|
VENOUS MAPPING UPPER EXT BI
|
Facility
|
OP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
2692225
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$269.30 |
| Max. Negotiated Rate |
$7,555.00 |
| Rate for Payer: Aetna Commercial |
$771.04
|
| Rate for Payer: Aetna Medicare Advantage |
$918.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,028.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,028.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$283.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$496.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,028.29
|
| Rate for Payer: Cigna Commercial |
$568.20
|
| Rate for Payer: Cigna Medicare Advantage |
$283.47
|
| Rate for Payer: Clover Medicare Advantage |
$269.30
|
| Rate for Payer: EmblemHealth Commercial |
$850.41
|
| Rate for Payer: Humana Medicare Advantage |
$291.97
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$283.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,472.00
|
| Rate for Payer: Oxford Commercial |
$6,888.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$7,555.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$543.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$283.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$283.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$488.48
|
|
|
VENOUS MAPPING UPPER EXT BI
|
Facility
|
OP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
74115047
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$269.30 |
| Max. Negotiated Rate |
$7,555.00 |
| Rate for Payer: Aetna Commercial |
$771.04
|
| Rate for Payer: Aetna Medicare Advantage |
$918.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,028.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,028.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$283.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$496.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,028.29
|
| Rate for Payer: Cigna Commercial |
$568.20
|
| Rate for Payer: Cigna Medicare Advantage |
$283.47
|
| Rate for Payer: Clover Medicare Advantage |
$269.30
|
| Rate for Payer: EmblemHealth Commercial |
$850.41
|
| Rate for Payer: Humana Medicare Advantage |
$291.97
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$283.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,472.00
|
| Rate for Payer: Oxford Commercial |
$6,888.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$7,555.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$543.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$283.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$283.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$488.48
|
|
|
VENOUS MAPPING UPPER EXT BI
|
Facility
|
IP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
2692225
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$2,580.00 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
|
|
VENOUS MAPPING UPPER EXT LT
|
Facility
|
IP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
2692230
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$2,580.00 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
|
|
VENOUS MAPPING UPPER EXT LT
|
Facility
|
OP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
2692230
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$117.99 |
| Max. Negotiated Rate |
$7,555.00 |
| 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 |
$479.60
|
| 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 |
$4,472.00
|
| Rate for Payer: Oxford Commercial |
$6,888.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$7,555.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$543.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$488.48
|
|
|
VENOUS MAPPING UPPER EXT RT
|
Facility
|
IP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
2692235
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$2,580.00 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
|
|
VENOUS MAPPING UPPER EXT RT
|
Facility
|
OP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
74115065
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$117.99 |
| Max. Negotiated Rate |
$7,555.00 |
| 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 |
$479.60
|
| 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 |
$4,472.00
|
| Rate for Payer: Oxford Commercial |
$6,888.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$7,555.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$543.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$488.48
|
|
|
VENOUS MAPPING UPPER EXT RT
|
Facility
|
IP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
74115065
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$2,580.00 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
|
|
VENOUS MAPPING UPPER EXT RT
|
Facility
|
OP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
2692235
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$117.99 |
| Max. Negotiated Rate |
$7,555.00 |
| 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 |
$479.60
|
| 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 |
$4,472.00
|
| Rate for Payer: Oxford Commercial |
$6,888.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$7,555.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$543.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$488.48
|
|
|
VENOUS MECH THROMBECTOMY
|
Facility
|
IP
|
$20,340.00
|
|
|
Service Code
|
HCPCS 37187
|
| Hospital Charge Code |
16000953
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,051.00 |
| Max. Negotiated Rate |
$3,051.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,051.00
|
|
|
VENOUS MECH THROMBECTOMY
|
Facility
|
OP
|
$20,340.00
|
|
|
Service Code
|
HCPCS 37187
|
| Hospital Charge Code |
16000953
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$577.66 |
| 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 |
$5,288.40
|
| Rate for Payer: Oxford Commercial |
$13,407.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,051.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,869.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$642.74
|
| 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 |
$577.66
|
|
|
VENTANA C INTERBODY 14X11X6MM
|
Facility
|
IP
|
$5,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$1,331.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,331.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$825.00
|
|
|
VENTANA C INTERBODY 14X11X6MM
|
Facility
|
OP
|
$5,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.20 |
| Max. Negotiated Rate |
$2,750.00 |
| Rate for Payer: Aetna Commercial |
$2,090.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,402.50
|
| Rate for Payer: Cigna Commercial |
$2,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,331.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$825.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$173.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$156.20
|
|
|
VENTILATOR ASSIST AND MANAGEM
|
Facility
|
IP
|
$2,375.50
|
|
|
Service Code
|
HCPCS 94002
|
| Hospital Charge Code |
1600000668
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$356.32 |
| Max. Negotiated Rate |
