|
ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC
|
Facility
|
IP
|
$59,534.72
|
|
|
Service Code
|
MSDRG 391
|
| Min. Negotiated Rate |
$18,127.56 |
| Max. Negotiated Rate |
$59,534.72 |
| Rate for Payer: Aetna Commercial |
$44,259.82
|
| Rate for Payer: Aetna Medicare Advantage |
$59,534.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$35,462.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$35,462.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$19,081.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$35,462.40
|
| Rate for Payer: Cigna Commercial |
$28,274.21
|
| Rate for Payer: Cigna Medicare Advantage |
$19,081.64
|
| Rate for Payer: Clover Medicare Advantage |
$18,127.56
|
| Rate for Payer: EmblemHealth Commercial |
$57,244.92
|
| Rate for Payer: Humana Medicare Advantage |
$19,654.09
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$19,081.64
|
| Rate for Payer: Oxford Commercial |
$22,347.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$29,912.86
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$19,081.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$19,081.64
|
|
|
ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$44,094.99
|
|
|
Service Code
|
MSDRG 392
|
| Min. Negotiated Rate |
$13,426.36 |
| Max. Negotiated Rate |
$44,094.99 |
| Rate for Payer: Aetna Commercial |
$33,263.45
|
| Rate for Payer: Aetna Medicare Advantage |
$44,094.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$21,886.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$21,886.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14,133.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$21,886.95
|
| Rate for Payer: Cigna Commercial |
$17,379.62
|
| Rate for Payer: Cigna Medicare Advantage |
$14,133.01
|
| Rate for Payer: Clover Medicare Advantage |
$13,426.36
|
| Rate for Payer: EmblemHealth Commercial |
$42,399.03
|
| Rate for Payer: Humana Medicare Advantage |
$14,557.00
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14,133.01
|
| Rate for Payer: Oxford Commercial |
$13,736.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$18,386.87
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14,133.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$14,133.01
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$5,347.00
|
|
|
Service Code
|
CPT 43235
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$166.10 |
| Max. Negotiated Rate |
$5,347.00 |
| 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 |
$3,908.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,908.70
|
| 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 |
$166.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,908.70
|
| 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: Oxford Commercial |
$5,018.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,077.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,077.52
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH BAND LIGATION OF ESOPHAGEAL/GASTRIC VARICES
|
Facility
|
OP
|
$8,269.65
|
|
|
Service Code
|
CPT 43244
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$166.10 |
| Max. Negotiated Rate |
$8,269.65 |
| Rate for Payer: Aetna Commercial |
$6,200.81
|
| Rate for Payer: Aetna Medicare Advantage |
$7,386.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,269.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,269.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,279.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$166.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,269.65
|
| Rate for Payer: Cigna Commercial |
$4,569.67
|
| Rate for Payer: Cigna Medicare Advantage |
$2,279.71
|
| Rate for Payer: Clover Medicare Advantage |
$2,165.72
|
| Rate for Payer: EmblemHealth Commercial |
$6,839.13
|
| Rate for Payer: Humana Medicare Advantage |
$2,348.10
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,279.71
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,279.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,279.71
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$5,347.00
|
|
|
Service Code
|
CPT 43239
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$220.62 |
| Max. Negotiated Rate |
$5,347.00 |
| 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 |
$3,908.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,908.70
|
| 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 |
$220.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,908.70
|
| 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: Oxford Commercial |
$5,018.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,077.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,077.52
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH CONTROL OF BLEEDING, ANY METHOD
|
Facility
|
OP
|
$8,269.65
|
|
|
Service Code
|
CPT 43255
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$179.30 |
| Max. Negotiated Rate |
$8,269.65 |
| Rate for Payer: Aetna Commercial |
$6,200.81
|
| Rate for Payer: Aetna Medicare Advantage |
$7,386.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,269.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,269.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,279.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,269.65
|
| Rate for Payer: Cigna Commercial |
$4,569.67
|
| Rate for Payer: Cigna Medicare Advantage |
$2,279.71
|
| Rate for Payer: Clover Medicare Advantage |
$2,165.72
|
| Rate for Payer: EmblemHealth Commercial |
$6,839.13
|
| Rate for Payer: Humana Medicare Advantage |
$2,348.10
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,279.71
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,279.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,279.71
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH DIRECTED PLACEMENT OF PERCUTANEOUS GASTROSTOMY TUBE
|
Facility
|
OP
|
$8,269.65
|
|
|
Service Code
|
CPT 43246
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,165.72 |
| Max. Negotiated Rate |
$8,269.65 |
| Rate for Payer: Aetna Commercial |
$6,200.81
|
| Rate for Payer: Aetna Medicare Advantage |
$7,386.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,269.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,269.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,279.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,269.65
