|
EXCERCISE THREE WEEK INITIAL
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
5200055
|
|
Hospital Revenue Code
|
999
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Aetna Commercial |
$11.40
|
| Rate for Payer: Aetna Medicare Advantage |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.65
|
| Rate for Payer: Cigna Commercial |
$15.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.72
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.80
|
|
|
EXCERCISE TWO WEEK INITIAL
|
Facility
|
OP
|
$20.00
|
|
| Hospital Charge Code |
5200054
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1,749.00 |
| Rate for Payer: Aetna Commercial |
$7.60
|
| Rate for Payer: Aetna Medicare Advantage |
$6.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5.10
|
| Rate for Payer: Cigna Commercial |
$10.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.00
|
| Rate for Payer: Oxford Commercial |
$997.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,749.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.53
|
|
|
EXCERCISE TWO WEEK INITIAL
|
Facility
|
IP
|
$20.00
|
|
| Hospital Charge Code |
5200054
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.00
|
|
|
EXC EXT EAR,PARTIAL SPL REPAIR
|
Facility
|
IP
|
$13,615.50
|
|
|
Service Code
|
HCPCS 69110
|
| Hospital Charge Code |
16000345
|
|
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 EXT EAR,PARTIAL SPL REPAIR
|
Facility
|
OP
|
$13,615.50
|
|
|
Service Code
|
HCPCS 69110
|
| Hospital Charge Code |
16000345
|
|
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 |
$862.00
|
| 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
|
|
|
EXC EYLID LSN WO CLOSE/SML RPR
|
Facility
|
OP
|
$7,645.60
|
|
|
Service Code
|
HCPCS 67840
|
| Hospital Charge Code |
16000774
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$184.26 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Aetna Commercial |
$3,221.35
|
| Rate for Payer: Aetna Medicare Advantage |
$3,837.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,275.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,275.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,184.32
|
| 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 |
$4,275.04
|
| Rate for Payer: Cigna Commercial |
$2,373.97
|
| Rate for Payer: Cigna Medicare Advantage |
$1,184.32
|
| Rate for Payer: Clover Medicare Advantage |
$1,125.10
|
| Rate for Payer: EmblemHealth Commercial |
$3,552.96
|
| Rate for Payer: Humana Medicare Advantage |
$1,219.85
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,184.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,293.68
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,146.84
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,311.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$184.26
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,184.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,184.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$202.61
|
|
|
EXC EYLID LSN WO CLOSE/SML RPR
|
Facility
|
IP
|
$7,645.60
|
|
|
Service Code
|
HCPCS 67840
|
| Hospital Charge Code |
16000774
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,146.84 |
| Max. Negotiated Rate |
$1,146.84 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,146.84
|
|
|
EXC FACE LES SBQ 2+ CM
|
Facility
|
OP
|
$7,918.25
|
|
|
Service Code
|
HCPCS 21012
|
| Hospital Charge Code |
16000233
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$190.83 |
| 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 |
$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 |
$1,962.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,962.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$209.83
|
|
|
EXC FACE LES SBQ 2+ CM
|
Facility
|
IP
|
$7,918.25
|
|
|
Service Code
|
HCPCS 21012
|
| Hospital Charge Code |
16000233
|
|
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 FACE LES SC < 2 CM
|
Facility
|
OP
|
$11,110.30
|
|
|
Service Code
|
HCPCS 21011
|
| Hospital Charge Code |
16000440
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$267.76 |
| 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 |
$3,333.09
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,666.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,593.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$267.76
|
| 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 |
$294.42
|
|
|
EXC FACE LES SC < 2 CM
|
Facility
|
IP
|
$11,110.30
|
|
|
Service Code
|
HCPCS 21011
|
| Hospital Charge Code |
16000440
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,666.55 |
| Max. Negotiated Rate |
$1,666.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,666.55
|
|
|
EXC FACE LES SC <2CM
|
Facility
|
OP
|
$8,662.30
|
|
|
Service Code
|
HCPCS 21011
|
| Hospital Charge Code |
323021011
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| 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) 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 |
$2,598.69
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,299.35
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| 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 |
