|
FELT ORTH 1/2TH 21/36
|
Facility
|
OP
|
$740.00
|
|
| Hospital Charge Code |
270300910
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.83 |
| Max. Negotiated Rate |
$370.00 |
| Rate for Payer: Aetna Commercial |
$281.20
|
| Rate for Payer: Aetna Medicare Advantage |
$222.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$188.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$188.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$188.70
|
| Rate for Payer: Cigna Commercial |
$370.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$222.00
|
| Rate for Payer: Oxford Commercial |
$148.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$148.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.61
|
|
|
FELT SURGICAL SUPPORT 4x4
|
Facility
|
IP
|
$51.45
|
|
| Hospital Charge Code |
270654566
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$7.72 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.72
|
|
|
FELT SURGICAL SUPPORT 4x4
|
Facility
|
OP
|
$51.45
|
|
| Hospital Charge Code |
270654566
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$25.73 |
| Rate for Payer: Aetna Commercial |
$19.55
|
| Rate for Payer: Aetna Medicare Advantage |
$15.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.12
|
| Rate for Payer: Cigna Commercial |
$25.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.44
|
| Rate for Payer: Oxford Commercial |
$10.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.72
|
| Rate for Payer: UnitedHealthcare Commercial |
$10.29
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.36
|
|
|
FEMADPTBIOLOXD 16/18 12-14 7MM
|
Facility
|
IP
|
$937.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270697543
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.62 |
| Max. Negotiated Rate |
$226.88 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$187.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$226.88
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$206.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$140.62
|
|
|
FEMADPTBIOLOXD 16/18 12-14 7MM
|
Facility
|
OP
|
$937.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270697543
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.59 |
| Max. Negotiated Rate |
$468.75 |
| Rate for Payer: Aetna Commercial |
$356.25
|
| Rate for Payer: Aetna Medicare Advantage |
$281.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$239.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$239.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$187.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$239.06
|
| Rate for Payer: Cigna Commercial |
$468.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$226.88
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$206.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$140.62
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.84
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
|
IP
|
$6,112.88
|
|
|
Service Code
|
APR-DRG 5311
|
| Min. Negotiated Rate |
$5,993.02 |
| Max. Negotiated Rate |
$6,112.88 |
| Rate for Payer: UnitedHealthcare Community & State |
$5,993.02
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$6,112.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5,993.02
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
|
IP
|
$8,006.23
|
|
|
Service Code
|
APR-DRG 5312
|
| Min. Negotiated Rate |
$7,849.25 |
| Max. Negotiated Rate |
$8,006.23 |
| Rate for Payer: UnitedHealthcare Community & State |
$7,849.25
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$8,006.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7,849.25
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
|
IP
|
$21,116.79
|
|
|
Service Code
|
APR-DRG 5314
|
| Min. Negotiated Rate |
$20,702.74 |
| Max. Negotiated Rate |
$21,116.79 |
| Rate for Payer: UnitedHealthcare Community & State |
$20,702.74
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$21,116.79
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20,702.74
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
|
IP
|
$12,376.45
|
|
|
Service Code
|
APR-DRG 5313
|
| Min. Negotiated Rate |
$12,133.77 |
| Max. Negotiated Rate |
$12,376.45 |
| Rate for Payer: UnitedHealthcare Community & State |
$12,133.77
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$12,376.45
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12,133.77
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
IP
|
$8,936.96
|
|
|
Service Code
|
APR-DRG 5302
|
| Min. Negotiated Rate |
$8,761.73 |
| Max. Negotiated Rate |
$8,936.96 |
| Rate for Payer: UnitedHealthcare Community & State |
$8,761.73
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$8,936.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8,761.73
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
IP
|
$13,359.45
|
|
|
Service Code
|
APR-DRG 5303
|
| Min. Negotiated Rate |
$13,097.50 |
| Max. Negotiated Rate |
$13,359.45 |
| Rate for Payer: UnitedHealthcare Community & State |
$13,097.50
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$13,359.45
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13,097.50
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
IP
|
$21,262.32
|
|
|
Service Code
|
APR-DRG 5304
|
| Min. Negotiated Rate |
$20,845.41 |
| Max. Negotiated Rate |
$21,262.32 |
| Rate for Payer: UnitedHealthcare Community & State |
$20,845.41
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$21,262.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20,845.41
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
IP
|
$6,781.87
|
|
|
Service Code
|
APR-DRG 5301
|
| Min. Negotiated Rate |
$6,648.89 |
| Max. Negotiated Rate |
$6,781.87 |
| Rate for Payer: UnitedHealthcare Community & State |
$6,648.89
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$6,781.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6,648.89
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$9,971.13
|
|
|
Service Code
|
APR-DRG 5141
|
| Min. Negotiated Rate |
$9,775.62 |
| Max. Negotiated Rate |
$9,971.13 |
| Rate for Payer: UnitedHealthcare Community & State |
$9,775.62
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$9,971.13
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9,775.62
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$14,880.03
|
|
|
Service Code
|
APR-DRG 5142
|
| Min. Negotiated Rate |
$14,588.26 |
| Max. Negotiated Rate |
$14,880.03 |
| Rate for Payer: UnitedHealthcare Community & State |