|
| Rate for Payer: Cigna Commercial |
$4,569.67
|
| Rate for Payer: Cigna Medicare Advantage |
$2,279.71
|
| Rate for Payer: Clover Medicare Advantage |
$2,165.72
|
| Rate for Payer: EmblemHealth Commercial |
$6,839.13
|
| Rate for Payer: Humana Medicare Advantage |
$2,348.10
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,279.71
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,279.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,279.71
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$4,829.61
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH REMOVAL OF FOREIGN BODY(S)
|
Facility
|
OP
|
$5,347.00
|
|
|
Service Code
|
CPT 43247
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$166.10 |
| Max. Negotiated Rate |
$5,347.00 |
| 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 |
$3,908.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,908.70
|
| 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 |
$166.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,908.70
|
| 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: Oxford Commercial |
$5,018.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,077.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,077.52
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE
|
Facility
|
OP
|
$8,269.65
|
|
|
Service Code
|
CPT 43251
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$166.10 |
| Max. Negotiated Rate |
$8,269.65 |
| Rate for Payer: Aetna Commercial |
$6,200.81
|
| Rate for Payer: Aetna Medicare Advantage |
$7,386.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,269.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,269.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,279.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$166.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,269.65
|
| Rate for Payer: Cigna Commercial |
$4,569.67
|
| Rate for Payer: Cigna Medicare Advantage |
$2,279.71
|
| Rate for Payer: Clover Medicare Advantage |
$2,165.72
|
| Rate for Payer: EmblemHealth Commercial |
$6,839.13
|
| Rate for Payer: Humana Medicare Advantage |
$2,348.10
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,279.71
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,279.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,279.71
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH TRANSENDOSCOPIC BALLOON DILATION OF ESOPHAGUS (LESS THAN 30 MM DIAMETER)
|
Facility
|
OP
|
$8,269.65
|
|
|
Service Code
|
CPT 43249
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$145.20 |
| Max. Negotiated Rate |
$8,269.65 |
| Rate for Payer: Aetna Commercial |
$6,200.81
|
| Rate for Payer: Aetna Medicare Advantage |
$7,386.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,269.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,269.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,279.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$145.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,269.65
|
| Rate for Payer: Cigna Commercial |
$4,569.67
|
| Rate for Payer: Cigna Medicare Advantage |
$2,279.71
|
| Rate for Payer: Clover Medicare Advantage |
$2,165.72
|
| Rate for Payer: EmblemHealth Commercial |
$6,839.13
|
| Rate for Payer: Humana Medicare Advantage |
$2,348.10
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,279.71
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,279.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,279.71
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$4,829.61
|
|
|
ESOPHAGOSCOPY FLEXIBLE BRUSH
|
Facility
|
IP
|
$7,963.40
|
|
|
Service Code
|
HCPCS 43200
|
| Hospital Charge Code |
16000641
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,194.51 |
| Max. Negotiated Rate |
$1,194.51 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,194.51
|
|
|
ESOPHAGOSCOPY FLEXIBLE BRUSH
|
Facility
|
OP
|
$7,963.40
|
|
|
Service Code
|
HCPCS 43200
|
| Hospital Charge Code |
16000641
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$226.16 |
| Max. Negotiated Rate |
$5,347.00 |
| 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 |
$3,908.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,908.70
|
| 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 |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,908.70
|
| 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 |
$2,070.48
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,194.51
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$251.64
|
| 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 |
$226.16
|
|
|
ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$8,269.65
|
|
|
Service Code
|
CPT 43202
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$106.70 |
| Max. Negotiated Rate |
$8,269.65 |
| Rate for Payer: Aetna Commercial |
$6,200.81
|
| Rate for Payer: Aetna Medicare Advantage |
$7,386.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,269.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,269.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,279.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$106.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,269.65
|
| Rate for Payer: Cigna Commercial |
$4,569.67
|
| Rate for Payer: Cigna Medicare Advantage |
$2,279.71
|
| Rate for Payer: Clover Medicare Advantage |
$2,165.72
|
| Rate for Payer: EmblemHealth Commercial |
$6,839.13
|
| Rate for Payer: Humana Medicare Advantage |
$2,348.10
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,279.71
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,279.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,279.71
|
|
|
ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH TRANSENDOSCOPIC BALLOON DILATION (LESS THAN 30 MM DIAMETER)
|
Facility
|
OP
|
$8,269.65
|
|
|
Service Code
|
CPT 43220
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$93.50 |
| Max. Negotiated Rate |
$8,269.65 |
| Rate for Payer: Aetna Commercial |
$6,200.81
|
| Rate for Payer: Aetna Medicare Advantage |
$7,386.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,269.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,269.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,279.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$93.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,269.65
|
| Rate for Payer: Cigna Commercial |
