|
UNIWASH SKIN WS SENSICARE
|
Facility
|
IP
|
$16.85
|
|
| Hospital Charge Code |
270302500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$2.53 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.53
|
|
|
UNIWASH SKIN WS SENSICARE
|
Facility
|
OP
|
$16.85
|
|
| Hospital Charge Code |
270302500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$8.43 |
| Rate for Payer: Aetna Commercial |
$6.40
|
| Rate for Payer: Aetna Medicare Advantage |
$5.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.30
|
| Rate for Payer: Cigna Commercial |
$8.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.05
|
| Rate for Payer: Oxford Commercial |
$3.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.53
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.37
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.45
|
|
|
UNLISTED CASTING/STRAPPING PRO
|
Facility
|
IP
|
$468.75
|
|
|
Service Code
|
HCPCS 29799
|
| Hospital Charge Code |
5780165
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$70.31 |
| Max. Negotiated Rate |
$70.31 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$70.31
|
|
|
UNLISTED CASTING/STRAPPING PRO
|
Facility
|
OP
|
$468.75
|
|
|
Service Code
|
HCPCS 29799
|
| Hospital Charge Code |
5780165
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$12.42 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$525.10
|
| Rate for Payer: Aetna Medicare Advantage |
$625.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$696.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$696.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$193.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$44.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$696.85
|
| Rate for Payer: Cigna Commercial |
$386.97
|
| Rate for Payer: Cigna Medicare Advantage |
$193.05
|
| Rate for Payer: Clover Medicare Advantage |
$183.40
|
| Rate for Payer: EmblemHealth Commercial |
$579.15
|
| Rate for Payer: Humana Medicare Advantage |
$198.84
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$193.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$140.62
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$70.31
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$193.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$193.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.42
|
|
|
UNLISTED CYTOPATH
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
HCPCS 88199
|
| Hospital Charge Code |
38477058
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$223.48 |
| Rate for Payer: Aetna Commercial |
$168.40
|
| Rate for Payer: Aetna Medicare Advantage |
$200.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$223.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$223.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$61.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$223.48
|
| Rate for Payer: Cigna Commercial |
$124.10
|
| Rate for Payer: Cigna Medicare Advantage |
$61.91
|
| Rate for Payer: Clover Medicare Advantage |
$58.81
|
| Rate for Payer: EmblemHealth Commercial |
$185.73
|
| Rate for Payer: Humana Medicare Advantage |
$63.77
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$61.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.59
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$61.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$61.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.75
|
|
|
UNLISTED CYTOPATH
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS 88199
|
| Hospital Charge Code |
38477058
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$9.90 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.90
|
|
|
UNLISTED HYSTEROSCOPY UTERUS
|
Facility
|
IP
|
$778.40
|
|
|
Service Code
|
HCPCS 58579
|
| Hospital Charge Code |
16001008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$116.76 |
| Max. Negotiated Rate |
$116.76 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.76
|
|
|
UNLISTED HYSTEROSCOPY UTERUS
|
Facility
|
OP
|
$778.40
|
|
|
Service Code
|
HCPCS 58579
|
| Hospital Charge Code |
16001008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$18.76 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$653.29
|
| Rate for Payer: Aetna Medicare Advantage |
$778.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$866.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$866.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$240.18
|
| 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 |
$866.98
|
| Rate for Payer: Cigna Commercial |
$481.45
|
| Rate for Payer: Cigna Medicare Advantage |
$240.18
|
| Rate for Payer: Clover Medicare Advantage |
$228.17
|
| Rate for Payer: EmblemHealth Commercial |
$720.54
|
| Rate for Payer: Humana Medicare Advantage |
$247.39
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$240.18
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$233.52
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.76
