|
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC
|
Facility
|
IP
|
$180,646.56
|
|
|
Service Code
|
MSDRG 461
|
| Min. Negotiated Rate |
$55,004.56 |
| Max. Negotiated Rate |
$180,646.56 |
| Rate for Payer: Aetna Commercial |
$124,382.11
|
| Rate for Payer: Aetna Medicare Advantage |
$180,646.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$158,640.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$158,640.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$57,899.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$158,640.02
|
| Rate for Payer: Cigna Commercial |
$100,318.27
|
| Rate for Payer: Cigna Medicare Advantage |
$57,899.54
|
| Rate for Payer: Clover Medicare Advantage |
$55,004.56
|
| Rate for Payer: EmblemHealth Commercial |
$173,698.62
|
| Rate for Payer: Humana Medicare Advantage |
$59,636.53
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$57,899.54
|
| Rate for Payer: Oxford Commercial |
$72,100.07
|
| Rate for Payer: UnitedHealthcare Commercial |
$126,429.75
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$57,899.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$57,899.54
|
|
|
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC
|
Facility
|
IP
|
$88,109.70
|
|
|
Service Code
|
MSDRG 462
|
| Min. Negotiated Rate |
$26,828.28 |
| Max. Negotiated Rate |
$88,109.70 |
| Rate for Payer: Aetna Commercial |
$60,798.75
|
| Rate for Payer: Aetna Medicare Advantage |
$88,109.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$66,293.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$66,293.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$28,240.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$66,293.85
|
| Rate for Payer: Cigna Commercial |
$49,779.24
|
| Rate for Payer: Cigna Medicare Advantage |
$28,240.29
|
| Rate for Payer: Clover Medicare Advantage |
$26,828.28
|
| Rate for Payer: EmblemHealth Commercial |
$84,720.87
|
| Rate for Payer: Humana Medicare Advantage |
$29,087.50
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$28,240.29
|
| Rate for Payer: Oxford Commercial |
$35,777.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$62,736.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$28,240.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$28,240.29
|
|
|
BILAYER WOUND MATRIX 2X2
|
Facility
|
IP
|
$9,890.00
|
|
| Hospital Charge Code |
270657166
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,483.50 |
| Max. Negotiated Rate |
$2,393.38 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,393.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,483.50
|
|
|
BILAYER WOUND MATRIX 2X2
|
Facility
|
OP
|
$9,890.00
|
|
| Hospital Charge Code |
270657166
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$238.35 |
| Max. Negotiated Rate |
$4,945.00 |
| Rate for Payer: Aetna Commercial |
$3,758.20
|
| Rate for Payer: Aetna Medicare Advantage |
$2,967.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,521.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,521.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,521.95
|
| Rate for Payer: Cigna Commercial |
$4,945.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,393.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,483.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$238.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$262.08
|
|
|
BILAYER WOUND MATRIX 4X5
|
Facility
|
OP
|
$16,665.00
|
|
|
Service Code
|
HCPCS Q4104
|
| Hospital Charge Code |
270648773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$4,032.93 |
| Rate for Payer: Aetna Commercial |
$402.12
|
| Rate for Payer: Aetna Medicare Advantage |
$479.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$533.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$533.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$147.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,333.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$533.66
|
| Rate for Payer: Cigna Commercial |
$296.35
|
| Rate for Payer: Cigna Medicare Advantage |
$147.84
|
| Rate for Payer: Clover Medicare Advantage |
$140.45
|
| Rate for Payer: EmblemHealth Commercial |
$443.52
|
| Rate for Payer: Humana Medicare Advantage |
$152.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$147.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,032.93
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,666.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,499.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$401.63
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$441.62
|
|
|
BILAYER WOUND MATRIX 4X5
|
Facility
|
IP
|
$16,665.00
|
|
|
Service Code
|
HCPCS Q4104
|
| Hospital Charge Code |
270648773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,499.75 |
| Max. Negotiated Rate |
$4,032.93 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,333.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,032.93
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,666.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,499.75
|
|
|
BILE ACIDS
|
Facility
|
OP
|
$117.25
|
|
|
Service Code
|
HCPCS 82239
|
| Hospital Charge Code |
3038072
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$46.57
|
| Rate for Payer: Aetna Medicare Advantage |
$55.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$42.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.80
