|
EW FULL THREAD 2.5X 16 MM
|
Facility
|
IP
|
$962.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701484
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.38 |
| Max. Negotiated Rate |
$232.93 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$192.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$232.93
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$211.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$144.38
|
|
|
EXAM/BIOPSY VAGINA W SCOPE
|
Facility
|
IP
|
$3,267.85
|
|
|
Service Code
|
HCPCS 57421
|
| Hospital Charge Code |
412367421
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$490.18 |
| Max. Negotiated Rate |
$490.18 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$490.18
|
|
|
EXAM/BIOPSY VAGINA W SCOPE
|
Facility
|
IP
|
$3,267.85
|
|
|
Service Code
|
HCPCS 57421
|
| Hospital Charge Code |
412357421
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$490.18 |
| Max. Negotiated Rate |
$490.18 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$490.18
|
|
|
EXAM/BIOPSY VAGINA W SCOPE
|
Facility
|
OP
|
$3,267.85
|
|
|
Service Code
|
HCPCS 57421
|
| Hospital Charge Code |
412367421
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$78.76 |
| Max. Negotiated Rate |
$3,949.84 |
| Rate for Payer: Aetna Commercial |
$2,976.31
|
| Rate for Payer: Aetna Medicare Advantage |
$3,545.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,949.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,949.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,094.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,949.84
|
| Rate for Payer: Cigna Commercial |
$2,193.38
|
| Rate for Payer: Cigna Medicare Advantage |
$1,094.23
|
| Rate for Payer: Clover Medicare Advantage |
$1,039.52
|
| Rate for Payer: EmblemHealth Commercial |
$3,282.69
|
| Rate for Payer: Humana Medicare Advantage |
$1,127.06
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,094.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$980.36
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$490.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,593.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$78.76
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,094.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,094.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$86.60
|
|
|
EXAM/BIOPSY VAGINA W SCOPE
|
Facility
|
OP
|
$3,267.85
|
|
|
Service Code
|
HCPCS 57421
|
| Hospital Charge Code |
412357421
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$78.76 |
| Max. Negotiated Rate |
$3,949.84 |
| Rate for Payer: Aetna Commercial |
$2,976.31
|
| Rate for Payer: Aetna Medicare Advantage |
$3,545.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,949.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,949.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,094.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,949.84
|
| Rate for Payer: Cigna Commercial |
$2,193.38
|
| Rate for Payer: Cigna Medicare Advantage |
$1,094.23
|
| Rate for Payer: Clover Medicare Advantage |
$1,039.52
|
| Rate for Payer: EmblemHealth Commercial |
$3,282.69
|
| Rate for Payer: Humana Medicare Advantage |
$1,127.06
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,094.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$980.36
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$490.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,593.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$78.76
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,094.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,094.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$86.60
|
|
|
EXAM OF VAGINA W/SCOPE
|
Facility
|
OP
|
$1,791.15
|
|
|
Service Code
|
HCPCS 57420
|
| Hospital Charge Code |
1600000594
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$43.17 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$984.72
|
| Rate for Payer: Aetna Medicare Advantage |
$1,172.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,306.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,306.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$362.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,306.82
|
| Rate for Payer: Cigna Commercial |
$725.69
|
| Rate for Payer: Cigna Medicare Advantage |
$362.03
|
| Rate for Payer: Clover Medicare Advantage |
$343.93
|
| Rate for Payer: EmblemHealth Commercial |
$1,086.09
|
| Rate for Payer: Humana Medicare Advantage |
$372.89
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$362.03
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$537.35
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$268.67
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$43.17
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$362.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$362.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$47.47
|
|
|
EXAM OF VAGINA W/SCOPE
|
Facility
|
IP
|
$1,791.15
|
|
|
Service Code
|
HCPCS 57420
|
| Hospital Charge Code |
1600000594
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$268.67 |
| Max. Negotiated Rate |
$268.67 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$268.67
|
|
|
EXAM/SELECT ARCHIVAL TISSUE
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS 88363
|
| Hospital Charge Code |
38477059
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$9.90 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.90
|
|
|
EXAM/SELECT ARCHIVAL TISSUE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
HCPCS 88363
|
| Hospital Charge Code |
38477059
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$93.46
|
| Rate for Payer: Aetna Medicare Advantage |
$111.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$124.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$124.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$34.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$124.03