$4,569.67
|
| Rate for Payer: Cigna Medicare Advantage |
$2,279.71
|
| Rate for Payer: Clover Medicare Advantage |
$2,165.72
|
| Rate for Payer: EmblemHealth Commercial |
$6,839.13
|
| Rate for Payer: Humana Medicare Advantage |
$2,348.10
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,279.71
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,279.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,279.71
|
|
|
ESOPHAGUS SURGERY PROCEDURE
|
Facility
|
OP
|
$3,487.18
|
|
|
Service Code
|
HCPCS 43499
|
| Hospital Charge Code |
16000966
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$99.04 |
| Max. Negotiated Rate |
$5,347.00 |
| 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 |
$3,908.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,908.70
|
| 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 |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,908.70
|
| 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 |
$906.67
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$523.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$110.19
|
| 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 |
$99.04
|
|
|
ESOPHAGUS SURGERY PROCEDURE
|
Facility
|
IP
|
$3,487.18
|
|
|
Service Code
|
HCPCS 43499
|
| Hospital Charge Code |
16000966
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$523.08 |
| Max. Negotiated Rate |
$523.08 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$523.08
|
|
|
ESSURE
|
Facility
|
OP
|
$8,750.00
|
|
| Hospital Charge Code |
270658503
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$248.50 |
| Max. Negotiated Rate |
$4,375.00 |
| Rate for Payer: Aetna Commercial |
$3,325.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,625.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,231.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,231.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,231.25
|
| Rate for Payer: Cigna Commercial |
$4,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,275.00
|
| Rate for Payer: Oxford Commercial |
$1,750.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,312.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,750.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$276.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$248.50
|
|
|
ESSURE
|
Facility
|
IP
|
$8,750.00
|
|
| Hospital Charge Code |
270658503
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,312.50 |
| Max. Negotiated Rate |
$1,312.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,312.50
|
|
|
ESTABLISHED BRAIN CAVITY SHUNT
|
Facility
|
IP
|
$2,647.00
|
|
|
Service Code
|
HCPCS 62223
|
| Hospital Charge Code |
1600000643
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$397.05 |
| Max. Negotiated Rate |
$397.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$397.05
|
|
|
ESTABLISHED BRAIN CAVITY SHUNT
|
Facility
|
OP
|
$2,647.00
|
|
|
Service Code
|
HCPCS 62223
|
| Hospital Charge Code |
1600000643
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$75.17 |
| Max. Negotiated Rate |
$10,269.00 |
| Rate for Payer: Aetna Commercial |
$1,005.86
|
| Rate for Payer: Aetna Medicare Advantage |
$794.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$674.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$674.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$674.99
|
| Rate for Payer: Cigna Commercial |
$1,323.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$688.22
|
| Rate for Payer: Oxford Commercial |
$9,354.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$397.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,269.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$83.65
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$75.17
|
|
|
ESTABLISH PATIENT SAME DAY
|
Facility
|
IP
|
$311.00
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
3408040
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.65 |
| Max. Negotiated Rate |
$46.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.65
|
|
|
ESTABLISH PATIENT SAME DAY
|
Facility
|
OP
|
$311.00
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
3408040
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.83 |
| Max. Negotiated Rate |
$155.50 |
| Rate for Payer: Aetna Commercial |
$118.18
|
| Rate for Payer: Aetna Medicare Advantage |
$93.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$79.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$79.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$79.31
|
| Rate for Payer: Cigna Commercial |
$155.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$80.86
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.65
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.83
|
|
|
ESTAB PATIENT LEV 2 >=10 MINS
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS 99212
|
| Hospital Charge Code |
4517716
|
|
Hospital Revenue Code
|
913
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$133.00
|
| Rate for Payer: Aetna Medicare Advantage |
$105.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$58.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$89.25
|
| Rate for Payer: Cigna Commercial |
$175.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$91.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.06
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$49.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.94
|
|
|
ESTAB PATIENT LEV 2 >=10 MINS
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
HCPCS 99212
|
| Hospital Charge Code |
93950145
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$118.00 |
| Rate for Payer: Aetna Commercial |
$89.68
|
| Rate for Payer: Aetna Medicare Advantage |
$70.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$60.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$60.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$60.18
|
| Rate for Payer: Cigna Commercial |
$118.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$61.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.70
|
|
|
ESTAB PATIENT LEV 2 >=10 MINS
|
Facility
|
IP
|
$367.85
|
|
|
Service Code
|
HCPCS 99212
|
| Hospital Charge Code |
87506070
|
|
Hospital Revenue Code
|
513
|
| Min. Negotiated Rate |
$55.18 |
| Max. Negotiated Rate |
$55.18 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$55.18
|
|