$14,588.26
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$14,880.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14,588.26
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$46,973.91
|
|
|
Service Code
|
MSDRG 748
|
| Min. Negotiated Rate |
$14,302.95 |
| Max. Negotiated Rate |
$46,973.91 |
| Rate for Payer: Aetna Commercial |
$32,533.75
|
| Rate for Payer: Aetna Medicare Advantage |
$46,973.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$32,565.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$32,565.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15,055.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$32,565.40
|
| Rate for Payer: Cigna Commercial |
$25,961.93
|
| Rate for Payer: Cigna Medicare Advantage |
$15,055.74
|
| Rate for Payer: Clover Medicare Advantage |
$14,302.95
|
| Rate for Payer: EmblemHealth Commercial |
$45,167.22
|
| Rate for Payer: Humana Medicare Advantage |
$15,507.41
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15,055.74
|
| Rate for Payer: Oxford Commercial |
$18,659.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$32,719.47
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15,055.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$15,055.74
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$25,101.38
|
|
|
Service Code
|
APR-DRG 5143
|
| Min. Negotiated Rate |
$24,609.20 |
| Max. Negotiated Rate |
$25,101.38 |
| Rate for Payer: UnitedHealthcare Community & State |
$24,609.20
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$25,101.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24,609.20
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$51,188.35
|
|
|
Service Code
|
APR-DRG 5144
|
| Min. Negotiated Rate |
$50,184.66 |
| Max. Negotiated Rate |
$51,188.35 |
| Rate for Payer: UnitedHealthcare Community & State |
$50,184.66
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$51,188.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$50,184.66
|
|
|
FEMAL NEX KNEE SZ FRT 59961652
|
Facility
|
IP
|
$11,580.00
|
|
| Hospital Charge Code |
270638062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,737.00 |
| Max. Negotiated Rate |
$2,802.36 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,316.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,802.36
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,547.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,737.00
|
|
|
FEMAL NEX KNEE SZ FRT 59961652
|
Facility
|
OP
|
$11,580.00
|
|
| Hospital Charge Code |
270638062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$279.08 |
| Max. Negotiated Rate |
$5,790.00 |
| Rate for Payer: Aetna Commercial |
$4,400.40
|
| Rate for Payer: Aetna Medicare Advantage |
$3,474.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,952.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,952.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,316.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,952.90
|
| Rate for Payer: Cigna Commercial |
$5,790.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,802.36
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,547.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,737.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$279.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$306.87
|
|
|
FEM AUG VANGARD DIST 65x10 RL/
|
Facility
|
OP
|
$6,210.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270679832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.66 |
| Max. Negotiated Rate |
$3,105.00 |
| Rate for Payer: Aetna Commercial |
$2,359.80
|
| Rate for Payer: Aetna Medicare Advantage |
$1,863.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,583.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,583.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,242.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,583.55
|
| Rate for Payer: Cigna Commercial |
$3,105.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,502.82
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,366.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$931.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$149.66
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$164.56
|
|
|
FEM AUG VANGARD DIST 65x10 RL/
|
Facility
|
IP
|
$6,210.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270679832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$931.50 |
| Max. Negotiated Rate |
$1,502.82 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,242.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,502.82
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,366.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$931.50
|
|
|
FEM AUG VNGRD DIST65X10 RL/LM
|
Facility
|
OP
|
$6,210.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270679833
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.66 |
| Max. Negotiated Rate |
$3,105.00 |
| Rate for Payer: Aetna Commercial |
$2,359.80
|
| Rate for Payer: Aetna Medicare Advantage |
$1,863.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,583.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,583.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,242.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,583.55
|
| Rate for Payer: Cigna Commercial |
$3,105.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,502.82
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,366.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$931.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$149.66
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$164.56
|
|
|
FEM AUG VNGRD DIST65X10 RL/LM
|
Facility
|
IP
|
$6,210.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270679833
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$931.50 |
| Max. Negotiated Rate |
$1,502.82 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,242.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,502.82
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,366.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$931.50
|
|
|
FEM AUG VNGRD DIST65X10 RL/RM
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270672832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$363.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$300.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$363.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$330.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
|