|
| Rate for Payer: Cigna Commercial |
$68.87
|
| Rate for Payer: Cigna Medicare Advantage |
$34.36
|
| Rate for Payer: Clover Medicare Advantage |
$32.64
|
| Rate for Payer: EmblemHealth Commercial |
$103.08
|
| Rate for Payer: Humana Medicare Advantage |
$35.39
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$34.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.38
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$34.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$34.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.75
|
|
|
EX ARM/ELBOW TUM DEEP < 5 CM
|
Facility
|
OP
|
$13,615.50
|
|
|
Service Code
|
HCPCS 24076
|
| Hospital Charge Code |
16000613
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$328.13 |
| Max. Negotiated Rate |
$12,456.64 |
| Rate for Payer: Aetna Commercial |
$9,386.39
|
| Rate for Payer: Aetna Medicare Advantage |
$11,180.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12,456.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12,456.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,450.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,016.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12,456.64
|
| Rate for Payer: Cigna Commercial |
$6,917.28
|
| Rate for Payer: Cigna Medicare Advantage |
$3,450.88
|
| Rate for Payer: Clover Medicare Advantage |
$3,278.34
|
| Rate for Payer: EmblemHealth Commercial |
$10,352.64
|
| Rate for Payer: Humana Medicare Advantage |
$3,554.41
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,450.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,084.65
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,042.33
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,311.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$328.13
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$360.81
|
|
|
EX ARM/ELBOW TUM DEEP < 5 CM
|
Facility
|
IP
|
$13,615.50
|
|
|
Service Code
|
HCPCS 24076
|
| Hospital Charge Code |
16000613
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,042.33 |
| Max. Negotiated Rate |
$2,042.33 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,042.33
|
|
|
EX ARM/ELBOW TUM DEEP 5 CM/>
|
Facility
|
IP
|
$11,141.64
|
|
|
Service Code
|
HCPCS 24073
|
| Hospital Charge Code |
16000391
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,671.25 |
| Max. Negotiated Rate |
$1,671.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,671.25
|
|
|
EX ARM/ELBOW TUM DEEP 5 CM/>
|
Facility
|
OP
|
$11,141.64
|
|
|
Service Code
|
HCPCS 24073
|
| Hospital Charge Code |
16000391
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$268.51 |
| Max. Negotiated Rate |
$12,456.64 |
| Rate for Payer: Aetna Commercial |
$9,386.39
|
| Rate for Payer: Aetna Medicare Advantage |
$11,180.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12,456.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12,456.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,450.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,742.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12,456.64
|
| Rate for Payer: Cigna Commercial |
$6,917.28
|
| Rate for Payer: Cigna Medicare Advantage |
$3,450.88
|
| Rate for Payer: Clover Medicare Advantage |
$3,278.34
|
| Rate for Payer: EmblemHealth Commercial |
$10,352.64
|
| Rate for Payer: Humana Medicare Advantage |
$3,554.41
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,450.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,342.49
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,671.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$268.51
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$295.25
|
|
|
EXC 1' WST GANGLION RT
|
Facility
|
IP
|
$23,750.00
|
|
|
Service Code
|
HCPCS 25111
|
| Hospital Charge Code |
16000229
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,562.50 |
| Max. Negotiated Rate |
$3,562.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,562.50
|
|
|
EXC 1' WST GANGLION RT
|
Facility
|
OP
|
$23,750.00
|
|
|
Service Code
|
HCPCS 25111
|
| Hospital Charge Code |
16000229
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$572.38 |
| Max. Negotiated Rate |
$8,157.00 |
| Rate for Payer: Aetna Commercial |
$5,196.12
|
| Rate for Payer: Aetna Medicare Advantage |
$6,189.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,895.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,895.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,910.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,355.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,895.75
|
| Rate for Payer: Cigna Commercial |
$3,829.26
|
| Rate for Payer: Cigna Medicare Advantage |
$1,910.34
|
| Rate for Payer: Clover Medicare Advantage |
$1,814.82
|
| Rate for Payer: EmblemHealth Commercial |
$5,731.02
|
| Rate for Payer: Humana Medicare Advantage |
$1,967.65
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,910.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,125.00
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,562.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$572.38
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,910.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,910.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$629.38
|
|
|
EXC ABD LES SC < 3 CM
|
Facility
|
OP
|
$13,615.50
|
|
|
Service Code
|
HCPCS 22902
|
| Hospital Charge Code |
16000499
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$328.13 |
| Max. Negotiated Rate |
$7,082.74 |
| 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 |
$7,082.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,082.74
|
| 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 |
$1,355.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,082.74
|
| 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 |
$4,084.65
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,042.33
