|
EXCSN OF LNGL FRNM (FRENECTOMY
|
Facility
|
IP
|
$6,474.80
|
|
|
Service Code
|
HCPCS 41115
|
| Hospital Charge Code |
16000583
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$971.22 |
| Max. Negotiated Rate |
$971.22 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$971.22
|
|
|
EXCSN OF LNGL FRNM (FRENECTOMY
|
Facility
|
OP
|
$6,474.80
|
|
|
Service Code
|
HCPCS 41115
|
| Hospital Charge Code |
16000583
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$156.04 |
| Max. Negotiated Rate |
$6,653.83 |
| Rate for Payer: Aetna Commercial |
$5,013.83
|
| Rate for Payer: Aetna Medicare Advantage |
$5,972.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,653.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,653.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,843.32
|
| 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 |
$6,653.83
|
| Rate for Payer: Cigna Commercial |
$3,694.94
|
| Rate for Payer: Cigna Medicare Advantage |
$1,843.32
|
| Rate for Payer: Clover Medicare Advantage |
$1,751.15
|
| Rate for Payer: EmblemHealth Commercial |
$5,529.96
|
| Rate for Payer: Humana Medicare Advantage |
$1,898.62
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,843.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,942.44
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$971.22
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,311.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$156.04
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,843.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,843.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$171.58
|
|
|
EXC ST LESION EXT AUDITRY CNL
|
Facility
|
IP
|
$13,615.50
|
|
|
Service Code
|
HCPCS 69145
|
| Hospital Charge Code |
16000528
|
|
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 ST LESION EXT AUDITRY CNL
|
Facility
|
OP
|
$13,615.50
|
|
|
Service Code
|
HCPCS 69145
|
| Hospital Charge Code |
16000528
|
|
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
|
|
|
EXC SYNOVIUAL CYST POPLTEAL SP
|
Facility
|
OP
|
$105,850.92
|
|
|
Service Code
|
HCPCS 27345
|
| Hospital Charge Code |
16000880
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,626.00 |
| Max. Negotiated Rate |
$31,755.28 |
| Rate for Payer: Aetna Commercial |
$10,573.24
|
| Rate for Payer: Aetna Medicare Advantage |
$12,594.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14,031.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14,031.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,887.22
|
| 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 |
$14,031.70
|
| Rate for Payer: Cigna Commercial |
$7,791.93
|
| Rate for Payer: Cigna Medicare Advantage |
$3,887.22
|
| Rate for Payer: Clover Medicare Advantage |
$3,692.86
|
| Rate for Payer: EmblemHealth Commercial |
$11,661.66
|
| Rate for Payer: Humana Medicare Advantage |
$4,003.84
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,887.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$31,755.28
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15,877.64
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2,551.01
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,887.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,887.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2,805.05
|
|
|
EXC SYNOVIUAL CYST POPLTEAL SP
|
Facility
|
IP
|
$105,850.92
|
|
|
Service Code
|
HCPCS 27345
|
| Hospital Charge Code |
16000880
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$15,877.64 |
| Max. Negotiated Rate |
$15,877.64 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15,877.64
|
|
|
EXC TARSAL/METATRAS CYST/TUMOR
|
Facility
|
OP
|
$21,064.35
|
|
|
Service Code
|
HCPCS 28104
|
| Hospital Charge Code |
16000282
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$507.65 |
| Max. Negotiated Rate |
$14,031.70 |
| Rate for Payer: Aetna Commercial |
$10,573.24
|
| Rate for Payer: Aetna Medicare Advantage |
$12,594.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14,031.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14,031.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,887.22
|
| 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 |
$14,031.70
|
| Rate for Payer: Cigna Commercial |
$7,791.93
|
| Rate for Payer: Cigna Medicare Advantage |
$3,887.22
|
| Rate for Payer: Clover Medicare Advantage |
$3,692.86
|
| Rate for Payer: EmblemHealth Commercial |
$11,661.66
|
| Rate for Payer: Humana Medicare Advantage |
$4,003.84
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,887.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,319.31
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,159.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$507.65
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,887.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,887.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$558.21
|
|
|
EXC TARSAL/METATRAS CYST/TUMOR
|
Facility
|
IP
|
