|
REMOVE BY LIGAT INT HEM2+GRPS
|
Facility
|
IP
|
$22,676.60
|
|
|
Service Code
|
HCPCS 46946
|
| Hospital Charge Code |
1600000341
|
|
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
|
|
|
REMOVE BY LIGAT INT HEM GRP
|
Facility
|
IP
|
$22,676.60
|
|
|
Service Code
|
HCPCS 46945
|
| Hospital Charge Code |
1600000262
|
|
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
|
|
|
REMOVE BY LIGAT INT HEM GRP
|
Facility
|
OP
|
$22,676.60
|
|
|
Service Code
|
HCPCS 46945
|
| Hospital Charge Code |
1600000262
|
|
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
|
|
|
REMOVE CERV ARTIF DISC
|
Facility
|
OP
|
$9,215.84
|
|
|
Service Code
|
HCPCS 22864
|
| Hospital Charge Code |
1600000800
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$222.10 |
| 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 |
$1,626.00
|
| 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 |
$2,764.75
|
| Rate for Payer: Oxford Commercial |
$8,679.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,382.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,834.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$222.10
|
| 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 |
$244.22
|
|
|
REMOVE CERV ARTIF DISC
|
Facility
|
IP
|
$9,215.84
|
|
|
Service Code
|
HCPCS 22864
|
| Hospital Charge Code |
1600000800
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,382.38 |
| Max. Negotiated Rate |
$1,382.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,382.38
|
|
|
REMOVE DEVITAL TISSUE WOUND
|
Facility
|
OP
|
$1,319.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
412397602
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.79 |
| Max. Negotiated Rate |
$860.41 |
| Rate for Payer: Aetna Commercial |
$648.34
|
| Rate for Payer: Aetna Medicare Advantage |
$772.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$860.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$860.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$238.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$149.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$860.41
|
| Rate for Payer: Cigna Commercial |
$477.79
|
| Rate for Payer: Cigna Medicare Advantage |
$238.36
|
| Rate for Payer: Clover Medicare Advantage |
$226.44
|
| Rate for Payer: EmblemHealth Commercial |
$715.08
|
| Rate for Payer: Humana Medicare Advantage |
$245.51
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$238.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$395.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$197.85
|
| Rate for Payer: UnitedHealthcare Community & State |
$31.79
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$34.95
|
|
|
REMOVE DEVITAL TISSUE WOUND
|
Facility
|
IP
|
$1,319.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
412397602
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$197.85 |
| Max. Negotiated Rate |
$197.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$197.85
|
|
|
REMOVE DIGIT NERVE LESION
|
Facility
|
IP
|
$4,643.50
|
|
|
Service Code
|
HCPCS 64776
|
| Hospital Charge Code |
1600000713
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$696.52 |
| Max. Negotiated Rate |
$696.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$696.52
|
|
|
REMOVE DIGIT NERVE LESION
|
Facility
|
OP
|
$4,643.50
|
|
|
Service Code
|
HCPCS 64776
|
| Hospital Charge Code |
1600000713
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$111.91 |
| Max. Negotiated Rate |
$8,374.11 |
| Rate for Payer: Aetna Commercial |
$6,310.10
|
| Rate for Payer: Aetna Medicare Advantage |
$7,516.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,374.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,374.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,319.89
|
| 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 |
$8,374.11
|
| Rate for Payer: Cigna Commercial |
$4,650.22
|
| Rate for Payer: Cigna Medicare Advantage |
$2,319.89
|
| Rate for Payer: Clover Medicare Advantage |
$2,203.90
|
| Rate for Payer: EmblemHealth Commercial |
$6,959.67
|
| Rate for Payer: Humana Medicare Advantage |
$2,389.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,319.89
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,393.05
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$696.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$111.91
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,319.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,319.89
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$123.05
|
|
|
REMOVE DRUG IMPLANT
|
Facility
|
OP
|
$1,704.00
|
|
|
Service Code
|
HCPCS 11982
|
| Hospital Charge Code |
16000155
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$41.07 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$1,443.56
|
| Rate for Payer: Aetna Medicare Advantage |
$1,719.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,915.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,915.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$530.72
|
| 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 |
$1,915.74
|
| Rate for Payer: Cigna Commercial |
