|
EXC FOREARM LES SC 3 CM/>
|
Facility
|
IP
|
$20,625.50
|
|
|
Service Code
|
HCPCS 25071
|
| Hospital Charge Code |
16000328
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,093.82 |
| Max. Negotiated Rate |
$3,093.82 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,093.82
|
|
|
EXC FOREARM LES SC 3 CM/>
|
Facility
|
OP
|
$20,625.50
|
|
|
Service Code
|
HCPCS 25071
|
| Hospital Charge Code |
16000328
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$585.76 |
| Max. Negotiated Rate |
$8,192.00 |
| Rate for Payer: Aetna Commercial |
$5,337.02
|
| Rate for Payer: Aetna Medicare Advantage |
$6,357.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,117.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,117.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,962.14
|
| 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 |
$7,117.66
|
| Rate for Payer: Cigna Commercial |
$3,933.12
|
| Rate for Payer: Cigna Medicare Advantage |
$1,962.14
|
| Rate for Payer: Clover Medicare Advantage |
$1,864.03
|
| Rate for Payer: EmblemHealth Commercial |
$5,886.42
|
| Rate for Payer: Humana Medicare Advantage |
$2,021.00
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,962.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,362.63
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,093.82
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$651.77
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,962.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,962.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$585.76
|
|
|
EXC FOREARM LES SC < 3 CM LT
|
Facility
|
IP
|
$13,615.50
|
|
|
Service Code
|
HCPCS 25075
|
| Hospital Charge Code |
16000444
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,042.33 |
| Max. Negotiated Rate |
$2,042.33 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,042.33
|
|
|
EXC FOREARM LES SC < 3 CM LT
|
Facility
|
OP
|
$13,615.50
|
|
|
Service Code
|
HCPCS 25075
|
| Hospital Charge Code |
16000444
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$386.68 |
| Max. Negotiated Rate |
$7,117.66 |
| Rate for Payer: Aetna Commercial |
$5,337.02
|
| Rate for Payer: Aetna Medicare Advantage |
$6,357.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,117.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,117.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,962.14
|
| 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 |
$7,117.66
|
| Rate for Payer: Cigna Commercial |
$3,933.12
|
| Rate for Payer: Cigna Medicare Advantage |
$1,962.14
|
| Rate for Payer: Clover Medicare Advantage |
$1,864.03
|
| Rate for Payer: EmblemHealth Commercial |
$5,886.42
|
| Rate for Payer: Humana Medicare Advantage |
$2,021.00
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,962.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,540.03
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,042.33
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$430.25
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,962.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,962.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$386.68
|
|
|
EXC FOREARM TUM DEEP < 3 CM
|
Facility
|
IP
|
$7,196.28
|
|
|
Service Code
|
HCPCS 25076
|
| Hospital Charge Code |
16000829
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,079.44 |
| Max. Negotiated Rate |
$1,079.44 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,079.44
|
|
|
EXC FOREARM TUM DEEP < 3 CM
|
Facility
|
OP
|
$7,196.28
|
|
|
Service Code
|
HCPCS 25076
|
| Hospital Charge Code |
16000829
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$204.37 |
| Max. Negotiated Rate |
$7,117.66 |
| Rate for Payer: Aetna Commercial |
$5,337.02
|
| Rate for Payer: Aetna Medicare Advantage |
$6,357.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,117.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,117.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,962.14
|
| 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 |
$7,117.66
|
| Rate for Payer: Cigna Commercial |
$3,933.12
|
| Rate for Payer: Cigna Medicare Advantage |
$1,962.14
|
| Rate for Payer: Clover Medicare Advantage |
$1,864.03
|
| Rate for Payer: EmblemHealth Commercial |
$5,886.42
|
| Rate for Payer: Humana Medicare Advantage |
$2,021.00
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,962.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,871.03
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,079.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$227.40
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,962.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,962.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$204.37
|
|
|
EXC FOREARM TUM DEEP 3 CM/>
|
Facility
|
OP
|
$20,625.50
|
|
|
Service Code
|
HCPCS 25073
|
| Hospital Charge Code |
16000615
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$585.76 |