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.76
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$240.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$240.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20.63
|
|
|
UNLISTED JNT ARTHROSC
|
Facility
|
OP
|
$11,779.44
|
|
|
Service Code
|
HCPCS 29999
|
| Hospital Charge Code |
16000247
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$278.40 |
| Max. Negotiated Rate |
$3,533.83 |
| Rate for Payer: Aetna Commercial |
$797.10
|
| Rate for Payer: Aetna Medicare Advantage |
$949.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,057.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,057.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$293.05
|
| 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 |
$1,057.82
|
| Rate for Payer: Cigna Commercial |
$587.42
|
| Rate for Payer: Cigna Medicare Advantage |
$293.05
|
| Rate for Payer: Clover Medicare Advantage |
$278.40
|
| Rate for Payer: EmblemHealth Commercial |
$879.15
|
| Rate for Payer: Humana Medicare Advantage |
$301.84
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$293.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,533.83
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,766.92
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$283.88
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$312.16
|
|
|
UNLISTED JNT ARTHROSC
|
Facility
|
IP
|
$11,779.44
|
|
|
Service Code
|
HCPCS 29999
|
| Hospital Charge Code |
16000247
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,766.92 |
| Max. Negotiated Rate |
$1,766.92 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,766.92
|
|
|
UNLISTED LAPAROSCOPY ABD PERIT
|
Facility
|
IP
|
$26,932.08
|
|
|
Service Code
|
HCPCS 49329
|
| Hospital Charge Code |
16000488
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,039.81 |
| Max. Negotiated Rate |
$4,039.81 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,039.81
|
|
|
UNLISTED LAPAROSCOPY ABD PERIT
|
Facility
|
OP
|
$26,932.08
|
|
|
Service Code
|
HCPCS 49329
|
| Hospital Charge Code |
16000488
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$649.06 |
| Max. Negotiated Rate |
$25,925.77 |
| Rate for Payer: Aetna Commercial |
$19,535.72
|
| Rate for Payer: Aetna Medicare Advantage |
$23,270.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$25,925.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$25,925.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7,182.25
|
| 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 |
$25,925.77
|
| Rate for Payer: Cigna Commercial |
$14,396.79
|
| Rate for Payer: Cigna Medicare Advantage |
$7,182.25
|
| Rate for Payer: Clover Medicare Advantage |
$6,823.14
|
| Rate for Payer: EmblemHealth Commercial |
$21,546.75
|
| Rate for Payer: Humana Medicare Advantage |
$7,397.72
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$7,182.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,079.62
|
| Rate for Payer: Oxford Commercial |
$7,559.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,039.81
|
| Rate for Payer: UnitedHealthcare Commercial |
$12,870.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$649.06
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7,182.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$7,182.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$713.70
|
|
|
UNLISTED LAPAROSCOPY BILIARY
|
Facility
|
OP
|
$23,722.52
|
|
|
Service Code
|
HCPCS 47579
|
| Hospital Charge Code |
160000186
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$571.71 |
| Max. Negotiated Rate |
$25,925.77 |
| Rate for Payer: Aetna Commercial |
$19,535.72
|
| Rate for Payer: Aetna Medicare Advantage |
$23,270.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$25,925.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$25,925.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7,182.25
|
| 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 |
$25,925.77
|
| Rate for Payer: Cigna Commercial |
$14,396.79
|
| Rate for Payer: Cigna Medicare Advantage |
$7,182.25
|
| Rate for Payer: Clover Medicare Advantage |
$6,823.14
|
| Rate for Payer: EmblemHealth Commercial |
$21,546.75
|
| Rate for Payer: Humana Medicare Advantage |
$7,397.72
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$7,182.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,116.76
|
| Rate for Payer: Oxford Commercial |
$7,559.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,558.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$12,870.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$571.71
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7,182.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$7,182.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$628.65
|
|
|
UNLISTED LAPAROSCOPY BILIARY
|
Facility
|
IP
|
$23,722.52
|
|
|
Service Code
|
HCPCS 47579
|
| Hospital Charge Code |
160000186
