|
UNLISTED LAPS PX BLADDER
|
Facility
|
IP
|
$34,354.45
|
|
|
Service Code
|
HCPCS 51999
|
| Hospital Charge Code |
1600000671
|
|
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 BLADDER
|
Facility
|
OP
|
$34,354.45
|
|
|
Service Code
|
HCPCS 51999
|
| Hospital Charge Code |
1600000671
|
|
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
|
|
|
UNLISTED PROCEDURE BILIARY TRA
|
Facility
|
OP
|
$3,684.28
|
|
|
Service Code
|
HCPCS 47999
|
| Hospital Charge Code |
1600000364
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$88.79 |
| 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 |
$1,105.28
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$552.64
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,311.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$88.79
|
| 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 |
$97.63
|
|
|
UNLISTED PROCEDURE BILIARY TRA
|
Facility
|
IP
|
$3,684.28
|
|
|
Service Code
|
HCPCS 47999
|
| Hospital Charge Code |
1600000364
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.64 |
| Max. Negotiated Rate |
$552.64 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$552.64
|
|
|
UNLISTED PROCEDURE FOOT OR TOE
|
Facility
|
OP
|
$859.60
|
|
|
Service Code
|
HCPCS 28899
|
| Hospital Charge Code |
16000271
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$20.72 |
| Max. Negotiated Rate |
$2,220.00 |
| 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 |
$257.88
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.72
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$22.78
|
|
|
UNLISTED PROCEDURE FOOT OR TOE
|
Facility
|
IP
|
$859.60
|
|
|
Service Code
|
HCPCS 28899
|
| Hospital Charge Code |
16000271
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$128.94 |
| Max. Negotiated Rate |
$128.94 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.94
|
|
|
UNLISTED PROCEDURE HAND/FINGER
|
Facility
|
IP
|
$1,241.80
|
|
|
Service Code
|
HCPCS 26989
|
| Hospital Charge Code |
323026989
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$186.27 |
| Max. Negotiated Rate |
$186.27 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$186.27
|
|
|
UNLISTED PROCEDURE HAND/FINGER
|
Facility
|
OP
|
$1,241.80
|
|
|
Service Code
|
HCPCS 26989
|
| Hospital Charge Code |
323026989
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$32.91 |
| Max. Negotiated Rate |
$1,057.82 |
| 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) 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 |
$372.54
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$186.27
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$32.91
|
|
|
UNLISTED PROCEDURE, LIVER
|
Facility
|
OP
|
$3,593.00
|
|
|
Service Code
|
CPT 47399
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$799.22 |
| Max. Negotiated Rate |
$3,593.00 |
| Rate for Payer: Aetna Commercial |
$2,288.28
|
| Rate for Payer: Aetna Medicare Advantage |
$2,725.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,036.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,036.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$841.28
|
| 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 |
$3,036.77
|
| Rate for Payer: Cigna Commercial |
$1,686.34
|
| Rate for Payer: Cigna Medicare Advantage |
$841.28
|
| Rate for Payer: Clover Medicare Advantage |
$799.22
|
| Rate for Payer: EmblemHealth Commercial |
$2,523.84
|
| Rate for Payer: Humana Medicare Advantage |
$866.52
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$841.28
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,593.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$841.28
|
|
|
UNLISTED PROCEDURE NOSE
|
Facility
|
OP
|
$1,367.40
|
|
|
Service Code
|
HCPCS 30999
|
| Hospital Charge Code |
1600000471
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$32.95 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$765.35
|
| Rate for Payer: Aetna Medicare Advantage |
$911.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,015.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,015.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$281.38
|
| 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 |
$1,015.70
|
| Rate for Payer: Cigna Commercial |
$564.04
|
| Rate for Payer: Cigna Medicare Advantage |
$281.38
|
| Rate for Payer: Clover Medicare Advantage |
$267.31
|
| Rate for Payer: EmblemHealth Commercial |
$844.14
|
| Rate for Payer: Humana Medicare Advantage |
$289.82
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$281.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$410.22
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$205.11
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$32.95
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$281.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$281.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$36.24
|
|
|
UNLISTED PROCEDURE NOSE
|
Facility
|
IP
|
$1,367.40
|
|
|
Service Code
|
HCPCS 30999
|
| Hospital Charge Code |
1600000471
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$205.11 |
| Max. Negotiated Rate |
$205.11 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$205.11
|
|
|
UNLISTED PROCEDURE,SPINE
|
Facility
|
OP
|
$859.60
|
|
|
Service Code
|
HCPCS 22899
|
| Hospital Charge Code |
16000442
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$20.72 |
| Max. Negotiated Rate |
$2,220.00 |
| 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 |
$257.88
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.72
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$22.78
|
|
|
UNLISTED PROCEDURE,SPINE
|
Facility
|
IP
|
$859.60
|
|
|
Service Code
|
HCPCS 22899
|
| Hospital Charge Code |
16000442
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$128.94 |
| Max. Negotiated Rate |
$128.94 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.94
|
|
|
UNLISTED PROCEDURE URINARY SYS
|
Facility
|
OP
|
$1,355.15
|
|
|
Service Code
|
HCPCS 53899
|
| Hospital Charge Code |
2600153
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.66 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$807.38
|
| Rate for Payer: Aetna Medicare Advantage |
$961.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,071.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,071.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$296.83
|
| 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 |
$1,071.47
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: Cigna Medicare Advantage |
$296.83
|
| Rate for Payer: Clover Medicare Advantage |
$281.99
|
| Rate for Payer: EmblemHealth Commercial |
$890.49
|
| Rate for Payer: Humana Medicare Advantage |
$305.73