$229.55
|
|
|
EXC FACE LES SC <2CM
|
Facility
|
IP
|
$8,662.30
|
|
|
Service Code
|
HCPCS 21011
|
| Hospital Charge Code |
323021011
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,299.35 |
| Max. Negotiated Rate |
$1,299.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,299.35
|
|
|
EXC FACE MM B9MARG 0.5CM
|
Facility
|
OP
|
$4,994.00
|
|
|
Service Code
|
HCPCS 11440
|
| Hospital Charge Code |
1600000700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$120.36 |
| 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 |
$1,016.00
|
| 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 |
$1,498.20
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$749.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,593.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$120.36
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$132.34
|
|
|
EXC FACE MM B9MARG 0.5CM
|
Facility
|
IP
|
$4,994.00
|
|
|
Service Code
|
HCPCS 11440
|
| Hospital Charge Code |
1600000700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$749.10 |
| Max. Negotiated Rate |
$749.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$749.10
|
|
|
EXC FACE-MM B9+MARG 0.6-1 CM
|
Facility
|
IP
|
$3,786.40
|
|
|
Service Code
|
HCPCS 11441
|
| Hospital Charge Code |
16000290
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$567.96 |
| Max. Negotiated Rate |
$567.96 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$567.96
|
|
|
EXC FACE-MM B9+MARG 0.6-1 CM
|
Facility
|
OP
|
$3,786.40
|
|
|
Service Code
|
HCPCS 11441
|
| Hospital Charge Code |
16000290
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$91.25 |
| 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 |
$1,135.92
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$567.96
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,593.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$91.25
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$100.34
|
|
|
EXC FACE-MM B9+MARG 1.1-2 CM
|
Facility
|
OP
|
$7,917.64
|
|
|
Service Code
|
HCPCS 11442
|
| Hospital Charge Code |
16000268
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$190.82 |
| 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 |
$2,375.29
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,187.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,593.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$190.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$209.82
|
|
|
EXC FACE-MM B9+MARG 1.1-2 CM
|
Facility
|
IP
|
$7,917.64
|
|
|
Service Code
|
HCPCS 11442
|
| Hospital Charge Code |
16000268
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,187.65 |
| Max. Negotiated Rate |
$1,187.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,187.65
|
|
|
EXC FACE-MM B9+MARG 2.1-3 CM
|
Facility
|
IP
|
$7,917.30
|
|
|
Service Code
|
HCPCS 11443
|
| Hospital Charge Code |
16000284
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,187.60 |
| Max. Negotiated Rate |
$1,187.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,187.60
|
|
|
EXC FACE-MM B9+MARG 2.1-3 CM
|
Facility
|
OP
|
$7,917.30
|
|
|
Service Code
|
HCPCS 11443
|
| Hospital Charge Code |
16000284
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$190.81 |
| 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 |
$2,375.19
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,187.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,593.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$190.81
|
| 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 |
$209.81
|
|
|
EXC FACE-MM B9+MARG 3.1-4CM E4
|
Facility
|
OP
|
$7,917.30
|
|
|
Service Code
|
HCPCS 11444
|
| Hospital Charge Code |
16000465
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$190.81 |
| 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 |
$2,375.19
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,187.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,593.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$190.81
|
| 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 |
$209.81
|
|
|
EXC FACE-MM B9+MARG 3.1-4CM E4
|
Facility
|
IP
|
$7,917.30
|
|
|
Service Code
|
HCPCS 11444
|
| Hospital Charge Code |
16000465
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,187.60 |
| Max. Negotiated Rate |
$1,187.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,187.60
|
|
|
EXC FACE-MM B9+MARG > 4 CM
|
Facility
|
OP
|
$22,279.93
|
|
|
Service Code
|
HCPCS 11446
|
| Hospital Charge Code |
16000418
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$536.95 |
| 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 |
$6,683.98
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,341.99
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$536.95
|
| 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 |
$590.42
|
|
|
EXC FACE-MM B9+MARG > 4 CM
|
Facility
|
IP
|
$22,279.93
|
|
|
Service Code
|
HCPCS 11446
|
| Hospital Charge Code |
16000418
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,341.99 |
| Max. Negotiated Rate |
$3,341.99 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,341.99
|
|
