|
EXC PRESACR/SACROCOCCYGEAL TUM
|
Facility
|
IP
|
$9,897.60
|
|
|
Service Code
|
HCPCS 49215
|
| Hospital Charge Code |
1600000538
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,484.64 |
| Max. Negotiated Rate |
$1,484.64 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,484.64
|
|
|
EXC RECT TUM TRANSANAL FULL
|
Facility
|
IP
|
$16,148.00
|
|
|
Service Code
|
HCPCS 45172
|
| Hospital Charge Code |
1600000698
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,422.20 |
| Max. Negotiated Rate |
$2,422.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,422.20
|
|
|
EXC RECT TUM TRANSANAL FULL
|
Facility
|
OP
|
$16,148.00
|
|
|
Service Code
|
HCPCS 45172
|
| Hospital Charge Code |
1600000698
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$389.17 |
| Max. Negotiated Rate |
$11,903.20 |
| Rate for Payer: Aetna Commercial |
$8,969.36
|
| Rate for Payer: Aetna Medicare Advantage |
$10,684.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11,903.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11,903.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,297.56
|
| 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 |
$11,903.20
|
| Rate for Payer: Cigna Commercial |
$6,609.93
|
| Rate for Payer: Cigna Medicare Advantage |
$3,297.56
|
| Rate for Payer: Clover Medicare Advantage |
$3,132.68
|
| Rate for Payer: EmblemHealth Commercial |
$9,892.68
|
| Rate for Payer: Humana Medicare Advantage |
$3,396.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,297.56
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,844.40
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,422.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,232.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$389.17
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,297.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,297.56
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$427.92
|
|
|
EXC RECT TUM TRANSANAL PART
|
Facility
|
IP
|
$22,676.60
|
|
|
Service Code
|
HCPCS 45171
|
| Hospital Charge Code |
16000980
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,401.49 |
| Max. Negotiated Rate |
$3,401.49 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,401.49
|
|
|
EXC RECT TUM TRANSANAL PART
|
Facility
|
OP
|
$22,676.60
|
|
|
Service Code
|
HCPCS 45171
|
| Hospital Charge Code |
16000980
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$546.51 |
| Max. Negotiated Rate |
$11,903.20 |
| Rate for Payer: Aetna Commercial |
$8,969.36
|
| Rate for Payer: Aetna Medicare Advantage |
$10,684.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11,903.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11,903.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,297.56
|
| 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 |
$11,903.20
|
| Rate for Payer: Cigna Commercial |
$6,609.93
|
| Rate for Payer: Cigna Medicare Advantage |
$3,297.56
|
| Rate for Payer: Clover Medicare Advantage |
$3,132.68
|
| Rate for Payer: EmblemHealth Commercial |
$9,892.68
|
| Rate for Payer: Humana Medicare Advantage |
$3,396.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,297.56
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,802.98
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,401.49
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$546.51
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,297.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,297.56
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$600.93
|
|
|
EXC RECURRENT WST GANGLION
|
Facility
|
OP
|
$19,467.90
|
|
|
Service Code
|
HCPCS 25112
|
| Hospital Charge Code |
16000687
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$469.18 |
| 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 |
$1,626.00
|
| 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 |
$5,840.37
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,920.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$469.18
|
| 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 |
$515.90
|
|
|
EXC RECURRENT WST GANGLION
|
Facility
|
IP
|
$19,467.90
|
|
|
Service Code
|
HCPCS 25112
|
| Hospital Charge Code |
16000687
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,920.18 |
| Max. Negotiated Rate |
$2,920.18 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,920.18
|
|
|
EXC SHOULDER LES SC 3 CM/>
|
Facility
|
OP
|
$6,443.85
|
|
|
Service Code
|
HCPCS 23071
|
| Hospital Charge Code |
16000301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$155.30 |
| Max. Negotiated Rate |
$8,157.00 |
| 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 |
$1,742.00
|
| 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 |
$1,933.15
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$966.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$155.30
|
| 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 |
$170.76
|
|
|
EXC SHOULDER LES SC 3 CM/>
|
Facility
|
IP
|
$6,443.85
|
|
|
Service Code
|
HCPCS 23071
|
| Hospital Charge Code |
16000301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$966.58 |
| Max. Negotiated Rate |
$966.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$966.58
|
|
|
EXC SHOULDER LES SC < 3 CM LT
|
Facility
|
IP
|
$13,615.50
|
|
|
Service Code
|
HCPCS 23075
|
| Hospital Charge Code |
16000501
|
|
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 SHOULDER LES SC < 3 CM LT
|
Facility
|
OP
|
$13,615.50
|
|
|
Service Code
|
HCPCS 23075
|
| Hospital Charge Code |
16000501
|
|
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
|
|
|
EXC SHOULDER TUM DEEP 5 CM/>
|
Facility
|
IP
|
$11,141.64
|
|
|
Service Code
|
HCPCS 23073
|
| Hospital Charge Code |
16000443
|
|
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
|
|
|
EXC SHOULDER TUM DEEP 5 CM/>
|
Facility
|
OP
|
$11,141.64
|
|
|
Service Code
|
HCPCS 23073
|
| Hospital Charge Code |
16000443
|
|