| Max. Negotiated Rate |
$12,518.07 |
| Rate for Payer: Aetna Commercial |
$9,386.39
|
| Rate for Payer: Aetna Medicare Advantage |
$11,180.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12,518.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12,518.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,450.88
|
| 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 |
$12,518.07
|
| Rate for Payer: Cigna Commercial |
$6,917.28
|
| Rate for Payer: Cigna Medicare Advantage |
$3,450.88
|
| Rate for Payer: Clover Medicare Advantage |
$3,278.34
|
| Rate for Payer: EmblemHealth Commercial |
$10,352.64
|
| Rate for Payer: Humana Medicare Advantage |
$3,554.41
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,450.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,362.63
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,093.82
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$651.77
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$585.76
|
|
|
EXC FOREARM TUM DEEP 3 CM/>
|
Facility
|
IP
|
$20,625.50
|
|
|
Service Code
|
HCPCS 25073
|
| Hospital Charge Code |
16000615
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,093.82 |
| Max. Negotiated Rate |
$3,093.82 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,093.82
|
|
|
EXC HAND LES SC < 1.5 CM
|
Facility
|
OP
|
$13,615.50
|
|
|
Service Code
|
HCPCS 26115
|
| Hospital Charge Code |
16000396
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$386.68 |
| Max. Negotiated Rate |
$7,117.66 |
| Rate for Payer: Aetna Commercial |
$5,337.02
|
| Rate for Payer: Aetna Medicare Advantage |
$6,357.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,117.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,117.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,962.14
|
| 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 |
$7,117.66
|
| Rate for Payer: Cigna Commercial |
$3,933.12
|
| Rate for Payer: Cigna Medicare Advantage |
$1,962.14
|
| Rate for Payer: Clover Medicare Advantage |
$1,864.03
|
| Rate for Payer: EmblemHealth Commercial |
$5,886.42
|
| Rate for Payer: Humana Medicare Advantage |
$2,021.00
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,962.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,540.03
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,042.33
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$430.25
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,962.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,962.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$386.68
|
|
|
EXC HAND LES SC < 1.5 CM
|
Facility
|
IP
|
$13,615.50
|
|
|
Service Code
|
HCPCS 26115
|
| Hospital Charge Code |
16000396
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,042.33 |
| Max. Negotiated Rate |
$2,042.33 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,042.33
|
|
|
EXC HAND LES SC 1.5 CM/>
|
Facility
|
OP
|
$20,625.50
|
|
|
Service Code
|
HCPCS 26111
|
| Hospital Charge Code |
16000445
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$585.76 |
| Max. Negotiated Rate |
$8,192.00 |
| Rate for Payer: Aetna Commercial |
$5,337.02
|
| Rate for Payer: Aetna Medicare Advantage |
$6,357.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,117.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,117.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,962.14
|
| 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 |
$7,117.66
|
| Rate for Payer: Cigna Commercial |
$3,933.12
|
| Rate for Payer: Cigna Medicare Advantage |
$1,962.14
|
| Rate for Payer: Clover Medicare Advantage |
$1,864.03
|
| Rate for Payer: EmblemHealth Commercial |
$5,886.42
|
| Rate for Payer: Humana Medicare Advantage |
$2,021.00
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,962.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,362.63
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,093.82
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$651.77
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,962.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,962.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$585.76
|
|
|
EXC HAND LES SC 1.5 CM/>
|
Facility
|
IP
|
$20,625.50
|
|
|
Service Code
|
HCPCS 26111
|
| Hospital Charge Code |
16000445
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,093.82 |
| Max. Negotiated Rate |
$3,093.82 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,093.82
|
|
|
EXC HAND TUM DEEP < 1.5 CM
|
Facility
|
IP
|
$13,615.50
|
|
|
Service Code
|
HCPCS 26116
|
| Hospital Charge Code |
16000842
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,042.33 |
| Max. Negotiated Rate |
$2,042.33 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,042.33
|
|
|
EXC HAND TUM DEEP < 1.5 CM
|
Facility
|
OP
|
$13,615.50
|
|
|
Service Code
|
HCPCS 26116
|
| Hospital Charge Code |
16000842
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$386.68 |