|
| Rate for Payer: Cigna Commercial |
$58.62
|
| Rate for Payer: Cigna Medicare Advantage |
$17.12
|
| Rate for Payer: Clover Medicare Advantage |
$16.26
|
| Rate for Payer: EmblemHealth Commercial |
$51.36
|
| Rate for Payer: Humana Medicare Advantage |
$17.63
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.17
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.59
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.11
|
|
|
BILE ACIDS
|
Facility
|
OP
|
$343.00
|
|
|
Service Code
|
HCPCS 82240
|
| Hospital Charge Code |
38472743
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$171.50 |
| Rate for Payer: Aetna Commercial |
$72.30
|
| Rate for Payer: Aetna Medicare Advantage |
$86.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$95.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$95.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$26.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$95.95
|
| Rate for Payer: Cigna Commercial |
$171.50
|
| Rate for Payer: Cigna Medicare Advantage |
$26.58
|
| Rate for Payer: Clover Medicare Advantage |
$25.25
|
| Rate for Payer: EmblemHealth Commercial |
$79.74
|
| Rate for Payer: Humana Medicare Advantage |
$27.38
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$26.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$102.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$51.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.26
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$26.58
|
| Rate for Payer: Wellcare Medicare Advantage |
$26.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.09
|
|
|
BILE ACIDS
|
Facility
|
IP
|
$343.00
|
|
|
Service Code
|
HCPCS 82240
|
| Hospital Charge Code |
38472743
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.45 |
| Max. Negotiated Rate |
$51.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$51.45
|
|
|
BILE ACIDS
|
Facility
|
IP
|
$117.25
|
|
|
Service Code
|
HCPCS 82239
|
| Hospital Charge Code |
3038072
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.59 |
| Max. Negotiated Rate |
$17.59 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.59
|
|
|
BILE ACIDS FRACTIONATED
|
Facility
|
IP
|
$181.65
|
|
|
Service Code
|
HCPCS 82452
|
| Hospital Charge Code |
3038076
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.25 |
| Max. Negotiated Rate |
$27.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.25
|
|
|
BILE ACIDS FRACTIONATED
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
HCPCS 83789
|
| Hospital Charge Code |
38478104
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.40
|
|
|
BILE ACIDS FRACTIONATED
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
HCPCS 83789
|
| Hospital Charge Code |
38478104
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$65.58
|
| Rate for Payer: Aetna Medicare Advantage |
$78.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$87.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$87.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$24.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$87.03
|
| Rate for Payer: Cigna Commercial |
$108.00
|
| Rate for Payer: Cigna Medicare Advantage |
$24.11
|
| Rate for Payer: Clover Medicare Advantage |
$22.90
|
| Rate for Payer: EmblemHealth Commercial |
$72.33
|
| Rate for Payer: Humana Medicare Advantage |
$24.83
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$24.11
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$64.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.29
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$24.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$24.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.72
|
|
|
BILE ACIDS FRACTIONATED
|
Facility
|
OP
|
$181.65
|
|
|
Service Code
|
HCPCS 82452
|
| Hospital Charge Code |
3038076
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$69.03
|
| Rate for Payer: Aetna Medicare Advantage |
$54.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.32
|
| Rate for Payer: Cigna Commercial |
$90.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.49
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.81
|
|
|
BILE ACIDS,FRACT/TOT,PREG
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 83789
|
| Hospital Charge Code |
39900339
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$65.58
|
| Rate for Payer: Aetna Medicare Advantage |
$78.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$87.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$87.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$24.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$87.03
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$24.11
|
| Rate for Payer: Clover Medicare Advantage |
$22.90
|
| Rate for Payer: EmblemHealth Commercial |
$72.33
|
| Rate for Payer: Humana Medicare Advantage |
$24.83
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$24.11
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.29
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$24.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$24.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
BILE ACIDS,FRACT/TOT,PREG
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 83789
|
| Hospital Charge Code |
39900339
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