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,558.38 |
| Max. Negotiated Rate |
$3,558.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,558.38
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE
|
Facility
|
IP
|
$43,334.60
|
|
|
Service Code
|
HCPCS 58679
|
| Hospital Charge Code |
1600000411
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,500.19 |
| Max. Negotiated Rate |
$6,500.19 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,500.19
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE
|
Facility
|
OP
|
$43,334.60
|
|
|
Service Code
|
HCPCS 58679
|
| Hospital Charge Code |
1600000411
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,044.36 |
| Max. Negotiated Rate |
$25,925.77 |
| Rate for Payer: Aetna Commercial |
$19,535.72
|
| Rate for Payer: Aetna Medicare Advantage |
$23,270.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$25,925.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$25,925.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7,182.25
|
| 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 |
$25,925.77
|
| Rate for Payer: Cigna Commercial |
$14,396.79
|
| Rate for Payer: Cigna Medicare Advantage |
$7,182.25
|
| Rate for Payer: Clover Medicare Advantage |
$6,823.14
|
| Rate for Payer: EmblemHealth Commercial |
$21,546.75
|
| Rate for Payer: Humana Medicare Advantage |
$7,397.72
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$7,182.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13,000.38
|
| Rate for Payer: Oxford Commercial |
$7,559.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,500.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$12,870.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,044.36
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7,182.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$7,182.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,148.37
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, ESOPHAGUS
|
Facility
|
OP
|
$25,925.77
|
|
|
Service Code
|
CPT 43289
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,626.00 |
| Max. Negotiated Rate |
$25,925.77 |
| Rate for Payer: Aetna Commercial |
$19,535.72
|
| Rate for Payer: Aetna Medicare Advantage |
$23,270.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$25,925.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$25,925.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7,182.25
|
| 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 |
$25,925.77
|
| Rate for Payer: Cigna Commercial |
$14,396.79
|
| Rate for Payer: Cigna Medicare Advantage |
$7,182.25
|
| Rate for Payer: Clover Medicare Advantage |
$6,823.14
|
| Rate for Payer: EmblemHealth Commercial |
$21,546.75
|
| Rate for Payer: Humana Medicare Advantage |
$7,397.72
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$7,182.25
|
| Rate for Payer: Oxford Commercial |
$7,559.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$12,870.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7,182.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$7,182.25
|
|
|
UNLISTED LAPAROSCOPY STOMACH
|
Facility
|
OP
|
$25,659.60
|
|
|
Service Code
|
HCPCS 43659
|
| Hospital Charge Code |
1600000601
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$618.40 |
| Max. Negotiated Rate |
$25,925.77 |
| Rate for Payer: Aetna Commercial |
$19,535.72
|
| Rate for Payer: Aetna Medicare Advantage |
$23,270.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$25,925.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$25,925.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7,182.25
|
| 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 |
$25,925.77
|
| Rate for Payer: Cigna Commercial |
$14,396.79
|
| Rate for Payer: Cigna Medicare Advantage |
$7,182.25
|
| Rate for Payer: Clover Medicare Advantage |
$6,823.14
|
| Rate for Payer: EmblemHealth Commercial |
$21,546.75
|
| Rate for Payer: Humana Medicare Advantage |
$7,397.72
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$7,182.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,697.88
|
| Rate for Payer: Oxford Commercial |
$7,559.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,848.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$12,870.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$618.40
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7,182.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$7,182.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$679.98
|
|
|
UNLISTED LAPAROSCOPY STOMACH
|
Facility
|
IP
|
$25,659.60
|
|
|
Service Code
|
HCPCS 43659
|
| Hospital Charge Code |
1600000601
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,848.94 |
| Max. Negotiated Rate |
$3,848.94 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,848.94
|
|
|
UNLISTED LAPAROSCOPY UTERUS
|
Facility
|
IP
|
$34,350.00
|
|
|
Service Code
|
HCPCS 58578
|
| Hospital Charge Code |
1600000734
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,152.50 |
