|
EXC NEUROMA; CUTANEOUS NRV SUR
|
Facility
|
IP
|
$16,424.70
|
|
|
Service Code
|
HCPCS 64774
|
| Hospital Charge Code |
160000194
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,463.70 |
| Max. Negotiated Rate |
$2,463.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,463.70
|
|
|
EXC OF EXT THROMBOSED HEMOR
|
Facility
|
IP
|
$9,954.00
|
|
|
Service Code
|
HCPCS 46320
|
| Hospital Charge Code |
83033015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,493.10 |
| Max. Negotiated Rate |
$1,493.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,493.10
|
|
|
EXC OF EXT THROMBOSED HEMOR
|
Facility
|
OP
|
$9,954.00
|
|
|
Service Code
|
HCPCS 46320
|
| Hospital Charge Code |
83033015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$282.69 |
| Max. Negotiated Rate |
$5,347.00 |
| Rate for Payer: Aetna Commercial |
$3,866.86
|
| Rate for Payer: Aetna Medicare Advantage |
$4,606.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,157.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,157.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,421.64
|
| 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 |
$5,157.00
|
| Rate for Payer: Cigna Commercial |
$2,849.67
|
| Rate for Payer: Cigna Medicare Advantage |
$1,421.64
|
| Rate for Payer: Clover Medicare Advantage |
$1,350.56
|
| Rate for Payer: EmblemHealth Commercial |
$4,264.92
|
| Rate for Payer: Humana Medicare Advantage |
$1,464.29
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,421.64
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,588.04
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,493.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$314.55
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,421.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,421.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$282.69
|
|
|
EXC OF TARSAL COALITION
|
Facility
|
IP
|
$19,998.60
|
|
|
Service Code
|
HCPCS 28116
|
| Hospital Charge Code |
16000571
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,999.79 |
| Max. Negotiated Rate |
$2,999.79 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,999.79
|
|
|
EXC OF TARSAL COALITION
|
Facility
|
OP
|
$19,998.60
|
|
|
Service Code
|
HCPCS 28116
|
| Hospital Charge Code |
16000571
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$567.96 |
| Max. Negotiated Rate |
$14,100.89 |
| Rate for Payer: Aetna Commercial |
$10,573.24
|
| Rate for Payer: Aetna Medicare Advantage |
$12,594.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14,100.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14,100.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,887.22
|
| 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 |
$14,100.89
|
| Rate for Payer: Cigna Commercial |
$7,791.93
|
| Rate for Payer: Cigna Medicare Advantage |
$3,887.22
|
| Rate for Payer: Clover Medicare Advantage |
$3,692.86
|
| Rate for Payer: EmblemHealth Commercial |
$11,661.66
|
| Rate for Payer: Humana Medicare Advantage |
$4,003.84
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,887.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,199.64
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,999.79
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$631.96
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,887.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,887.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$567.96
|
|
|
EXC PILONID CYST; EXTENS
|
Facility
|
IP
|
$11,141.64
|
|
|
Service Code
|
HCPCS 11771
|
| Hospital Charge Code |
16000259
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,671.25 |
| Max. Negotiated Rate |
$1,671.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,671.25
|
|
|
EXC PILONID CYST; EXTENS
|
Facility
|
OP
|
$11,141.64
|
|
|
Service Code
|
HCPCS 11771
|
| Hospital Charge Code |
16000259
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$316.42 |
| 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 |
$2,896.83
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,671.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$352.08
|
| 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 |
$316.42
|
|
|
EXC PILONID CYST,SMPL
|
Facility
|
IP
|
$20,625.50
|
|
|
Service Code
|
HCPCS 11770
|
| Hospital Charge Code |
16000334
|
|
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 PILONID CYST,SMPL
|
Facility
|
IP
|
$20,625.50
|
|
|
Service Code
|
HCPCS 11770
|
| Hospital Charge Code |
160000239
|
|
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 PILONID CYST,SMPL
|
Facility
|
OP
|
$20,625.50
|
|
|
Service Code
|
HCPCS 11770
|
| Hospital Charge Code |
160000239
|
|
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 PILONID CYST,SMPL
|
Facility
|
OP
|
$20,625.50
|
|
|
Service Code
|
HCPCS 11770
|
| Hospital Charge Code |
16000334
|
|
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 PILONID CYT; COMPL
|
Facility
|
OP
|
$11,141.64
|
|
|
Service Code
|
HCPCS 11772
|
| Hospital Charge Code |
16000420
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$316.42 |
| 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 |
$2,896.83
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,671.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$352.08
|
| 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 |
$316.42
|
|
|
EXC PILONID CYT; COMPL
|
Facility
|
IP
|
$11,141.64
|
|
|
Service Code
|
HCPCS 11772
|
| Hospital Charge Code |
16000420
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,671.25 |
| Max. Negotiated Rate |
$1,671.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,671.25
|
|
|
EXC PRESACR/SACROCOCCYGEAL TUM
|
Facility
|
OP
|
$9,897.60
|
|
|
Service Code
|
HCPCS 49215
|
| Hospital Charge Code |
1600000538
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.09 |
| Max. Negotiated Rate |
$10,269.00 |
| Rate for Payer: Aetna Commercial |
$3,761.09
|
| Rate for Payer: Aetna Medicare Advantage |
$2,969.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,523.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,523.89
|
| 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 |
$2,523.89
|
| Rate for Payer: Cigna Commercial |
$4,948.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,573.38
|
| Rate for Payer: Oxford Commercial |
$9,354.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,484.64
