|
EXC BENIGN LES DIAM 2.1-3.0 CM
|
Facility
|
OP
|
$3,472.00
|
|
|
Service Code
|
HCPCS 11443
|
| Hospital Charge Code |
75190090
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.68 |
| 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 |
$130.10
|
| 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 |
$1,041.60
|
| Rate for Payer: Oxford Commercial |
$694.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$520.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$694.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$83.68
|
| 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 |
$92.01
|
|
|
EXC BENIGN LES DIAM 2.1-3.0CM
|
Facility
|
OP
|
$3,439.81
|
|
|
Service Code
|
HCPCS 11403
|
| Hospital Charge Code |
75190045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.90 |
| Max. Negotiated Rate |
$3,036.77 |
| Rate for Payer: Aetna Commercial |
$2,288.28
|
| Rate for Payer: Aetna Medicare Advantage |
$2,725.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,036.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,036.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$841.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$206.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,036.77
|
| Rate for Payer: Cigna Commercial |
$1,686.34
|
| Rate for Payer: Cigna Medicare Advantage |
$841.28
|
| Rate for Payer: Clover Medicare Advantage |
$799.22
|
| Rate for Payer: EmblemHealth Commercial |
$2,523.84
|
| Rate for Payer: Humana Medicare Advantage |
$866.52
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$841.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,031.94
|
| Rate for Payer: Oxford Commercial |
$687.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$515.97
|
| Rate for Payer: UnitedHealthcare Commercial |
$687.96
|
| Rate for Payer: UnitedHealthcare Community & State |
$82.90
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$91.15
|
|
|
EXC BENIGN LES DIAM 2.1-3.0CM
|
Facility
|
IP
|
$3,439.81
|
|
|
Service Code
|
HCPCS 11403
|
| Hospital Charge Code |
75190045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$515.97 |
| Max. Negotiated Rate |
$515.97 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$515.97
|
|
|
EXC BENIGN LES DIAM 3.1-4.0 CM
|
Facility
|
IP
|
$7,070.14
|
|
|
Service Code
|
HCPCS 11404
|
| Hospital Charge Code |
75190050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,060.52 |
| Max. Negotiated Rate |
$1,060.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,060.52
|
|
|
EXC BENIGN LES DIAM 3.1-4.0 CM
|
Facility
|
OP
|
$7,392.00
|
|
|
Service Code
|
HCPCS 11424
|
| Hospital Charge Code |
75190070
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$178.15 |
| 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 |
$251.43
|
| 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 |
$2,217.60
|
| Rate for Payer: Oxford Commercial |
$1,478.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,108.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,478.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$178.15
|
| 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 |
$195.89
|
|
|
EXC BENIGN LES DIAM 3.1-4.0 CM
|
Facility
|
IP
|
$7,392.00
|
|
|
Service Code
|
HCPCS 11424
|
| Hospital Charge Code |
75190070
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,108.80 |
| Max. Negotiated Rate |
$1,108.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,108.80
|
|
|
EXC BENIGN LES DIAM 3.1-4.0 CM
|
Facility
|
OP
|
$7,070.14
|
|
|
Service Code
|
HCPCS 11404
|
| Hospital Charge Code |
75190050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.10 |
| 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 |
$130.10
|
| 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 |
$2,121.04
|
| Rate for Payer: Oxford Commercial |
$1,414.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,060.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,414.03
|
| Rate for Payer: UnitedHealthcare Community & State |
$170.39
|
| 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 |
$187.36
|
|
|
EXC BENIGN LES DIAM > 4.0 CM
|
Facility
|
IP
|
$7,070.14
|
|
|
Service Code
|
HCPCS 11406
|
| Hospital Charge Code |
75190055
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,060.52 |
| Max. Negotiated Rate |
$1,060.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,060.52
|
|
|
EXC BENIGN LES DIAM > 4.0 CM
|
Facility
|
OP
|
$7,070.14
|
|
|
Service Code
|
HCPCS 11406
|
| Hospital Charge Code |
75190055
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.10 |
| 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 |
$130.10
|
| 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 |
$2,121.04
|
| Rate for Payer: Oxford Commercial |
$1,414.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,060.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,414.03
|
| Rate for Payer: UnitedHealthcare Community & State |
$170.39
|