| Max. Negotiated Rate |
$7,117.66 |
| Rate for Payer: Aetna Commercial |
$5,337.02
|
| Rate for Payer: Aetna Medicare Advantage |
$6,357.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,117.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,117.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,962.14
|
| 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 |
$7,117.66
|
| Rate for Payer: Cigna Commercial |
$3,933.12
|
| Rate for Payer: Cigna Medicare Advantage |
$1,962.14
|
| Rate for Payer: Clover Medicare Advantage |
$1,864.03
|
| Rate for Payer: EmblemHealth Commercial |
$5,886.42
|
| Rate for Payer: Humana Medicare Advantage |
$2,021.00
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,962.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,540.03
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,042.33
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$430.25
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,962.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,962.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$386.68
|
|
|
EXCHANGE BILIARY DRG CATH
|
Facility
|
OP
|
$17,259.20
|
|
|
Service Code
|
HCPCS 47536
|
| Hospital Charge Code |
2600236
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$490.16 |
| Max. Negotiated Rate |
$15,429.97 |
| Rate for Payer: Aetna Commercial |
$11,569.82
|
| Rate for Payer: Aetna Medicare Advantage |
$13,781.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15,429.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15,429.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4,253.61
|
| 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 |
$15,429.97
|
| Rate for Payer: Cigna Commercial |
$8,526.35
|
| Rate for Payer: Cigna Medicare Advantage |
$4,253.61
|
| Rate for Payer: Clover Medicare Advantage |
$4,040.93
|
| Rate for Payer: EmblemHealth Commercial |
$12,760.83
|
| Rate for Payer: Humana Medicare Advantage |
$4,381.22
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4,253.61
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,487.39
|
| Rate for Payer: Oxford Commercial |
$9,354.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,588.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,269.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$545.39
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4,253.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$4,253.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$490.16
|
|
|
EXCHANGE BILIARY DRG CATH
|
Facility
|
OP
|
$17,067.55
|
|
|
Service Code
|
HCPCS 47536
|
| Hospital Charge Code |
411047536
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$484.72 |
| Max. Negotiated Rate |
$15,429.97 |
| Rate for Payer: Aetna Commercial |
$11,569.82
|
| Rate for Payer: Aetna Medicare Advantage |
$13,781.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15,429.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15,429.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4,253.61
|
| 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 |
$15,429.97
|
| Rate for Payer: Cigna Commercial |
$8,526.35
|
| Rate for Payer: Cigna Medicare Advantage |
$4,253.61
|
| Rate for Payer: Clover Medicare Advantage |
$4,040.93
|
| Rate for Payer: EmblemHealth Commercial |
$12,760.83
|
| Rate for Payer: Humana Medicare Advantage |
$4,381.22
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4,253.61
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,437.56
|
| Rate for Payer: Oxford Commercial |
$9,354.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,560.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,269.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$539.33
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4,253.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$4,253.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$484.72
|
|
|
EXCHANGE BILIARY DRG CATH
|
Facility
|
IP
|
$17,067.55
|
|
|
Service Code
|
HCPCS 47536
|
| Hospital Charge Code |
411047536
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,560.13 |
| Max. Negotiated Rate |
$2,560.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,560.13
|
|
|
EXCHANGE BILIARY DRG CATH
|
Facility
|
IP
|
$17,259.20
|
|
|
Service Code
|
HCPCS 47536
|
| Hospital Charge Code |
2600236
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,588.88 |
| Max. Negotiated Rate |
$2,588.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,588.88
|
|
|
EXCHANGE BILIARY DRG CATH
|
Facility
|
IP
|
$17,067.55
|
|
|
Service Code
|
HCPCS 47536
|
| Hospital Charge Code |
366847536
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,560.13 |
| Max. Negotiated Rate |
$2,560.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,560.13
|
|
|
EXCHANGE BILIARY DRG CATH
|
Facility
|
IP
|
$12,827.31
|
|
|
Service Code
|
HCPCS 47536
|
| Hospital Charge Code |
2011567
