|
EXC THIGH/KNEE LES SC < 3CM
|
Facility
|
IP
|
$20,625.50
|
|
|
Service Code
|
HCPCS 27327
|
| Hospital Charge Code |
16000413
|
|
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 THIGH/KNEE TUM DEEP <5CM
|
Facility
|
OP
|
$13,615.50
|
|
|
Service Code
|
HCPCS 27328
|
| Hospital Charge Code |
16000559
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$386.68 |
| 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 |
$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 |
$3,450.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$386.68
|
|
|
EXC THIGH/KNEE TUM DEEP <5CM
|
Facility
|
IP
|
$13,615.50
|
|
|
Service Code
|
HCPCS 27328
|
| Hospital Charge Code |
16000559
|
|
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 THIGH/KNEE TUM DEP 5CM/>
|
Facility
|
OP
|
$9,686.20
|
|
|
Service Code
|
HCPCS 27339
|
| Hospital Charge Code |
16000477
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$275.09 |
| 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 |
$2,518.41
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,452.93
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$306.08
|
| 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 |
$275.09
|
|
|
EXC THIGH/KNEE TUM DEP 5CM/>
|
Facility
|
IP
|
$9,686.20
|
|
|
Service Code
|
HCPCS 27339
|
| Hospital Charge Code |
16000477
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,452.93 |
| Max. Negotiated Rate |
$1,452.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,452.93
|
|
|
EXC TIB/FIB BONE CYST/TUMOR
|
Facility
|
IP
|
$30,663.00
|
|
|
Service Code
|
HCPCS 27635
|
| Hospital Charge Code |
16000891
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,599.45 |
| Max. Negotiated Rate |
$4,599.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,599.45
|
|
|
EXC TIB/FIB BONE CYST/TUMOR
|
Facility
|
OP
|
$30,663.00
|
|
|
Service Code
|
HCPCS 27635
|
| Hospital Charge Code |
16000891
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$870.83 |
| 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 |
$7,972.38
|
| Rate for Payer: Oxford Commercial |
$9,354.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,599.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,269.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$968.95
|
| 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 |
$870.83
|
|
|
EXC TIB/FIG CYST/TMR W AUTGRFT
|
Facility
|
OP
|
$30,595.00
|
|
|
Service Code
|
HCPCS 27637
|
| Hospital Charge Code |
16000712
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$868.90 |
| Max. Negotiated Rate |
$31,271.12 |
| Rate for Payer: Aetna Commercial |
$23,447.95
|
| Rate for Payer: Aetna Medicare Advantage |
$27,930.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31,271.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31,271.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8,620.57
|
| 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 |
$31,271.12
|
| Rate for Payer: Cigna Commercial |
$17,279.91
|
| Rate for Payer: Cigna Medicare Advantage |
$8,620.57
|
| Rate for Payer: Clover Medicare Advantage |
$8,189.54
|
| Rate for Payer: EmblemHealth Commercial |
$25,861.71
|
| Rate for Payer: Humana Medicare Advantage |
$8,879.19
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$8,620.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,954.70
|
| Rate for Payer: Oxford Commercial |
$9,354.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,589.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,269.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$966.80
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8,620.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$8,620.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$868.90
|
|
|
EXC TIB/FIG CYST/TMR W AUTGRFT
|
Facility
|
IP
|
$30,595.00
|
|
|
Service Code
|
HCPCS 27637
|
| Hospital Charge Code |
16000712
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,589.25 |
| Max. Negotiated Rate |
$4,589.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,589.25
|
|
|
EXC TNDN SHTH LES HND/FING F1
|
Facility
|
OP
|
$16,001.80
|
|
|
Service Code
|
HCPCS 26160
|
| Hospital Charge Code |
16000350
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$454.45 |
| Max. Negotiated Rate |
$6,929.76 |
| 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 |
$4,160.47
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,400.27
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$505.66
|
| 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 |
$454.45
|
|
|
EXC TNDN SHTH LES HND/FING F1
|
Facility
|
IP
|
$16,001.80
|
|
|
Service Code
|
HCPCS 26160
|
| Hospital Charge Code |
16000350
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,400.27 |
| Max. Negotiated Rate |
$2,400.27 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,400.27
|
|
|
EXC TNDN SHTH LESIN LEG/ANK RT
|
Facility
|
IP
|
$21,417.75
|
|
|
Service Code
|
HCPCS 27630
|
| Hospital Charge Code |
16000510
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,212.66 |
| Max. Negotiated Rate |
$3,212.66 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,212.66
|
|
|
EXC TNDN SHTH LESIN LEG/ANK RT
|
Facility
|
OP
|
$21,417.75
|
|
|
Service Code
|
HCPCS 27630
|
| Hospital Charge Code |
16000510
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$608.26 |
| 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 |
$5,568.61
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,212.66
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$676.80
|
| 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 |
$608.26
|
|
|
EXC/TRANSPOS PTERYGIUM,W GRAFT
|
Facility
|
IP
|
$20,773.00
|
|
|
Service Code
|
HCPCS 65426
|
| Hospital Charge Code |
16000773
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,115.95 |
| Max. Negotiated Rate |
$3,115.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,115.95
|
|
|
EXC/TRANSPOS PTERYGIUM,W GRAFT
|
Facility
|
OP
|
$20,773.00
|
|
|
Service Code
|
HCPCS 65426
|
| Hospital Charge Code |
16000773
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$589.95 |
| Max. Negotiated Rate |
$10,245.95 |
| Rate for Payer: Aetna Commercial |
$7,682.69
|
| Rate for Payer: Aetna Medicare Advantage |
$9,151.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10,245.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10,245.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,824.52
|
| 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 |
$10,245.95
|
| Rate for Payer: Cigna Commercial |