| 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 |
$187.36
|
|
|
EXC BENIGN LES DIAM > 4.0CM
|
Facility
|
IP
|
$9,771.00
|
|
|
Service Code
|
HCPCS 11426
|
| Hospital Charge Code |
75190075
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,465.65 |
| Max. Negotiated Rate |
$1,465.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,465.65
|
|
|
EXC BENIGN LES DIAM > 4.0CM
|
Facility
|
OP
|
$9,771.00
|
|
|
Service Code
|
HCPCS 11426
|
| Hospital Charge Code |
75190075
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$235.48 |
| 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 |
$355.04
|
| 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 |
$2,931.30
|
| Rate for Payer: Oxford Commercial |
$1,954.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,465.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,954.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$235.48
|
| 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 |
$258.93
|
|
|
EXC BEN LES TAL 0.6-1.0 CM
|
Facility
|
OP
|
$2,403.20
|
|
|
Service Code
|
HCPCS 11401
|
| Hospital Charge Code |
5792277
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$63.68 |
| Max. Negotiated Rate |
$1,743.30 |
| Rate for Payer: Aetna Commercial |
$1,313.62
|
| Rate for Payer: Aetna Medicare Advantage |
$1,564.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,743.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,743.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$482.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$86.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,743.30
|
| Rate for Payer: Cigna Commercial |
$968.07
|
| Rate for Payer: Cigna Medicare Advantage |
$482.95
|
| Rate for Payer: Clover Medicare Advantage |
$458.80
|
| Rate for Payer: EmblemHealth Commercial |
$1,448.85
|
| Rate for Payer: Humana Medicare Advantage |
$497.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$482.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$720.96
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$360.48
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$1,058.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$63.68
|
|
|
EXC BEN LES TAL 0.6-1.0 CM
|
Facility
|
IP
|
$2,403.20
|
|
|
Service Code
|
HCPCS 11401
|
| Hospital Charge Code |
5792277
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$360.48 |
| Max. Negotiated Rate |
$360.48 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$360.48
|
|
|
EXC BEN LES T/A/L,0.6-1.0CM
|
Facility
|
IP
|
$3,972.54
|
|
|
Service Code
|
HCPCS 11401
|
| Hospital Charge Code |
16000255
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$595.88 |
| Max. Negotiated Rate |
$595.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$595.88
|
|
|
EXC BEN LES T/A/L,0.6-1.0CM
|
Facility
|
OP
|
$3,972.54
|
|
|
Service Code
|
HCPCS 11401
|
| Hospital Charge Code |
16000255
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$95.74 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$1,313.62
|
| Rate for Payer: Aetna Medicare Advantage |
$1,564.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,743.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,743.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$482.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$862.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,743.30
|
| Rate for Payer: Cigna Commercial |
$968.07
|
| Rate for Payer: Cigna Medicare Advantage |
$482.95
|
| Rate for Payer: Clover Medicare Advantage |
$458.80
|
| Rate for Payer: EmblemHealth Commercial |
$1,448.85
|
| Rate for Payer: Humana Medicare Advantage |
$497.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$482.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,191.76
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$595.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$95.74
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$1,058.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,037.98
|
|
|
EXC BEN LES T/A/L 1.1-2.0CM
|
Facility
|
OP
|
$4,744.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
160000240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$114.33 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$1,313.62
|
| Rate for Payer: Aetna Medicare Advantage |
$1,564.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,743.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,743.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$482.95
|
| 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 |
$1,743.30
|
| Rate for Payer: Cigna Commercial |
$968.07
|
| Rate for Payer: Cigna Medicare Advantage |
$482.95
|
| Rate for Payer: Clover Medicare Advantage |
$458.80
|
| Rate for Payer: EmblemHealth Commercial |
$1,448.85
|
| Rate for Payer: Humana Medicare Advantage |
$497.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$482.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,423.20