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,924.10 |
| Max. Negotiated Rate |
$1,924.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,924.10
|
|
|
EXCHANGE BILIARY DRG CATH
|
Facility
|
OP
|
$17,259.20
|
|
|
Service Code
|
HCPCS 47536
|
| Hospital Charge Code |
321047536
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$490.16 |
| Max. Negotiated Rate |
$15,429.97 |
| Rate for Payer: Aetna Commercial |
$11,569.82
|
| Rate for Payer: Aetna Medicare Advantage |
$13,781.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15,429.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15,429.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4,253.61
|
| 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 |
$15,429.97
|
| Rate for Payer: Cigna Commercial |
$8,526.35
|
| Rate for Payer: Cigna Medicare Advantage |
$4,253.61
|
| Rate for Payer: Clover Medicare Advantage |
$4,040.93
|
| Rate for Payer: EmblemHealth Commercial |
$12,760.83
|
| Rate for Payer: Humana Medicare Advantage |
$4,381.22
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4,253.61
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,487.39
|
| Rate for Payer: Oxford Commercial |
$9,354.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,588.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,269.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$545.39
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4,253.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$4,253.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$490.16
|
|
|
EXCHANGE BILIARY DRG CATH
|
Facility
|
IP
|
$17,259.20
|
|
|
Service Code
|
HCPCS 47536
|
| Hospital Charge Code |
321047536
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,588.88 |
| Max. Negotiated Rate |
$2,588.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,588.88
|
|
|
EXCHANGE BILIARY DRG CATH
|
Facility
|
OP
|
$17,067.55
|
|
|
Service Code
|
HCPCS 47536
|
| Hospital Charge Code |
366847536
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$484.72 |
| Max. Negotiated Rate |
$15,429.97 |
| Rate for Payer: Aetna Commercial |
$11,569.82
|
| Rate for Payer: Aetna Medicare Advantage |
$13,781.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15,429.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15,429.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4,253.61
|
| 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 |
$15,429.97
|
| Rate for Payer: Cigna Commercial |
$8,526.35
|
| Rate for Payer: Cigna Medicare Advantage |
$4,253.61
|
| Rate for Payer: Clover Medicare Advantage |
$4,040.93
|
| Rate for Payer: EmblemHealth Commercial |
$12,760.83
|
| Rate for Payer: Humana Medicare Advantage |
$4,381.22
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4,253.61
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,437.56
|
| Rate for Payer: Oxford Commercial |
$9,354.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,560.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,269.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$539.33
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4,253.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$4,253.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$484.72
|
|
|
EXCHANGE BILIARY DRG CATH
|
Facility
|
OP
|
$12,827.31
|
|
|
Service Code
|
HCPCS 47536
|
| Hospital Charge Code |
7411565
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$364.30 |
| Max. Negotiated Rate |
$15,429.97 |
| Rate for Payer: Aetna Commercial |
$11,569.82
|
| Rate for Payer: Aetna Medicare Advantage |
$13,781.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15,429.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15,429.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4,253.61
|
| 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 |
$15,429.97
|
| Rate for Payer: Cigna Commercial |
$8,526.35
|
| Rate for Payer: Cigna Medicare Advantage |
$4,253.61
|
| Rate for Payer: Clover Medicare Advantage |
$4,040.93
|
| Rate for Payer: EmblemHealth Commercial |
$12,760.83
|
| Rate for Payer: Humana Medicare Advantage |
$4,381.22
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4,253.61
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,335.10
|
| Rate for Payer: Oxford Commercial |
$9,354.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,924.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,269.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$405.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4,253.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$4,253.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$364.30
|
|
|
EXCHANGE BILIARY DRG CATH
|
Facility
|
IP
|
$12,827.31
|
|
|
Service Code
|
HCPCS 47536
|
| Hospital Charge Code |
7411565
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,924.10 |
| Max. Negotiated Rate |
$1,924.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,924.10
|
|