$21,064.35
|
|
|
Service Code
|
HCPCS 28104
|
| Hospital Charge Code |
16000282
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,159.65 |
| Max. Negotiated Rate |
$3,159.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,159.65
|
|
|
EXC THIGH/KNEE LES SC 3 CM/>
|
Facility
|
IP
|
$16,680.90
|
|
|
Service Code
|
HCPCS 27337
|
| Hospital Charge Code |
16000238
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,502.14 |
| Max. Negotiated Rate |
$2,502.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,502.14
|
|
|
EXC THIGH/KNEE LES SC 3 CM/>
|
Facility
|
OP
|
$16,680.90
|
|
|
Service Code
|
HCPCS 27337
|
| Hospital Charge Code |
16000238
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$402.01 |
| 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 |
$1,742.00
|
| 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 |
$5,004.27
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,502.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$402.01
|
| 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 |
$442.04
|
|
|
EXC THIGH/KNEE LES SC < 3CM
|
Facility
|
OP
|
$20,625.50
|
|
|
Service Code
|
HCPCS 27327
|
| Hospital Charge Code |
16000413
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$497.07 |
| 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 |
$1,016.00
|
| 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 |
$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 |
$1,962.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,962.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$546.58
|
|
|
EXC THIGH/KNEE LES SC < 3CM
|
Facility
|
IP
|
$20,625.50
|
|
|
Service Code
|
HCPCS 27327
|
| Hospital Charge Code |
16000413
|
|
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 THIGH/KNEE TUM DEEP <5CM
|
Facility
|
OP
|
$13,615.50
|
|
|
Service Code
|
HCPCS 27328
|
| Hospital Charge Code |
16000559
|
|
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 |
$1,355.00
|
| 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 THIGH/KNEE TUM DEEP <5CM
|
Facility
|
IP
|
$13,615.50
|
|
|
Service Code
|
HCPCS 27328
|
| Hospital Charge Code |
16000559
|
|
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 THIGH/KNEE TUM DEP 5CM/>
|
Facility
|
IP
|
$9,686.20
|
|
|
Service Code
|
HCPCS 27339
|
| Hospital Charge Code |
16000477
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,452.93 |
| Max. Negotiated Rate |
$1,452.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,452.93
|
|
|
EXC THIGH/KNEE TUM DEP 5CM/>
|
Facility
|
OP
|
$9,686.20
|
|
|
Service Code
|
HCPCS 27339
|
| Hospital Charge Code |
16000477
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$233.44 |
| 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 |
$2,905.86
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,452.93
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$233.44
|
| 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 |
$256.68
|
|
|
EXC TIB/FIB BONE CYST/TUMOR
|
Facility
|
OP
|
$30,663.00
|
|
|
Service Code
|
HCPCS 27635
|
| Hospital Charge Code |
16000891
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$738.98 |
| Max. Negotiated Rate |
$14,031.70 |
| Rate for Payer: Aetna Commercial |
$10,573.24
|
| Rate for Payer: Aetna Medicare Advantage |
$12,594.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14,031.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14,031.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,887.22
|
| 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 |
$14,031.70
|
| Rate for Payer: Cigna Commercial |
$7,791.93
|
| Rate for Payer: Cigna Medicare Advantage |
$3,887.22
|
| Rate for Payer: Clover Medicare Advantage |
$3,692.86
|
| Rate for Payer: EmblemHealth Commercial |
$11,661.66
|
| Rate for Payer: Humana Medicare Advantage |
$4,003.84
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,887.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,198.90
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,599.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,232.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$738.98
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,887.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,887.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$812.57
|
|
|
EXC TIB/FIB BONE CYST/TUMOR
|
Facility
|
IP
|
$30,663.00
|
|
|
Service Code
|
HCPCS 27635
|
| Hospital Charge Code |
16000891
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,599.45 |
| Max. Negotiated Rate |
$4,599.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,599.45
|
|
|
EXC TIB/FIG CYST/TMR W AUTGRFT
|
Facility
|
IP
|
$30,595.00
|
|
|
Service Code
|
HCPCS 27637
|
| Hospital Charge Code |
16000712
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,589.25 |
| Max. Negotiated Rate |
$4,589.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,589.25
|
|
|
EXC TIB/FIG CYST/TMR W AUTGRFT
|
Facility
|
OP
|
$30,595.00
|
|
|
Service Code
|
HCPCS 27637
|
| Hospital Charge Code |
