commercial |
$88.88
|
| Rate for Payer: Cigna Medicare Advantage |
$44.34
|
| Rate for Payer: Clover Medicare Advantage |
$42.12
|
| Rate for Payer: EmblemHealth Commercial |
$133.02
|
| Rate for Payer: Humana Medicare Advantage |
$45.67
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$44.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$168.74
|
| Rate for Payer: Oxford Commercial |
$2,169.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$97.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,460.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.51
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$44.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$44.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.43
|
|
|
TRANSUR ELECTR RESECT OF PROST
|
Facility
|
IP
|
$34,504.00
|
|
|
Service Code
|
HCPCS 52601
|
| Hospital Charge Code |
1600000271
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,175.60 |
| Max. Negotiated Rate |
$5,175.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,175.60
|
|
|
TRANSUR ELECTR RESECT OF PROST
|
Facility
|
OP
|
$34,504.00
|
|
|
Service Code
|
HCPCS 52601
|
| Hospital Charge Code |
1600000271
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$979.91 |
| Max. Negotiated Rate |
$23,107.03 |
| Rate for Payer: Aetna Commercial |
$17,326.29
|
| Rate for Payer: Aetna Medicare Advantage |
$20,638.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,107.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,107.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,369.96
|
| 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 |
$23,107.03
|
| Rate for Payer: Cigna Commercial |
$12,768.54
|
| Rate for Payer: Cigna Medicare Advantage |
$6,369.96
|
| Rate for Payer: Clover Medicare Advantage |
$6,051.46
|
| Rate for Payer: EmblemHealth Commercial |
$19,109.88
|
| Rate for Payer: Humana Medicare Advantage |
$6,561.06
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,369.96
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,971.04
|
| Rate for Payer: Oxford Commercial |
$11,677.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,175.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$12,906.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,090.33
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,369.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,369.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$979.91
|
|
|
TRANSUR ELECTR RESECT OF PROST
|
Facility
|
IP
|
$34,504.00
|
|
|
Service Code
|
HCPCS 52601
|
| Hospital Charge Code |
1600000259
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,175.60 |
| Max. Negotiated Rate |
$5,175.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,175.60
|
|
|
TRANSUR ELECTR RESECT OF PROST
|
Facility
|
OP
|
$34,504.00
|
|
|
Service Code
|
HCPCS 52601
|
| Hospital Charge Code |
1600000259
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$979.91 |
| Max. Negotiated Rate |
$23,107.03 |
| Rate for Payer: Aetna Commercial |
$17,326.29
|
| Rate for Payer: Aetna Medicare Advantage |
$20,638.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,107.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,107.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,369.96
|
| 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 |
$23,107.03
|
| Rate for Payer: Cigna Commercial |
$12,768.54
|
| Rate for Payer: Cigna Medicare Advantage |
$6,369.96
|
| Rate for Payer: Clover Medicare Advantage |
$6,051.46
|
| Rate for Payer: EmblemHealth Commercial |
$19,109.88
|
| Rate for Payer: Humana Medicare Advantage |
$6,561.06
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,369.96
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,971.04
|
| Rate for Payer: Oxford Commercial |
$11,677.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,175.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$12,906.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,090.33
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,369.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,369.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$979.91
|
|
|
TRANSURETHRAL PROCEDURES WITH CC
|
Facility
|
IP
|
$68,497.88
|
|
|
Service Code
|
MSDRG 669
|
| Min. Negotiated Rate |
$20,856.73 |
| Max. Negotiated Rate |
$68,497.88 |
| Rate for Payer: Aetna Commercial |
$50,643.48
|
| Rate for Payer: Aetna Medicare Advantage |
$68,497.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$42,388.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$42,388.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$21,954.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$42,388.65
|
| Rate for Payer: Cigna Commercial |
$34,598.74
|
| Rate for Payer: Cigna Medicare Advantage |
$21,954.45
|
| Rate for Payer: Clover Medicare Advantage |
$20,856.73
|
| Rate for Payer: EmblemHealth Commercial |
$65,863.35
|
| Rate for Payer: Humana Medicare Advantage |
$22,613.08
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$21,954.45
|
| Rate for Payer: Oxford Commercial |
$27,346.24
|
| Rate for Payer: UnitedHealthcare Commercial |
$36,603.92
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$21,954.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$21,954.45
|
|
|
TRANSURETHRAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$111,717.81
|
|
|
Service Code
|
MSDRG 668
|
| Min. Negotiated Rate |
$34,016.64 |
| Max. Negotiated Rate |
$111,717.81 |
| Rate for Payer: Aetna Commercial |
$81,425.21
|
| Rate for Payer: Aetna Medicare Advantage |
$111,717.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$78,128.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$78,128.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$35,806.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$78,128.10
|
| Rate for Payer: Cigna Commercial |
$65,095.56
|
| Rate for Payer: Cigna Medicare Advantage |
$35,806.99
|
| Rate for Payer: Clover Medicare Advantage |
$34,016.64
|
| Rate for Payer: EmblemHealth Commercial |
$107,420.97
|
| Rate for Payer: Humana Medicare Advantage |
$36,881.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$35,806.99
|
| Rate for Payer: Oxford Commercial |
$51,450.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$68,868.20
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$35,806.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$35,806.99
|
|
|
TRANSURETHRAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$50,341.01
|
|
|
Service Code
|
MSDRG 670
|
| Min. Negotiated Rate |
$15,328.19 |
| Max. Negotiated Rate |
$50,341.01 |
| Rate for Payer: Aetna Commercial |
$37,711.95
|
| Rate for Payer: Aetna Medicare Advantage |
$50,341.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$26,596.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$26,596.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16,134.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$26,596.80
|
| Rate for Payer: Cigna Commercial |
$21,786.95
|
| Rate for Payer: Cigna Medicare Advantage |
$16,134.94
|
| Rate for Payer: Clover Medicare Advantage |
$15,328.19
|
| Rate for Payer: EmblemHealth Commercial |
$48,404.82
|
| Rate for Payer: Humana Medicare Advantage |
$16,618.99
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16,134.94
|
| Rate for Payer: Oxford Commercial |
$17,220.03
|
| Rate for Payer: UnitedHealthcare Commercial |
$23,049.62
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16,134.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$16,134.94
|
|
|
TRANSURETHRAL PROSTATECTOMY
|
Facility
|
IP
|
$22,134.44
|
|
|
Service Code
|
APR-DRG 4823
|
| Min. Negotiated Rate |
$21,700.43 |
| Max. Negotiated Rate |
$22,134.44 |
| Rate for Payer: UnitedHealthcare Community & State |
$21,700.43
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$22,134.44
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21,700.43
|
|
|
TRANSURETHRAL PROSTATECTOMY
|
Facility
|
IP
|
$37,197.83
|
|
|
Service Code
|
APR-DRG 4824
|
| Min. Negotiated Rate |
$36,468.46 |
| Max. Negotiated Rate |
$37,197.83 |
| Rate for Payer: UnitedHealthcare Community & State |
$36,468.46
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$37,197.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$36,468.46
|
|
|
TRANSURETHRAL PROSTATECTOMY
|
Facility
|
IP
|
$9,819.46
|
|
|
Service Code
|
APR-DRG 4821
|
| Min. Negotiated Rate |
$9,626.92 |
| Max. Negotiated Rate |
$9,819.46 |
| Rate for Payer: UnitedHealthcare Community & State |
$9,626.92
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$9,819.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9,626.92
|
|
|
TRANSURETHRAL PROSTATECTOMY
|
Facility
|
IP
|
$12,156.36
|
|
|
Service Code
|
APR-DRG 4822
|
| Min. Negotiated Rate |
$11,918.00 |
| Max. Negotiated Rate |
$12,156.36 |
| Rate for Payer: UnitedHealthcare Community & State |
$11,918.00
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$12,156.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11,918.00
|
|
|
TRANSURETHRAL PROSTATECTOMY WITH CC/MCC
|
Facility
|
IP
|
$66,962.44
|
|
|
Service Code
|
MSDRG 713
|
| Min. Negotiated Rate |
$20,389.20 |
| Max. Negotiated Rate |
$66,962.44 |
| Rate for Payer: Aetna Commercial |
$49,549.90
|
| Rate for Payer: Aetna Medicare Advantage |
$66,962.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$40,172.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$40,172.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$21,462.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$40,172.25
|
| Rate for Payer: Cigna Commercial |
$33,515.30
|
| Rate for Payer: Cigna Medicare Advantage |
$21,462.32
|
| Rate for Payer: Clover Medicare Advantage |
$20,389.20
|
| Rate for Payer: EmblemHealth Commercial |
$64,386.96
|
| Rate for Payer: Humana Medicare Advantage |
$22,106.19
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$21,462.32
|
| Rate for Payer: Oxford Commercial |
$26,489.91
|
| Rate for Payer: UnitedHealthcare Commercial |
$35,457.69
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$21,462.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$21,462.32
|
|
|
TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$52,871.68
|
|
|
Service Code
|
MSDRG 714
|
| Min. Negotiated Rate |
$16,098.75 |
| Max. Negotiated Rate |
$52,871.68 |
| Rate for Payer: Aetna Commercial |
$39,514.33
|
| Rate for Payer: Aetna Medicare Advantage |
$52,871.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$26,596.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$26,596.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16,946.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$26,596.80