$1,063.82
|
| Rate for Payer: Cigna Medicare Advantage |
$530.72
|
| Rate for Payer: Clover Medicare Advantage |
$504.18
|
| Rate for Payer: EmblemHealth Commercial |
$1,592.16
|
| Rate for Payer: Humana Medicare Advantage |
$546.64
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$530.72
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$511.20
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$255.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$41.07
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$530.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$530.72
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$45.16
|
|
|
REMOVE DRUG IMPLANT
|
Facility
|
IP
|
$1,704.00
|
|
|
Service Code
|
HCPCS 11982
|
| Hospital Charge Code |
16000155
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$255.60 |
| Max. Negotiated Rate |
$255.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$255.60
|
|
|
REMOVE ELBOW JOINT LINING-LT
|
Facility
|
IP
|
$30,595.00
|
|
|
Service Code
|
HCPCS 24102
|
| Hospital Charge Code |
16000681
|
|
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
|
|
|
REMOVE ELBOW JOINT LINING-LT
|
Facility
|
OP
|
$30,595.00
|
|
|
Service Code
|
HCPCS 24102
|
| Hospital Charge Code |
16000681
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$737.34 |
| 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 |
$1,626.00
|
| 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 |
$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 |
$3,887.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,887.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$810.77
|
|
|
REMOVE ELECTRD TRANSVENOUS
|
Facility
|
IP
|
$20,101.20
|
|
|
Service Code
|
HCPCS 33244
|
| Hospital Charge Code |
411033244
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$3,015.18 |
| Max. Negotiated Rate |
$3,015.18 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,015.18
|
|
|
REMOVE ELECTRD TRANSVENOUS
|
Facility
|
OP
|
$20,101.20
|
|
|
Service Code
|
HCPCS 33244
|
| Hospital Charge Code |
411033244
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$484.44 |
| Max. Negotiated Rate |
$16,025.66 |
| Rate for Payer: Aetna Commercial |
$12,075.74
|
| Rate for Payer: Aetna Medicare Advantage |
$14,384.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$16,025.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$16,025.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4,439.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$612.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$16,025.66
|
| Rate for Payer: Cigna Commercial |
$8,899.18
|
| Rate for Payer: Cigna Medicare Advantage |
$4,439.61
|
| Rate for Payer: Clover Medicare Advantage |
$4,217.63
|
| Rate for Payer: EmblemHealth Commercial |
$13,318.83
|
| Rate for Payer: Humana Medicare Advantage |
$4,572.80
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4,439.61
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,030.36
|
| Rate for Payer: Oxford Commercial |
$1,580.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,015.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,770.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$484.44
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4,439.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$4,439.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$532.68
|
|
|
REMOVE EPIDIDYMIS
|
Facility
|
IP
|
$16,246.84
|
|
|
Service Code
|
HCPCS 54830
|
| Hospital Charge Code |
1600000261
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,437.03 |
| Max. Negotiated Rate |
$2,437.03 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,437.03
|
|
|
REMOVE EPIDIDYMIS
|
Facility
|
OP
|
$16,246.84
|
|
|
Service Code
|
HCPCS 54830
|
| Hospital Charge Code |
1600000261
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$391.55 |
| Max. Negotiated Rate |
$15,116.59 |
| Rate for Payer: Aetna Commercial |
$11,390.73
|
| Rate for Payer: Aetna Medicare Advantage |
$13,568.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15,116.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15,116.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4,187.77
|
| 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 |
$15,116.59
|
| Rate for Payer: Cigna Commercial |
$8,394.37
|
| Rate for Payer: Cigna Medicare Advantage |
$4,187.77
|
| Rate for Payer: Clover Medicare Advantage |
$3,978.38
|
| Rate for Payer: EmblemHealth Commercial |
$12,563.31
|
| Rate for Payer: Humana Medicare Advantage |
$4,313.40
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4,187.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,874.05
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,437.03
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$391.55
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4,187.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$4,187.77
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$430.54
|
|
|
REMOVE EPIDIDYMIS LESION
|
Facility
|
OP
|
$9,649.80
|
|
|
Service Code
|
HCPCS 54840
|
| Hospital Charge Code |
