|
FEMADPTBIOLOXD 16/18 12-14 7MM
|
Facility
|
IP
|
$937.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270697543
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.62 |
| Max. Negotiated Rate |
$226.88 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$187.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$226.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$140.62
|
|
|
FEMADPTBIOLOXD 16/18 12-14 7MM
|
Facility
|
OP
|
$937.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270697543
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.62 |
| Max. Negotiated Rate |
$468.75 |
| Rate for Payer: Aetna Commercial |
$281.25
|
| Rate for Payer: Aetna Medicare Advantage |
$281.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$239.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$239.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$187.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$239.06
|
| Rate for Payer: Cigna Commercial |
$468.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$226.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$140.62
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
|
IP
|
$23,228.49
|
|
|
Service Code
|
APR-DRG 5314
|
| Min. Negotiated Rate |
$19,527.00 |
| Max. Negotiated Rate |
$23,228.49 |
| Rate for Payer: Aetna Better Health Medicaid |
$22,773.03
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$23,228.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19,527.00
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
|
IP
|
$13,614.10
|
|
|
Service Code
|
APR-DRG 5313
|
| Min. Negotiated Rate |
$10,052.02 |
| Max. Negotiated Rate |
$13,614.10 |
| Rate for Payer: Aetna Better Health Medicaid |
$13,347.16
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$13,614.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10,052.02
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
|
IP
|
$6,724.17
|
|
|
Service Code
|
APR-DRG 5311
|
| Min. Negotiated Rate |
$4,735.44 |
| Max. Negotiated Rate |
$6,724.17 |
| Rate for Payer: Aetna Better Health Medicaid |
$6,592.32
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$6,724.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4,735.44
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
|
IP
|
$8,806.86
|
|
|
Service Code
|
APR-DRG 5312
|
| Min. Negotiated Rate |
$6,375.48 |
| Max. Negotiated Rate |
$8,806.86 |
| Rate for Payer: Aetna Better Health Medicaid |
$8,634.18
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$8,806.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6,375.48
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
IP
|
$9,830.67
|
|
|
Service Code
|
APR-DRG 5302
|
| Min. Negotiated Rate |
$6,692.98 |
| Max. Negotiated Rate |
$9,830.67 |
| Rate for Payer: Aetna Better Health Medicaid |
$9,637.91
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$9,830.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6,692.98
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
IP
|
$14,695.41
|
|
|
Service Code
|
APR-DRG 5303
|
| Min. Negotiated Rate |
$11,302.09 |
| Max. Negotiated Rate |
$14,695.41 |
| Rate for Payer: Aetna Better Health Medicaid |
$14,407.26
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$14,695.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11,302.09
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
IP
|
$23,388.57
|
|
|
Service Code
|
APR-DRG 5304
|
| Min. Negotiated Rate |
$20,811.93 |
| Max. Negotiated Rate |
$23,388.57 |
| Rate for Payer: Aetna Better Health Medicaid |
$22,929.97
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$23,388.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20,811.93
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
IP
|
$7,460.07
|
|
|
Service Code
|
APR-DRG 5301
|
| Min. Negotiated Rate |
$5,206.41 |
| Max. Negotiated Rate |
$7,460.07 |
| Rate for Payer: Aetna Better Health Medicaid |
$7,313.79
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$7,460.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5,206.41
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$27,611.54
|
|
|
Service Code
|
APR-DRG 5143
|
| Min. Negotiated Rate |
$17,062.31 |
| Max. Negotiated Rate |
$27,611.54 |
| Rate for Payer: Aetna Better Health Medicaid |
$27,070.14
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$27,611.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17,062.31
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$52,089.63
|
|
|
Service Code
|
MSDRG 748
|
| Min. Negotiated Rate |
$15,139.03 |
| Max. Negotiated Rate |
$52,089.63 |
| Rate for Payer: Aetna Commercial |
$46,779.60
|
| Rate for Payer: Aetna Medicare Advantage |
$15,139.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$38,593.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$38,593.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17,363.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$38,593.80
|
| Rate for Payer: Cigna Commercial |
$29,856.08
|
| Rate for Payer: Cigna Medicare Advantage |
$17,363.21
|
| Rate for Payer: Clover Medicare Advantage |
$16,495.05
|
| Rate for Payer: EmblemHealth Commercial |
$52,089.63
|
| Rate for Payer: Humana Medicare Advantage |
$17,884.11
|
| Rate for Payer: Oxford Commercial |
$18,659.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$21,179.91
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17,363.21
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$18,405.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$17,363.21
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$56,307.22
|
|
|
Service Code
|
APR-DRG 5144
|
| Min. Negotiated Rate |
$47,288.78 |
| Max. Negotiated Rate |
$56,307.22 |
| Rate for Payer: Aetna Better Health Medicaid |
$55,203.16
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$56,307.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$47,288.78
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$10,968.25