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$711.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$114.33
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$1,058.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,037.98
|
|
|
EXC BEN LES T/A/L 1.1-2.0CM
|
Facility
|
IP
|
$4,151.00
|
|
|
Service Code
|
HCPCS 11402
|
| Hospital Charge Code |
1600000386
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$622.65 |
| Max. Negotiated Rate |
$622.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$622.65
|
|
|
EXC BEN LES T/A/L 1.1-2.0CM
|
Facility
|
OP
|
$4,151.00
|
|
|
Service Code
|
HCPCS 11402
|
| Hospital Charge Code |
1600000386
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$100.04 |
| Max. Negotiated Rate |
$3,593.00 |
| Rate for Payer: Aetna Commercial |
$2,288.28
|
| Rate for Payer: Aetna Medicare Advantage |
$2,725.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,036.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,036.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$841.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$862.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,036.77
|
| Rate for Payer: Cigna Commercial |
$1,686.34
|
| Rate for Payer: Cigna Medicare Advantage |
$841.28
|
| Rate for Payer: Clover Medicare Advantage |
$799.22
|
| Rate for Payer: EmblemHealth Commercial |
$2,523.84
|
| Rate for Payer: Humana Medicare Advantage |
$866.52
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$841.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,245.30
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$622.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,593.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$100.04
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$110.00
|
|
|
EXC BEN LES T/A/L 1.1-2.0CM
|
Facility
|
IP
|
$4,744.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
160000240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$711.60 |
| Max. Negotiated Rate |
$711.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$711.60
|
|
|
EXC BEN LES T/A/L,2.1-3.0CM
|
Facility
|
IP
|
$7,918.25
|
|
|
Service Code
|
HCPCS 11403
|
| Hospital Charge Code |
16000189
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,187.74 |
| Max. Negotiated Rate |
$1,187.74 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,187.74
|
|
|
EXC BEN LES T/A/L,2.1-3.0CM
|
Facility
|
OP
|
$7,918.25
|
|
|
Service Code
|
HCPCS 11403
|
| Hospital Charge Code |
16000189
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$190.83 |
| Max. Negotiated Rate |
$3,593.00 |
| Rate for Payer: Aetna Commercial |
$2,288.28
|
| Rate for Payer: Aetna Medicare Advantage |
$2,725.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,036.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,036.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$841.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$862.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,036.77
|
| Rate for Payer: Cigna Commercial |
$1,686.34
|
| Rate for Payer: Cigna Medicare Advantage |
$841.28
|
| Rate for Payer: Clover Medicare Advantage |
$799.22
|
| Rate for Payer: EmblemHealth Commercial |
$2,523.84
|
| Rate for Payer: Humana Medicare Advantage |
$866.52
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$841.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,375.47
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,187.74
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,593.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$190.83
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$209.83
|
|
|
EXC BEN LES T/A/L,3.1-4.0CM
|
Facility
|
IP
|
$16,853.95
|
|
|
Service Code
|
HCPCS 11404
|
| Hospital Charge Code |
16000204
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,528.09 |
| Max. Negotiated Rate |
$2,528.09 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,528.09
|
|
|
EXC BEN LES T/A/L,3.1-4.0CM
|
Facility
|
OP
|
$16,853.95
|
|
|
Service Code
|
HCPCS 11404
|
| Hospital Charge Code |
16000204
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$406.18 |
| 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 |
$862.00
|
| 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 |
$5,056.19
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,528.09
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,311.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$406.18
|
| 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 |
$446.63
|
|
|
EXC BEN LES T/A/L,> 4.0CM
|
Facility
|
IP
|
$13,615.50
|
|
|
Service Code
|
HCPCS 11406
|
| Hospital Charge Code |
16000181
|
|
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 BEN LES T/A/L,> 4.0CM
|
Facility
|
OP
|
$13,615.50
|
|
|
Service Code
|
HCPCS 11406
|
| Hospital Charge Code |
16000181
|
|
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 |
$1,016.00
|
| 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
|
|