1600000260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$232.56 |
| Max. Negotiated Rate |
$8,964.44 |
| Rate for Payer: Aetna Commercial |
$6,754.93
|
| Rate for Payer: Aetna Medicare Advantage |
$8,046.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,964.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,964.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,483.43
|
| 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 |
$8,964.44
|
| Rate for Payer: Cigna Commercial |
$4,978.04
|
| Rate for Payer: Cigna Medicare Advantage |
$2,483.43
|
| Rate for Payer: Clover Medicare Advantage |
$2,359.26
|
| Rate for Payer: EmblemHealth Commercial |
$7,450.29
|
| Rate for Payer: Humana Medicare Advantage |
$2,557.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,483.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,894.94
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,447.47
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$232.56
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,483.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,483.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$255.72
|
|
|
REMOVE EPIDIDYMIS LESION
|
Facility
|
IP
|
$12,062.25
|
|
|
Service Code
|
HCPCS 54840
|
| Hospital Charge Code |
1600000322
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,809.34 |
| Max. Negotiated Rate |
$1,809.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,809.34
|
|
|
REMOVE EPIDIDYMIS LESION
|
Facility
|
OP
|
$12,062.25
|
|
|
Service Code
|
HCPCS 54840
|
| Hospital Charge Code |
1600000322
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$290.70 |
| Max. Negotiated Rate |
$8,964.44 |
| Rate for Payer: Aetna Commercial |
$6,754.93
|
| Rate for Payer: Aetna Medicare Advantage |
$8,046.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,964.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,964.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,483.43
|
| 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 |
$8,964.44
|
| Rate for Payer: Cigna Commercial |
$4,978.04
|
| Rate for Payer: Cigna Medicare Advantage |
$2,483.43
|
| Rate for Payer: Clover Medicare Advantage |
$2,359.26
|
| Rate for Payer: EmblemHealth Commercial |
$7,450.29
|
| Rate for Payer: Humana Medicare Advantage |
$2,557.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,483.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,618.68
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,809.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$290.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,483.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,483.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$319.65
|
|
|
REMOVE EPIDIDYMIS LESION
|
Facility
|
IP
|
$9,649.80
|
|
|
Service Code
|
HCPCS 54840
|
| Hospital Charge Code |
1600000260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,447.47 |
| Max. Negotiated Rate |
$1,447.47 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,447.47
|
|
|
REMOVE EXT HEM GROUPS 2+
|
Facility
|
IP
|
$22,676.60
|
|
|
Service Code
|
HCPCS 46250
|
| Hospital Charge Code |
1600000455
|
|
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
|
|
|
REMOVE EXT HEM GROUPS 2+
|
Facility
|
OP
|
$22,676.60
|
|
|
Service Code
|
HCPCS 46250
|
| Hospital Charge Code |
1600000455
|
|
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 |
$1,355.00
|
| 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
|
|
|
REMOVE EXTRA SPINE SEGMENT
|
Facility
|
OP
|
$15,178.00
|
|
|
Service Code
|
HCPCS 22116
|
| Hospital Charge Code |
1600000682
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$365.79 |
| Max. Negotiated Rate |
$7,589.00 |
| Rate for Payer: Aetna Commercial |
$5,767.64
|
| Rate for Payer: Aetna Medicare Advantage |
$4,553.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,870.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,870.39
|
| 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 |
$3,870.39
|
| Rate for Payer: Cigna Commercial |
$7,589.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,553.40
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,276.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$365.79
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$402.22
|
|
|
REMOVE EXTRA SPINE SEGMENT
|
Facility
|
OP
|
$15,178.00
|
|
|
Service Code
|
HCPCS 22116
|
| Hospital Charge Code |
24001253
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$365.79 |
| Max. Negotiated Rate |
$7,589.00 |
| Rate for Payer: Aetna Commercial |
$5,767.64
|
| Rate for Payer: Aetna Medicare Advantage |
$4,553.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,870.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,870.39
|
| 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 |
$3,870.39
|
| Rate for Payer: Cigna Commercial |
$7,589.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,553.40
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,276.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$365.79
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$402.22
|
|