$356.32 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$356.32
|
|
|
VENTILATOR ASSIST AND MANAGEM
|
Facility
|
OP
|
$2,375.50
|
|
|
Service Code
|
HCPCS 94002
|
| Hospital Charge Code |
1600000668
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$67.46 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$1,996.34
|
| Rate for Payer: Aetna Medicare Advantage |
$2,378.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,662.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,662.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$733.95
|
| 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 |
$2,662.40
|
| Rate for Payer: Cigna Commercial |
$1,471.21
|
| Rate for Payer: Cigna Medicare Advantage |
$733.95
|
| Rate for Payer: Clover Medicare Advantage |
$697.25
|
| Rate for Payer: EmblemHealth Commercial |
$2,201.85
|
| Rate for Payer: Humana Medicare Advantage |
$755.97
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$733.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$617.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$356.32
|
| Rate for Payer: UnitedHealthcare Community & State |
$75.07
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$733.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$733.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$67.46
|
|
|
VENTILATOR MGMT ADULT - SUBSEQ
|
Facility
|
IP
|
$2,375.50
|
|
|
Service Code
|
HCPCS 94003
|
| Hospital Charge Code |
1600000669
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$356.32 |
| Max. Negotiated Rate |
$356.32 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$356.32
|
|
|
VENTILATOR MGMT ADULT - SUBSEQ
|
Facility
|
OP
|
$2,375.50
|
|
|
Service Code
|
HCPCS 94003
|
| Hospital Charge Code |
1600000669
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$67.46 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$1,996.34
|
| Rate for Payer: Aetna Medicare Advantage |
$2,378.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,662.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,662.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$733.95
|
| 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 |
$2,662.40
|
| Rate for Payer: Cigna Commercial |
$1,471.21
|
| Rate for Payer: Cigna Medicare Advantage |
$733.95
|
| Rate for Payer: Clover Medicare Advantage |
$697.25
|
| Rate for Payer: EmblemHealth Commercial |
$2,201.85
|
| Rate for Payer: Humana Medicare Advantage |
$755.97
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$733.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$617.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$356.32
|
| Rate for Payer: UnitedHealthcare Community & State |
$75.07
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$733.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$733.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$67.46
|
|
|
Ventiscan Kit
|
Facility
|
OP
|
$2,421.17
|
|
| Hospital Charge Code |
4509092
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$68.76 |
| Max. Negotiated Rate |
$1,210.59 |
| Rate for Payer: Aetna Commercial |
$920.04
|
| Rate for Payer: Aetna Medicare Advantage |
$726.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$617.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$617.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$617.40
|
| Rate for Payer: Cigna Commercial |
$1,210.59
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$629.50
|
| Rate for Payer: Oxford Commercial |
$484.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$363.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$484.23
|
| Rate for Payer: UnitedHealthcare Community & State |
$76.51
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$68.76
|
|
|
Ventiscan Kit
|
Facility
|
IP
|
$2,421.17
|
|
| Hospital Charge Code |
4509092
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$363.18 |
| Max. Negotiated Rate |
$363.18 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$363.18
|
|
|
VENTRALIGHT ST
|
Facility
|
IP
|
$4,700.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270685166
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$705.00 |
| Max. Negotiated Rate |
$1,137.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$940.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,137.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$705.00
|
|
|
VENTRALIGHT ST
|
Facility
|
OP
|
$4,700.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270685166
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$133.48 |
| Max. Negotiated Rate |
$2,350.00 |
| Rate for Payer: Aetna Commercial |
$1,786.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,410.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,198.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,198.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$940.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,198.50
|
| Rate for Payer: Cigna Commercial |
$2,350.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,137.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$705.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$148.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$133.48
|
|
|
VENTRALIGHT ST MESH WECHO 2
|
Facility
|
IP
|
$6,000.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
270686763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$1,452.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,452.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$900.00
|
|
|
VENTRALIGHT ST MESH WECHO 2
|
Facility
|
OP
|
$6,000.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
270686763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.40 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,280.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,530.00
|
| Rate for Payer: Cigna Commercial |
$3,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,452.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$900.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$189.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$170.40
|
|
|
VENTRALIGHT ST MESH WITH ECHO
|
Facility
|
IP
|
$8,750.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270686899
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,312.50 |
| Max. Negotiated Rate |
$2,117.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,117.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,312.50
|
|
|
VENTRALIGHT ST MESH WITH ECHO
|
Facility
|
OP
|
$8,750.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270686899
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$248.50 |
| Max. Negotiated Rate |
$4,375.00 |
| Rate for Payer: Aetna Commercial |
$3,325.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,625.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,231.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,231.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,231.25
|
| Rate for Payer: Cigna Commercial |
$4,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,117.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,312.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$276.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$248.50
|
|