$5,661.73
|
| Rate for Payer: Cigna Medicare Advantage |
$2,824.52
|
| Rate for Payer: Clover Medicare Advantage |
$2,683.29
|
| Rate for Payer: EmblemHealth Commercial |
$8,473.56
|
| Rate for Payer: Humana Medicare Advantage |
$2,909.26
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,824.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,400.98
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,115.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$656.43
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,824.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,824.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$589.95
|
|
|
EXC TR--EXT B9+MARG 0.5CM/<
|
Facility
|
IP
|
$3,786.40
|
|
|
Service Code
|
HCPCS 11400
|
| Hospital Charge Code |
16000216
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$567.96 |
| Max. Negotiated Rate |
$567.96 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$567.96
|
|
|
EXC TR--EXT B9+MARG 0.5CM/<
|
Facility
|
OP
|
$3,786.40
|
|
|
Service Code
|
HCPCS 11400
|
| Hospital Charge Code |
16000216
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$107.53 |
| Max. Negotiated Rate |
$3,629.00 |
| Rate for Payer: Aetna Commercial |
$2,288.28
|
| Rate for Payer: Aetna Medicare Advantage |
$2,725.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,051.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,051.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$841.28
|
| 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 |
$3,051.74
|
| Rate for Payer: Cigna Commercial |
$1,686.34
|
| Rate for Payer: Cigna Medicare Advantage |
$841.28
|
| Rate for Payer: Clover Medicare Advantage |
$799.22
|
| Rate for Payer: EmblemHealth Commercial |
$2,523.84
|
| Rate for Payer: Humana Medicare Advantage |
$866.52
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$841.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$984.46
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$567.96
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$119.65
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$107.53
|
|
|
EXC TR-EXT MAL+MARG 2.1-3 CM
|
Facility
|
IP
|
$7,917.64
|
|
|
Service Code
|
HCPCS 11603
|
| Hospital Charge Code |
16000492
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,187.65 |
| Max. Negotiated Rate |
$1,187.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,187.65
|
|
|
EXC TR-EXT MAL+MARG 2.1-3 CM
|
Facility
|
OP
|
$7,917.64
|
|
|
Service Code
|
HCPCS 11603
|
| Hospital Charge Code |
16000492
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$224.86 |
| Max. Negotiated Rate |
$3,629.00 |
| Rate for Payer: Aetna Commercial |
$2,288.28
|
| Rate for Payer: Aetna Medicare Advantage |
$2,725.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,051.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,051.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$841.28
|
| 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 |
$3,051.74
|
| Rate for Payer: Cigna Commercial |
$1,686.34
|
| Rate for Payer: Cigna Medicare Advantage |
$841.28
|
| Rate for Payer: Clover Medicare Advantage |
$799.22
|
| Rate for Payer: EmblemHealth Commercial |
$2,523.84
|
| Rate for Payer: Humana Medicare Advantage |
$866.52
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$841.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,058.59
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,187.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$250.20
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$224.86
|
|
|
EXC TR-EXT MAL+MARG 3.1-4 CM
|
Facility
|
OP
|
$7,612.30
|
|
|
Service Code
|
HCPCS 11604
|
| Hospital Charge Code |
16000436
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$216.19 |
| Max. Negotiated Rate |
$3,629.00 |
| Rate for Payer: Aetna Commercial |
$2,288.28
|
| Rate for Payer: Aetna Medicare Advantage |
$2,725.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,051.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,051.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$841.28
|
| 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 |
$3,051.74
|
| Rate for Payer: Cigna Commercial |
$1,686.34
|
| Rate for Payer: Cigna Medicare Advantage |
$841.28
|
| Rate for Payer: Clover Medicare Advantage |
$799.22
|
| Rate for Payer: EmblemHealth Commercial |
$2,523.84
|
| Rate for Payer: Humana Medicare Advantage |
$866.52
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$841.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,979.20
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,141.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$240.55
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$216.19
|
|
|
EXC TR-EXT MAL+MARG 3.1-4 CM
|
Facility
|
IP
|
$7,612.30
|
|
|
Service Code
|
HCPCS 11604
|
| Hospital Charge Code |
16000436
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,141.85 |
| Max. Negotiated Rate |
$1,141.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,141.85
|
|
|
EXC TR-EXT MAL+MARG >4 CM
|
Facility
|
IP
|
$6,929.84
|
|
|
Service Code
|
HCPCS 11606
|
| Hospital Charge Code |
16000419
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,039.48 |
| Max. Negotiated Rate |
$1,039.48 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,039.48
|
|
|
EXC TR-EXT MAL+MARG >4 CM
|
Facility
|
OP
|
$6,929.84
|
|
|
Service Code
|
HCPCS 11606
|
| Hospital Charge Code |
16000419
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$196.81 |
| 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 |
$1,801.76
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,039.48
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$218.98
|
| 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 |
$196.81
|
|
|
EXC TROCHANTEC BURSA/CAL RT
|
Facility
|
IP
|
$21,422.50
|
|
|
Service Code
|
HCPCS 27062
|
| Hospital Charge Code |
16000705
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,213.38 |
| Max. Negotiated Rate |
$3,213.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,213.38
|
|
|
EXC TROCHANTEC BURSA/CAL RT
|
Facility
|
OP
|
$21,422.50
|
|
|
Service Code
|
HCPCS 27062
|
| Hospital Charge Code |
16000705
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$608.40 |
| 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 |
$5,569.85
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,213.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$676.95
|
| 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 |
$608.40
|
|