BILE ACIDS, TOTAL
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82239
|
| Hospital Charge Code |
39900049
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
BILE ACIDS, TOTAL
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82239
|
| Hospital Charge Code |
39900049
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$46.57
|
| Rate for Payer: Aetna Medicare Advantage |
$55.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$42.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.80
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$17.12
|
| Rate for Payer: Clover Medicare Advantage |
$16.26
|
| Rate for Payer: EmblemHealth Commercial |
$51.36
|
| Rate for Payer: Humana Medicare Advantage |
$17.63
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
BILE ACIDS;TOTAL
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
HCPCS 82239
|
| Hospital Charge Code |
38477144
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$46.57
|
| Rate for Payer: Aetna Medicare Advantage |
$55.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$42.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.80
|
| Rate for Payer: Cigna Commercial |
$60.50
|
| Rate for Payer: Cigna Medicare Advantage |
$17.12
|
| Rate for Payer: Clover Medicare Advantage |
$16.26
|
| Rate for Payer: EmblemHealth Commercial |
$51.36
|
| Rate for Payer: Humana Medicare Advantage |
$17.63
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.21
|
|
|
BILE ACIDS;TOTAL
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
HCPCS 82239
|
| Hospital Charge Code |
38477144
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.15 |
| Max. Negotiated Rate |
$18.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.15
|
|
|
BILE TRACT SURGERY PROCEDURE
|
Facility
|
IP
|
$10,620.50
|
|
|
Service Code
|
HCPCS 47999
|
| Hospital Charge Code |
2209085
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,593.08 |
| Max. Negotiated Rate |
$1,593.08 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,593.08
|
|
|
BILE TRACT SURGERY PROCEDURE
|
Facility
|
OP
|
$10,620.50
|
|
|
Service Code
|
HCPCS 47999
|
| Hospital Charge Code |
2209085
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$255.95 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Aetna Commercial |
$2,930.85
|
| Rate for Payer: Aetna Medicare Advantage |
$3,491.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,889.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,889.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,077.52
|
| 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 |
$3,889.52
|
| Rate for Payer: Cigna Commercial |
$2,159.89
|
| Rate for Payer: Cigna Medicare Advantage |
$1,077.52
|
| Rate for Payer: Clover Medicare Advantage |
$1,023.64
|
| Rate for Payer: EmblemHealth Commercial |
$3,232.56
|
| Rate for Payer: Humana Medicare Advantage |
$1,109.85
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,077.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,186.15
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,593.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,311.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$255.95
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,077.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,077.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$281.44
|
|
|
BILIAR STENT 6x30 6F P06030RXB
|
Facility
|
OP
|
$10,725.00
|
|
| Hospital Charge Code |
270631755V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$258.47 |
| Max. Negotiated Rate |
$5,362.50 |
| Rate for Payer: Aetna Commercial |
$4,075.50
|
| Rate for Payer: Aetna Medicare Advantage |
$3,217.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,734.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,734.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,145.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,734.88
|
| Rate for Payer: Cigna Commercial |
$5,362.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,595.45
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,359.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,608.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$258.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$284.21
|
|
|
BILIAR STENT 6x30 6F P06030RXB
|
Facility
|
IP
|
$10,725.00
|
|
| Hospital Charge Code |
270631755V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.75 |
| Max. Negotiated Rate |
$2,595.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,145.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,595.45
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,359.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,608.75
|
|
|
BILIARY DILATOR
|
Facility
|
OP
|
$146.00
|
|
| Hospital Charge Code |
270325606
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: Aetna Commercial |
$55.48
|
| Rate for Payer: Aetna Medicare Advantage |
$43.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$37.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$37.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$37.23
|
| Rate for Payer: Cigna Commercial |
$73.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$43.80
|
| Rate for Payer: Oxford Commercial |
$29.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$29.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.87
|
|