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,311.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$328.13
|
| 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 |
$360.81
|
|
|
EXC ABD LES SC < 3 CM
|
Facility
|
IP
|
$13,615.50
|
|
|
Service Code
|
HCPCS 22902
|
| Hospital Charge Code |
16000499
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,042.33 |
| Max. Negotiated Rate |
$2,042.33 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,042.33
|
|
|
EXC ABD LES SC > 3 CM
|
Facility
|
IP
|
$23,455.00
|
|
|
Service Code
|
HCPCS 22903
|
| Hospital Charge Code |
16000254
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,518.25 |
| Max. Negotiated Rate |
$3,518.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,518.25
|
|
|
EXC ABD LES SC > 3 CM
|
Facility
|
OP
|
$23,455.00
|
|
|
Service Code
|
HCPCS 22903
|
| Hospital Charge Code |
16000254
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$565.27 |
| Max. Negotiated Rate |
$12,456.64 |
| Rate for Payer: Aetna Commercial |
$9,386.39
|
| Rate for Payer: Aetna Medicare Advantage |
$11,180.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12,456.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12,456.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,450.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,742.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12,456.64
|
| Rate for Payer: Cigna Commercial |
$6,917.28
|
| Rate for Payer: Cigna Medicare Advantage |
$3,450.88
|
| Rate for Payer: Clover Medicare Advantage |
$3,278.34
|
| Rate for Payer: EmblemHealth Commercial |
$10,352.64
|
| Rate for Payer: Humana Medicare Advantage |
$3,554.41
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,450.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,036.50
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,518.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$565.27
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$621.56
|
|
|
EXC ABDL TUM DEEP < 5 CM
|
Facility
|
OP
|
$20,625.50
|
|
|
Service Code
|
HCPCS 22900
|
| Hospital Charge Code |
16000811
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$497.07 |
| Max. Negotiated Rate |
$12,456.64 |
| Rate for Payer: Aetna Commercial |
$9,386.39
|
| Rate for Payer: Aetna Medicare Advantage |
$11,180.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12,456.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12,456.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,450.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12,456.64
|
| Rate for Payer: Cigna Commercial |
$6,917.28
|
| Rate for Payer: Cigna Medicare Advantage |
$3,450.88
|
| Rate for Payer: Clover Medicare Advantage |
$3,278.34
|
| Rate for Payer: EmblemHealth Commercial |
$10,352.64
|
| Rate for Payer: Humana Medicare Advantage |
$3,554.41
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,450.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,187.65
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,093.82
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$497.07
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$546.58
|
|
|
EXC ABDL TUM DEEP < 5 CM
|
Facility
|
IP
|
$20,625.50
|
|
|
Service Code
|
HCPCS 22900
|
| Hospital Charge Code |
16000811
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,093.82 |
| Max. Negotiated Rate |
$3,093.82 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,093.82
|
|
|
EXC ABDL TUM DEEP 5 CM/>
|
Facility
|
IP
|
$21,488.80
|
|
|
Service Code
|
HCPCS 22901
|
| Hospital Charge Code |
16000470
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,223.32 |
| Max. Negotiated Rate |
$3,223.32 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,223.32
|
|
|
EXC ABDL TUM DEEP 5 CM/>
|
Facility
|
OP
|
$21,488.80
|
|
|
Service Code
|
HCPCS 22901
|
| Hospital Charge Code |
16000470
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$517.88 |
| Max. Negotiated Rate |
$12,456.64 |
| Rate for Payer: Aetna Commercial |
$9,386.39
|
| Rate for Payer: Aetna Medicare Advantage |
$11,180.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12,456.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12,456.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,450.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,742.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12,456.64
|
| Rate for Payer: Cigna Commercial |
$6,917.28
|
| Rate for Payer: Cigna Medicare Advantage |
$3,450.88
|
| Rate for Payer: Clover Medicare Advantage |
$3,278.34
|
| Rate for Payer: EmblemHealth Commercial |
$10,352.64
|
| Rate for Payer: Humana Medicare Advantage |
$3,554.41
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,450.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,446.64
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,223.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$517.88
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$569.45
|
|
|
EXC ABD TUM 5 CM OR LESS
|
Facility
|
OP
|
$13,300.00
|
|
|
Service Code
|
HCPCS 49203
|
| Hospital Charge Code |
16000986
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$320.53 |
| Max. Negotiated Rate |
$8,157.00 |
| Rate for Payer: Aetna Commercial |
$5,054.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,990.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,391.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,391.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,391.50
|
| Rate for Payer: Cigna Commercial |
$6,650.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,990.00
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,995.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$320.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$352.45
|
|
|
EXC ABD TUM 5 CM OR LESS
|
Facility
|
IP
|
$13,300.00
|
|
|
Service Code
|
HCPCS 49203
|
| Hospital Charge Code |
16000986
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$1,995.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,995.00
|
|