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,269.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$312.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$281.09
|
|
|
EXC PRESACR/SACROCOCCYGEAL TUM
|
Facility
|
IP
|
$9,897.60
|
|
|
Service Code
|
HCPCS 49215
|
| Hospital Charge Code |
1600000538
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,484.64 |
| Max. Negotiated Rate |
$1,484.64 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,484.64
|
|
|
EXC RECT TUM TRANSANAL FULL
|
Facility
|
OP
|
$16,148.00
|
|
|
Service Code
|
HCPCS 45172
|
| Hospital Charge Code |
1600000698
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$458.60 |
| Max. Negotiated Rate |
$11,961.90 |
| Rate for Payer: Aetna Commercial |
$8,969.36
|
| Rate for Payer: Aetna Medicare Advantage |
$10,684.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11,961.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11,961.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,297.56
|
| 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 |
$11,961.90
|
| Rate for Payer: Cigna Commercial |
$6,609.93
|
| Rate for Payer: Cigna Medicare Advantage |
$3,297.56
|
| Rate for Payer: Clover Medicare Advantage |
$3,132.68
|
| Rate for Payer: EmblemHealth Commercial |
$9,892.68
|
| Rate for Payer: Humana Medicare Advantage |
$3,396.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,297.56
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,198.48
|
| Rate for Payer: Oxford Commercial |
$9,354.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,422.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,269.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$510.28
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,297.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,297.56
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$458.60
|
|
|
EXC RECT TUM TRANSANAL FULL
|
Facility
|
IP
|
$16,148.00
|
|
|
Service Code
|
HCPCS 45172
|
| Hospital Charge Code |
1600000698
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,422.20 |
| Max. Negotiated Rate |
$2,422.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,422.20
|
|
|
EXC RECT TUM TRANSANAL PART
|
Facility
|
IP
|
$22,676.60
|
|
|
Service Code
|
HCPCS 45171
|
| Hospital Charge Code |
16000980
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,401.49 |
| Max. Negotiated Rate |
$3,401.49 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,401.49
|
|
|
EXC RECT TUM TRANSANAL PART
|
Facility
|
OP
|
$22,676.60
|
|
|
Service Code
|
HCPCS 45171
|
| Hospital Charge Code |
16000980
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$644.02 |
| Max. Negotiated Rate |
$11,961.90 |
| Rate for Payer: Aetna Commercial |
$8,969.36
|
| Rate for Payer: Aetna Medicare Advantage |
$10,684.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11,961.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11,961.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,297.56
|
| 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 |
$11,961.90
|
| Rate for Payer: Cigna Commercial |
$6,609.93
|
| Rate for Payer: Cigna Medicare Advantage |
$3,297.56
|
| Rate for Payer: Clover Medicare Advantage |
$3,132.68
|
| Rate for Payer: EmblemHealth Commercial |
$9,892.68
|
| Rate for Payer: Humana Medicare Advantage |
$3,396.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,297.56
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,895.92
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,401.49
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$716.58
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,297.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,297.56
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$644.02
|
|
|
EXC RECURRENT WST GANGLION
|
Facility
|
OP
|
$19,467.90
|
|
|
Service Code
|
HCPCS 25112
|
| Hospital Charge Code |
16000687
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.89 |
| Max. Negotiated Rate |
$8,192.00 |
| Rate for Payer: Aetna Commercial |
$5,196.12
|
| Rate for Payer: Aetna Medicare Advantage |
$6,189.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,929.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,929.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,910.34
|
| 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 |
$6,929.76
|
| Rate for Payer: Cigna Commercial |
$3,829.26
|
| Rate for Payer: Cigna Medicare Advantage |
$1,910.34
|
| Rate for Payer: Clover Medicare Advantage |
$1,814.82
|
| Rate for Payer: EmblemHealth Commercial |
$5,731.02
|
| Rate for Payer: Humana Medicare Advantage |
$1,967.65
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,910.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,061.65
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,920.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$615.19
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,910.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,910.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$552.89
|
|
|
EXC RECURRENT WST GANGLION
|
Facility
|
IP
|
$19,467.90
|
|
|
Service Code
|
HCPCS 25112
|
| Hospital Charge Code |
16000687
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,920.18 |
| Max. Negotiated Rate |
$2,920.18 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,920.18
|
|
|
EXC SHOULDER LES SC 3 CM/>
|
Facility
|
IP
|
$6,443.85
|
|
|
Service Code
|
HCPCS 23071
|
| Hospital Charge Code |
16000301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$966.58 |
| Max. Negotiated Rate |
$966.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$966.58
|
|
|
EXC SHOULDER LES SC 3 CM/>
|
Facility
|
OP
|
$6,443.85
|
|
|
Service Code
|
HCPCS 23071
|
| Hospital Charge Code |
16000301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$183.01 |
| 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 |
$1,675.40
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$966.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$203.63
|
| 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 |
$183.01
|
|
|
EXC SHOULDER LES SC < 3 CM LT
|
Facility
|
OP
|
$13,615.50
|
|
|
Service Code
|
HCPCS 23075
|
| Hospital Charge Code |
16000501
|
|
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 SHOULDER LES SC < 3 CM LT
|
Facility
|
IP
|
$13,615.50
|
|
|
Service Code
|
HCPCS 23075
|
| Hospital Charge Code |
16000501
|
|
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
|
|