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 SHOULDER TUM DEEP< 5 CM B
|
Facility
|
IP
|
$15,933.34
|
|
|
Service Code
|
HCPCS 23076
|
| Hospital Charge Code |
16000812
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,390.00 |
| Max. Negotiated Rate |
$2,390.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,390.00
|
|
|
EXC SHOULDER TUM DEEP< 5 CM B
|
Facility
|
OP
|
$15,933.34
|
|
|
Service Code
|
HCPCS 23076
|
| Hospital Charge Code |
16000812
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$383.99 |
| 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 |
$4,780.00
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,390.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,311.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$383.99
|
| 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 |
$422.23
|
|
|
EXC SKIN ABD
|
Facility
|
IP
|
$42,601.70
|
|
|
Service Code
|
HCPCS 15830
|
| Hospital Charge Code |
16000353
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,390.26 |
| Max. Negotiated Rate |
$6,390.26 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,390.26
|
|
|
EXC SKIN ABD
|
Facility
|
OP
|
$42,601.70
|
|
|
Service Code
|
HCPCS 15830
|
| Hospital Charge Code |
16000353
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,026.70 |
| Max. Negotiated Rate |
$28,475.80 |
| Rate for Payer: Aetna Commercial |
$21,457.24
|
| Rate for Payer: Aetna Medicare Advantage |
$25,559.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$28,475.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$28,475.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7,888.69
|
| 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 |
$28,475.80
|
| Rate for Payer: Cigna Commercial |
$15,812.86
|
| Rate for Payer: Cigna Medicare Advantage |
$7,888.69
|
| Rate for Payer: Clover Medicare Advantage |
$7,494.26
|
| Rate for Payer: EmblemHealth Commercial |
$23,666.07
|
| Rate for Payer: Humana Medicare Advantage |
$8,125.35
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$7,888.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12,780.51
|
| Rate for Payer: Oxford Commercial |
$7,559.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,390.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$12,870.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,026.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7,888.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$7,888.69
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,128.95
|
|
|
EXC SKIN ABD ADD-ON
|
Facility
|
IP
|
$42,601.70
|
|
|
Service Code
|
HCPCS 15847
|
| Hospital Charge Code |
16000438
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,390.26 |
| Max. Negotiated Rate |
$6,390.26 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,390.26
|
|
|
EXC SKIN ABD ADD-ON
|
Facility
|
OP
|
$42,601.70
|
|
|
Service Code
|
HCPCS 15847
|
| Hospital Charge Code |
16000438
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,026.70 |
| Max. Negotiated Rate |
$21,300.85 |
| Rate for Payer: Aetna Commercial |
$16,188.65
|
| Rate for Payer: Aetna Medicare Advantage |
$12,780.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10,863.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10,863.43
|
| 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 |
$10,863.43
|
| Rate for Payer: Cigna Commercial |
$21,300.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12,780.51
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,390.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,026.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,128.95
|
|
|
EXC SKN HDRDNT ING SMPL/NTRM
|
Facility
|
OP
|
$16,852.60
|
|
|
Service Code
|
HCPCS 11462
|
| Hospital Charge Code |
1600000500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$406.15 |
| 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 |
$5,055.78
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,527.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$406.15
|
| 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 |
$446.59
|
|
|
EXC SKN HDRDNT ING SMPL/NTRM
|
Facility
|
IP
|
$16,852.60
|
|
|
Service Code
|
HCPCS 11462
|
| Hospital Charge Code |
1600000500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,527.89 |
| Max. Negotiated Rate |
$2,527.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,527.89
|
|
|
EXC S/N/H/F/G MAL+MRG 3.1-4
|
Facility
|
IP
|
$6,322.68
|
|
|
Service Code
|
HCPCS 11624
|
| Hospital Charge Code |
16000777
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$948.40 |
| Max. Negotiated Rate |
$948.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$948.40
|
|
|
EXC S/N/H/F/G MAL+MRG 3.1-4
|
Facility
|
OP
|
$6,322.68
|
|
|
Service Code
|
HCPCS 11624
|
| Hospital Charge Code |
16000777
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$152.38 |
| 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 |
$1,896.80
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$948.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,311.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$152.38
|
| 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 |
$167.55
|
|
|
EXC S/N/H/F/G MAL+MRG > 4 CM
|
Facility
|
IP
|
$11,452.64
|
|
|
Service Code
|
HCPCS 11626
|
| Hospital Charge Code |
16000493
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,717.90 |
| Max. Negotiated Rate |
$1,717.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,717.90
|
|
|
EXC S/N/H/F/G MAL+MRG > 4 CM
|
Facility
|
OP
|
$11,452.64
|
|
|
Service Code
|
HCPCS 11626
|
| Hospital Charge Code |
16000493
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$276.01 |
| 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 |
$3,435.79
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,717.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$276.01
|
| 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 |
$303.49
|
|