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$296.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$406.55
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.27
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$32.66
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.91
|
|
|
UNLISTED PROCEDURE URINARY SYS
|
Facility
|
OP
|
$1,355.15
|
|
|
Service Code
|
HCPCS 53899
|
| Hospital Charge Code |
321053899
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.66 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$807.38
|
| Rate for Payer: Aetna Medicare Advantage |
$961.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,071.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,071.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$296.83
|
| 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 |
$1,071.47
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: Cigna Medicare Advantage |
$296.83
|
| Rate for Payer: Clover Medicare Advantage |
$281.99
|
| Rate for Payer: EmblemHealth Commercial |
$890.49
|
| Rate for Payer: Humana Medicare Advantage |
$305.73
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$296.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$406.55
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.27
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$32.66
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.91
|
|
|
UNLISTED PROCEDURE URINARY SYS
|
Facility
|
IP
|
$1,355.15
|
|
|
Service Code
|
HCPCS 53899
|
| Hospital Charge Code |
321053899
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$203.27 |
| Max. Negotiated Rate |
$203.27 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.27
|
|
|
UNLISTED PROCEDURE URINARY SYS
|
Facility
|
OP
|
$250.95
|
|
|
Service Code
|
HCPCS 53899
|
| Hospital Charge Code |
7411633
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$807.38
|
| Rate for Payer: Aetna Medicare Advantage |
$961.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,071.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,071.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$296.83
|
| 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 |
$1,071.47
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: Cigna Medicare Advantage |
$296.83
|
| Rate for Payer: Clover Medicare Advantage |
$281.99
|
| Rate for Payer: EmblemHealth Commercial |
$890.49
|
| Rate for Payer: Humana Medicare Advantage |
$305.73
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$296.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$75.28
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.64
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.05
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.65
|
|
|
UNLISTED PROCEDURE URINARY SYS
|
Facility
|
IP
|
$250.95
|
|
|
Service Code
|
HCPCS 53899
|
| Hospital Charge Code |
7411633
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$37.64 |
| Max. Negotiated Rate |
$37.64 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.64
|
|
|
UNLISTED PROCEDURE URINARY SYS
|
Facility
|
IP
|
$1,355.15
|
|
|
Service Code
|
HCPCS 53899
|
| Hospital Charge Code |
2600153
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$203.27 |
| Max. Negotiated Rate |
$203.27 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.27
|
|
|
UNLISTED PX ANUS
|
Facility
|
OP
|
$3,926.45
|
|
|
Service Code
|
HCPCS 46999
|
| Hospital Charge Code |
5792294
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.05 |
| Max. Negotiated Rate |
$3,988.03 |
| Rate for Payer: Aetna Commercial |
$3,005.08
|
| Rate for Payer: Aetna Medicare Advantage |
$3,579.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,988.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,988.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,104.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,988.03
|
| Rate for Payer: Cigna Commercial |
$2,214.60
|
| Rate for Payer: Cigna Medicare Advantage |
$1,104.81
|
| Rate for Payer: Clover Medicare Advantage |
$1,049.57
|
| Rate for Payer: EmblemHealth Commercial |
$3,314.43
|
| Rate for Payer: Humana Medicare Advantage |
$1,137.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,104.81
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,177.93
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$588.97
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,104.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,104.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$104.05
|
|
|
UNLISTED PX ANUS
|
Facility
|
IP
|
$3,926.45
|
|
|
Service Code
|
HCPCS 46999
|
| Hospital Charge Code |
5792294
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$588.97 |
| Max. Negotiated Rate |
$588.97 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$588.97
|
|
|
UNLISTED PX DIAPHRAGM
|
Facility
|
IP
|
$46,087.00
|
|
|
Service Code
|
HCPCS 39599
|
| Hospital Charge Code |
1600000605
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,913.05 |
| Max. Negotiated Rate |
$6,913.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,913.05
|
|
|
UNLISTED PX DIAPHRAGM
|
Facility
|
OP
|
$46,087.00
|
|
|
Service Code
|
HCPCS 39599
|
| Hospital Charge Code |
1600000605
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,110.70 |
| Max. Negotiated Rate |
$23,043.50 |
| Rate for Payer: Aetna Commercial |
$17,513.06
|
| Rate for Payer: Aetna Medicare Advantage |
$13,826.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11,752.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11,752.18
|
| 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 |
$11,752.18
|
| Rate for Payer: Cigna Commercial |
$23,043.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13,826.10
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,913.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,232.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,110.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,221.31
|
|
|
UNLISTED PX LEG/ANKLE
|
Facility
|
OP
|
$999.15
|
|
|
Service Code
|
HCPCS 27899
|
| Hospital Charge Code |
5792291
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.48 |
| Max. Negotiated Rate |
$1,057.82 |
| 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) 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 |
$299.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$149.87
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.48
|
|
|
UNLISTED PX LEG/ANKLE
|
Facility
|
IP
|
$999.15
|
|
|
Service Code
|
HCPCS 27899
|
| Hospital Charge Code |
5792291
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.87 |
| Max. Negotiated Rate |
$149.87 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$149.87
|
|