16000712
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$737.34 |
| Max. Negotiated Rate |
$31,117.67 |
| Rate for Payer: Aetna Commercial |
$23,447.95
|
| Rate for Payer: Aetna Medicare Advantage |
$27,930.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31,117.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31,117.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8,620.57
|
| 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 |
$31,117.67
|
| Rate for Payer: Cigna Commercial |
$17,279.91
|
| Rate for Payer: Cigna Medicare Advantage |
$8,620.57
|
| Rate for Payer: Clover Medicare Advantage |
$8,189.54
|
| Rate for Payer: EmblemHealth Commercial |
$25,861.71
|
| Rate for Payer: Humana Medicare Advantage |
$8,879.19
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$8,620.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,178.50
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,589.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,232.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$737.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8,620.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$8,620.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$810.77
|
|
|
EXC TNDN SHTH LES HND/FING F1
|
Facility
|
IP
|
$16,001.80
|
|
|
Service Code
|
HCPCS 26160
|
| Hospital Charge Code |
16000350
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,400.27 |
| Max. Negotiated Rate |
$2,400.27 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,400.27
|
|
|
EXC TNDN SHTH LES HND/FING F1
|
Facility
|
OP
|
$16,001.80
|
|
|
Service Code
|
HCPCS 26160
|
| Hospital Charge Code |
16000350
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$385.64 |
| Max. Negotiated Rate |
$6,895.75 |
| 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 |
$4,800.54
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,400.27
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,311.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$385.64
|
| 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 |
$424.05
|
|
|
EXC TNDN SHTH LESIN LEG/ANK RT
|
Facility
|
OP
|
$21,417.75
|
|
|
Service Code
|
HCPCS 27630
|
| Hospital Charge Code |
16000510
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$516.17 |
| Max. Negotiated Rate |
$14,031.70 |
| Rate for Payer: Aetna Commercial |
$10,573.24
|
| Rate for Payer: Aetna Medicare Advantage |
$12,594.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14,031.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14,031.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,887.22
|
| 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 |
$14,031.70
|
| Rate for Payer: Cigna Commercial |
$7,791.93
|
| Rate for Payer: Cigna Medicare Advantage |
$3,887.22
|
| Rate for Payer: Clover Medicare Advantage |
$3,692.86
|
| Rate for Payer: EmblemHealth Commercial |
$11,661.66
|
| Rate for Payer: Humana Medicare Advantage |
$4,003.84
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,887.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,425.32
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,212.66
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$516.17
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,887.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,887.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$567.57
|
|
|
EXC TNDN SHTH LESIN LEG/ANK RT
|
Facility
|
IP
|
$21,417.75
|
|
|
Service Code
|
HCPCS 27630
|
| Hospital Charge Code |
16000510
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,212.66 |
| Max. Negotiated Rate |
$3,212.66 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,212.66
|
|
|
EXC/TRANSPOS PTERYGIUM,W GRAFT
|
Facility
|
OP
|
$20,773.00
|
|
|
Service Code
|
HCPCS 65426
|
| Hospital Charge Code |
16000773
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$500.63 |
| Max. Negotiated Rate |
$10,195.67 |
| Rate for Payer: Aetna Commercial |
$7,682.69
|
| Rate for Payer: Aetna Medicare Advantage |
$9,151.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10,195.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10,195.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,824.52
|
| 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 |
$10,195.67
|
| Rate for Payer: Cigna Commercial |
$5,661.73
|
| Rate for Payer: Cigna Medicare Advantage |
$2,824.52
|
| Rate for Payer: Clover Medicare Advantage |
$2,683.29
|
| Rate for Payer: EmblemHealth Commercial |
$8,473.56
|
| Rate for Payer: Humana Medicare Advantage |
$2,909.26
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,824.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,231.90
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,115.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$500.63
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,824.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,824.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$550.48
|
|