| Max. Negotiated Rate |
$5,152.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,152.50
|
|
|
UNLISTED LAPAROSCOPY UTERUS
|
Facility
|
OP
|
$34,350.00
|
|
|
Service Code
|
HCPCS 58578
|
| Hospital Charge Code |
1600000734
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$827.84 |
| Max. Negotiated Rate |
$25,925.77 |
| Rate for Payer: Aetna Commercial |
$19,535.72
|
| Rate for Payer: Aetna Medicare Advantage |
$23,270.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$25,925.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$25,925.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7,182.25
|
| 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 |
$25,925.77
|
| Rate for Payer: Cigna Commercial |
$14,396.79
|
| Rate for Payer: Cigna Medicare Advantage |
$7,182.25
|
| Rate for Payer: Clover Medicare Advantage |
$6,823.14
|
| Rate for Payer: EmblemHealth Commercial |
$21,546.75
|
| Rate for Payer: Humana Medicare Advantage |
$7,397.72
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$7,182.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10,305.00
|
| Rate for Payer: Oxford Commercial |
$7,559.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,152.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$12,870.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$827.84
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7,182.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$7,182.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$910.27
|
|
|
UNLISTED LAP PROCEDURE,STOMACH
|
Facility
|
IP
|
$29,470.30
|
|
|
Service Code
|
HCPCS 43659
|
| Hospital Charge Code |
1600178
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,420.55 |
| Max. Negotiated Rate |
$4,420.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,420.55
|
|
|
UNLISTED LAP PROCEDURE,STOMACH
|
Facility
|
OP
|
$29,470.30
|
|
|
Service Code
|
HCPCS 43659
|
| Hospital Charge Code |
1600178
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$710.23 |
| Max. Negotiated Rate |
$25,925.77 |
| Rate for Payer: Aetna Commercial |
$19,535.72
|
| Rate for Payer: Aetna Medicare Advantage |
$23,270.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$25,925.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$25,925.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7,182.25
|
| 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 |
$25,925.77
|
| Rate for Payer: Cigna Commercial |
$14,396.79
|
| Rate for Payer: Cigna Medicare Advantage |
$7,182.25
|
| Rate for Payer: Clover Medicare Advantage |
$6,823.14
|
| Rate for Payer: EmblemHealth Commercial |
$21,546.75
|
| Rate for Payer: Humana Medicare Advantage |
$7,397.72
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$7,182.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,841.09
|
| Rate for Payer: Oxford Commercial |
$7,559.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,420.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$12,870.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$710.23
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7,182.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$7,182.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$780.96
|
|
|
UNLISTED LAPS PX APPENDIX
|
Facility
|
IP
|
$34,354.45
|
|
|
Service Code
|
HCPCS 44979
|
| Hospital Charge Code |
1600000773
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,153.17 |
| Max. Negotiated Rate |
$5,153.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,153.17
|
|
|
UNLISTED LAPS PX APPENDIX
|
Facility
|
OP
|
$34,354.45
|
|
|
Service Code
|
HCPCS 44979
|
| Hospital Charge Code |
1600000773
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$827.94 |
| Max. Negotiated Rate |
$25,925.77 |
| Rate for Payer: Aetna Commercial |
$19,535.72
|
| Rate for Payer: Aetna Medicare Advantage |
$23,270.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$25,925.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$25,925.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7,182.25
|
| 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 |
$25,925.77
|
| Rate for Payer: Cigna Commercial |
$14,396.79
|
| Rate for Payer: Cigna Medicare Advantage |
$7,182.25
|
| Rate for Payer: Clover Medicare Advantage |
$6,823.14
|
| Rate for Payer: EmblemHealth Commercial |
$21,546.75
|
| Rate for Payer: Humana Medicare Advantage |
$7,397.72
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$7,182.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10,306.33
|
| Rate for Payer: Oxford Commercial |
$7,559.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,153.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$12,870.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$827.94
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7,182.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$7,182.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$910.39
|
|