|
|
|
Service Code
|
APR-DRG 5141
|
| Min. Negotiated Rate |
$6,783.78 |
| Max. Negotiated Rate |
$10,968.25 |
| Rate for Payer: Aetna Better Health Medicaid |
$10,753.19
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$10,968.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6,783.78
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$16,368.04
|
|
|
Service Code
|
APR-DRG 5142
|
| Min. Negotiated Rate |
$9,851.59 |
| Max. Negotiated Rate |
$16,368.04 |
| Rate for Payer: Aetna Better Health Medicaid |
$16,047.10
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$16,368.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9,851.59
|
|
|
FEMAL NEX KNEE SZ FRT 59961652
|
Facility
|
OP
|
$11,580.00
|
|
| Hospital Charge Code |
270638062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,737.00 |
| Max. Negotiated Rate |
$5,790.00 |
| Rate for Payer: Aetna Commercial |
$3,474.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,474.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,952.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,952.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,316.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,952.90
|
| Rate for Payer: Cigna Commercial |
$5,790.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,802.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,737.00
|
|
|
FEMAL NEX KNEE SZ FRT 59961652
|
Facility
|
IP
|
$11,580.00
|
|
| Hospital Charge Code |
270638062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,737.00 |
| Max. Negotiated Rate |
$2,802.36 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,316.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,802.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,737.00
|
|
|
FEM AUG VANGARD DIST 65x10 RL/
|
Facility
|
IP
|
$6,210.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270679832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$931.50 |
| Max. Negotiated Rate |
$1,502.82 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,242.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,502.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$931.50
|
|
|
FEM AUG VANGARD DIST 65x10 RL/
|
Facility
|
OP
|
$6,210.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270679832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$931.50 |
| Max. Negotiated Rate |
$3,105.00 |
| Rate for Payer: Aetna Commercial |
$1,863.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,863.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,583.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,583.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,242.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,583.55
|
| Rate for Payer: Cigna Commercial |
$3,105.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,502.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$931.50
|
|
|
FEM AUG VNGRD DIST65X10 RL/LM
|
Facility
|
IP
|
$6,210.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270679833
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$931.50 |
| Max. Negotiated Rate |
$1,502.82 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,242.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,502.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$931.50
|
|
|
FEM AUG VNGRD DIST65X10 RL/LM
|
Facility
|
OP
|
$6,210.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270679833
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$931.50 |
| Max. Negotiated Rate |
$3,105.00 |
| Rate for Payer: Aetna Commercial |
$1,863.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,863.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,583.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,583.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,242.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,583.55
|
| Rate for Payer: Cigna Commercial |
$3,105.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,502.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$931.50
|
|
|
FEM AUG VNGRD DIST65X10 RL/RM
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270672832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$363.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$300.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$363.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
|
|
FEM AUG VNGRD DIST65X10 RL/RM
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270672832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$450.00
|
| Rate for Payer: Aetna Medicare Advantage |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$382.50
|
| Rate for Payer: Cigna Commercial |
$750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$363.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
|
|
FEM COMP PS TRIATH PS LT SZ5
|
Facility
|
OP
|
$7,971.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270694177
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,195.71 |
| Max. Negotiated Rate |
$3,985.70 |
| Rate for Payer: Aetna Commercial |
$2,391.42
|
| Rate for Payer: Aetna Medicare Advantage |
$2,391.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,032.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,032.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,594.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,032.71
|
| Rate for Payer: Cigna Commercial |
$3,985.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,929.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,195.71
|
|
|
FEM COMP PS TRIATH PS LT SZ5
|
Facility
|
IP
|
$7,971.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270694177
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,195.71 |
| Max. Negotiated Rate |
$1,929.08 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,594.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,929.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,195.71
|
|