|
| Rate for Payer: Cigna Commercial |
$23,572.62
|
| Rate for Payer: Cigna Medicare Advantage |
$16,946.05
|
| Rate for Payer: Clover Medicare Advantage |
$16,098.75
|
| Rate for Payer: EmblemHealth Commercial |
$50,838.15
|
| Rate for Payer: Humana Medicare Advantage |
$17,454.43
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16,946.05
|
| Rate for Payer: Oxford Commercial |
$18,631.39
|
| Rate for Payer: UnitedHealthcare Commercial |
$24,938.78
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16,946.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$16,946.05
|
|
|
TRANSURETHRAL RSCTN BLDDR NECK
|
Facility
|
IP
|
$23,841.70
|
|
|
Service Code
|
HCPCS 52500
|
| Hospital Charge Code |
1600000310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,576.26 |
| Max. Negotiated Rate |
$3,576.26 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,576.26
|
|
|
TRANSURETHRAL RSCTN BLDDR NECK
|
Facility
|
OP
|
$23,841.70
|
|
|
Service Code
|
HCPCS 52500
|
| Hospital Charge Code |
1600000310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$677.10 |
| Max. Negotiated Rate |
$15,191.14 |
| Rate for Payer: Aetna Commercial |
$11,390.73
|
| Rate for Payer: Aetna Medicare Advantage |
$13,568.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15,191.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15,191.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4,187.77
|
| 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 |
$15,191.14
|
| Rate for Payer: Cigna Commercial |
$8,394.37
|
| Rate for Payer: Cigna Medicare Advantage |
$4,187.77
|
| Rate for Payer: Clover Medicare Advantage |
$3,978.38
|
| Rate for Payer: EmblemHealth Commercial |
$12,563.31
|
| Rate for Payer: Humana Medicare Advantage |
$4,313.40
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4,187.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,198.84
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,576.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$753.40
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4,187.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$4,187.77
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$677.10
|
|
|
TRANSVAGINAL
|
Facility
|
IP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76830
|
| Hospital Charge Code |
94061177
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,005.00 |
| Max. Negotiated Rate |
$1,005.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,005.00
|
|
|
TRANSVAGINAL
|
Facility
|
OP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76830
|
| Hospital Charge Code |
94061177
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$117.99 |
| Max. Negotiated Rate |
$2,904.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$121.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$450.54
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,742.00
|
| Rate for Payer: Oxford Commercial |
$2,697.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,005.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,904.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$211.72
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$190.28
|
|
|
TRANSVAGINAL US, OBSTETRIC
|
Facility
|
OP
|
$2,298.80
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
83653080
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$65.29 |
| Max. Negotiated Rate |
$2,904.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$133.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$450.54
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$597.69
|
| Rate for Payer: Oxford Commercial |
$2,697.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$344.82
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,904.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$72.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$65.29
|
|
|
TRANSVAGINAL US, OBSTETRIC
|
Facility
|
IP
|
$2,298.80
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
83653080
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$344.82 |
| Max. Negotiated Rate |
$344.82 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$344.82
|
|
|
TRAPEZOID 2cm
|
Facility
|
OP
|
$2,743.10
|
|
| Hospital Charge Code |
270674941
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.90 |
| Max. Negotiated Rate |
$1,371.55 |
| Rate for Payer: Aetna Commercial |
$1,042.38
|
| Rate for Payer: Aetna Medicare Advantage |
$822.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$699.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$699.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$699.49
|
| Rate for Payer: Cigna Commercial |
$1,371.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$713.21
|
| Rate for Payer: Oxford Commercial |
$548.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$411.46
|
| Rate for Payer: UnitedHealthcare Commercial |
$548.62
|
| Rate for Payer: UnitedHealthcare Community & State |
$86.68
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$77.90
|
|
|
TRAPEZOID 2cm
|
Facility
|
IP
|
$2,743.10
|
|
| Hospital Charge Code |
270674941
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$411.46 |
| Max. Negotiated Rate |
$411.46 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$411.46
|
|
