|
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 |
$1,864.00 |
| Max. Negotiated Rate |
$14,396.79 |
| Rate for Payer: Aetna Commercial |
$10,305.00
|
| Rate for Payer: Aetna Medicare Advantage |
$10,305.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,759.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,759.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,759.25
|
| Rate for Payer: Cigna Commercial |
$14,396.79
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,465.50
|
| Rate for Payer: Oxford Commercial |
$7,559.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,152.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,580.00
|
|
|
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 |
$1,864.00 |
| Max. Negotiated Rate |
$14,396.79 |
| Rate for Payer: Aetna Commercial |
$8,841.09
|
| Rate for Payer: Aetna Medicare Advantage |
$8,841.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,514.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,514.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,514.93
|
| Rate for Payer: Cigna Commercial |
$14,396.79
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,831.14
|
| Rate for Payer: Oxford Commercial |
$7,559.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,420.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,580.00
|
|
|
UNLISTED LAPS PX APPENDIX
|
Facility
|
OP
|
$34,354.45
|
|
|
Service Code
|
HCPCS 44979
|
| Hospital Charge Code |
1600000773
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$14,396.79 |
| Rate for Payer: Aetna Commercial |
$10,306.33
|
| Rate for Payer: Aetna Medicare Advantage |
$10,306.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,760.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,760.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,760.38
|
| Rate for Payer: Cigna Commercial |
$14,396.79
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,466.08
|
| Rate for Payer: Oxford Commercial |
$7,559.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,153.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,580.00
|
|
|
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 BLADDER
|
Facility
|
OP
|
$34,354.45
|
|
|
Service Code
|
HCPCS 51999
|
| Hospital Charge Code |
1600000671
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$14,396.79 |
| Rate for Payer: Aetna Commercial |
$10,306.33
|
| Rate for Payer: Aetna Medicare Advantage |
$10,306.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,760.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,760.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,760.38
|
| Rate for Payer: Cigna Commercial |
$14,396.79
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,466.08
|
| Rate for Payer: Oxford Commercial |
$7,559.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,153.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,580.00
|
|
|
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 PROCEDURE BILIARY TRA
|
Facility
|
OP
|
$3,684.28
|
|
|
Service Code
|
HCPCS 47999
|
| Hospital Charge Code |
1600000364
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$478.96 |
| Max. Negotiated Rate |
$3,687.00 |
| Rate for Payer: Aetna Commercial |
$1,105.28
|
| Rate for Payer: Aetna Medicare Advantage |
$1,105.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$939.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$939.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$939.49
|
| Rate for Payer: Cigna Commercial |
$2,159.89
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$478.96
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$552.64
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,687.00
|
|
|
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
|
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 FOOT OR TOE
|
Facility
|
OP
|
$859.60
|
|
|
Service Code
|
HCPCS 28899
|
| Hospital Charge Code |
16000271
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$111.75 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$257.88
|
| Rate for Payer: Aetna Medicare Advantage |
$257.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$219.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$219.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$219.20
|
| Rate for Payer: Cigna Commercial |
$587.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$111.75
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
UNLISTED PROCEDURE HAND/FINGER
|
Facility
|
OP
|
$1,241.80
|
|
|
Service Code
|
HCPCS 26989
|
| Hospital Charge Code |
323026989
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$161.43 |
| Max. Negotiated Rate |
$587.42 |
| Rate for Payer: Aetna Commercial |
$372.54
|
| Rate for Payer: Aetna Medicare Advantage |
$372.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$316.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$316.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$316.66
|
| Rate for Payer: Cigna Commercial |
$587.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$161.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$186.27
|
|
|
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 NOSE
|
Facility
|
OP
|
$1,367.40
|
|
|
Service Code
|
HCPCS 30999
|
| Hospital Charge Code |
1600000471
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$177.76 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$410.22
|
| Rate for Payer: Aetna Medicare Advantage |
$410.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$348.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$348.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$348.69
|
| Rate for Payer: Cigna Commercial |
$564.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$177.76
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$205.11
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
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
|
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,SPINE
|
Facility
|
OP
|
$859.60
|
|
|
Service Code
|
HCPCS 22899
|
| Hospital Charge Code |
16000442
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$111.75 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$257.88
|
| Rate for Payer: Aetna Medicare Advantage |
$257.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$219.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$219.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$219.20
|
| Rate for Payer: Cigna Commercial |
$587.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$111.75
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
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
|
OP
|
$1,355.15
|
|
|
Service Code
|
HCPCS 53899
|
| Hospital Charge Code |
321053899
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$176.17 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$406.55
|
| Rate for Payer: Aetna Medicare Advantage |
$406.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$345.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$345.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$345.56
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$176.17
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.27
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
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 PROCEDURE URINARY SYS
|
Facility
|
OP
|
$1,355.15
|
|
|
Service Code
|
HCPCS 53899
|
| Hospital Charge Code |
2600153
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$176.17 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$406.55
|
| Rate for Payer: Aetna Medicare Advantage |
$406.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$345.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$345.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$345.56
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$176.17
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.27
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
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 |
$32.62 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$75.28
|
| Rate for Payer: Aetna Medicare Advantage |
$75.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$63.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$63.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$63.99
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.62
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.64
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
UNLISTED PX ANUS
|
Facility
|
OP
|
$3,926.45
|
|
|
Service Code
|
HCPCS 46999
|
| Hospital Charge Code |
5792294
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$510.44 |
| Max. Negotiated Rate |
$2,214.60 |
| Rate for Payer: Aetna Commercial |
$1,177.93
|
| Rate for Payer: Aetna Medicare Advantage |
$1,177.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,001.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,001.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,001.24
|
| Rate for Payer: Cigna Commercial |
$2,214.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$510.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$588.97
|
|
