|
AMP NUCLEID ACID,EACH ADDITNL
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
HCPCS 8390191
|
| Hospital Charge Code |
38472805
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$44.84
|
| Rate for Payer: Aetna Medicare Advantage |
$35.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$30.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$30.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$30.09
|
| Rate for Payer: Cigna Commercial |
$59.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.68
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.35
|
|
|
AMP NUCLEID ACID,EACH ADDITNL
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
HCPCS 8390191
|
| Hospital Charge Code |
38472805
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$17.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.70
|
|
|
AMPUTAION OF THE KNEE
|
Facility
|
IP
|
$19,503.55
|
|
|
Service Code
|
HCPCS 27599
|
| Hospital Charge Code |
16000478
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,925.53 |
| Max. Negotiated Rate |
$2,925.53 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,925.53
|
|
|
AMPUTAION OF THE KNEE
|
Facility
|
OP
|
$19,503.55
|
|
|
Service Code
|
HCPCS 27599
|
| Hospital Charge Code |
16000478
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$278.40 |
| Max. Negotiated Rate |
$5,070.92 |
| Rate for Payer: Aetna Commercial |
$797.10
|
| Rate for Payer: Aetna Medicare Advantage |
$949.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,063.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,063.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$293.05
|
| 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 |
$1,063.04
|
| Rate for Payer: Cigna Commercial |
$587.42
|
| Rate for Payer: Cigna Medicare Advantage |
$293.05
|
| Rate for Payer: Clover Medicare Advantage |
$278.40
|
| Rate for Payer: EmblemHealth Commercial |
$879.15
|
| Rate for Payer: Humana Medicare Advantage |
$301.84
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$293.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,070.92
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,925.53
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$616.31
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$553.90
|
|
|
AMPUTATE FOOT,TRANSMETATARSAL
|
Facility
|
IP
|
$19,998.60
|
|
|
Service Code
|
HCPCS 28805
|
| Hospital Charge Code |
1600000340
|
|
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
|
|
|
AMPUTATE FOOT,TRANSMETATARSAL
|
Facility
|
IP
|
$19,998.60
|
|
|
Service Code
|
HCPCS 28805
|
| Hospital Charge Code |
16000727
|
|
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
|
|
|
AMPUTATE FOOT,TRANSMETATARSAL
|
Facility
|
OP
|
$19,998.60
|
|
|
Service Code
|
HCPCS 28805
|
| Hospital Charge Code |
16000727
|
|
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
|
|
|
AMPUTATE FOOT,TRANSMETATARSAL
|
Facility
|
OP
|
$19,998.60
|
|
|
Service Code
|
HCPCS 28805
|
| Hospital Charge Code |
1600000340
|
|
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
|
|
|
AMPUTATELEG THRU TIBIA +FIBULA
|
Facility
|
IP
|
$10,368.60
|
|
|
Service Code
|
HCPCS 27880
|
| Hospital Charge Code |
160000211
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,555.29 |
| Max. Negotiated Rate |
$1,555.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,555.29
|
|
|
AMPUTATELEG THRU TIBIA +FIBULA
|
Facility
|
OP
|
$10,368.60
|
|
|
Service Code
|
HCPCS 27880
|
| Hospital Charge Code |
160000211
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$294.47 |
| 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 |
$2,695.84
|
| Rate for Payer: Oxford Commercial |
$14,968.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,555.29
|
| Rate for Payer: UnitedHealthcare Commercial |
$16,639.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$327.65
|
| 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 |
$294.47
|
|
|
AMPUTATE LOWER LEG AT KNEE
|
Facility
|
OP
|
$7,443.40
|
|
|
Service Code
|
HCPCS 27598
|
| Hospital Charge Code |
1600000684
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$211.39 |
| Max. Negotiated Rate |
$14,869.00 |
| 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 |
$1,935.28
|
| Rate for Payer: Oxford Commercial |
$13,407.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,116.51
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,869.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$235.21
|
| 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 |
$211.39
|
|
|
AMPUTATE LOWER LEG AT KNEE
|
Facility
|
IP
|
$7,443.40
|
|
|
Service Code
|
HCPCS 27598
|
| Hospital Charge Code |
1600000684
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,116.51 |
| Max. Negotiated Rate |
$1,116.51 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,116.51
|
|
|
AMPUTATE THIGH-FEMUR ANY LEVEL
|
Facility
|
IP
|
$10,492.75
|
|
|
Service Code
|
HCPCS 27590
|
| Hospital Charge Code |
1600000413
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,573.91 |
| Max. Negotiated Rate |
$1,573.91 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,573.91
|
|
|
AMPUTATE THIGH-FEMUR ANY LEVEL
|
Facility
|
OP
|
$10,492.75
|
|
|
Service Code
|
HCPCS 27590
|
| Hospital Charge Code |
1600000413
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$297.99 |
| Max. Negotiated Rate |
$16,639.00 |
| 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 |
$2,728.11
|
| Rate for Payer: Oxford Commercial |
$14,968.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,573.91
|
| Rate for Payer: UnitedHealthcare Commercial |
$16,639.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$331.57
|
| 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 |
$297.99
|
|
|
AMPUTATE THIGH- FEMUR OP CIRCU
|
Facility
|
OP
|
$6,231.22
|
|
|
Service Code
|
HCPCS 27592
|
| Hospital Charge Code |
1600000418
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$176.97 |
| Max. Negotiated Rate |
$16,639.00 |
| 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 |
$1,620.12
|
| Rate for Payer: Oxford Commercial |
$14,968.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$934.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$16,639.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$196.91
|
| 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 |
$176.97
|
|
|
AMPUTATE THIGH- FEMUR OP CIRCU
|
Facility
|
IP
|
$6,231.22
|
|
|
Service Code
|
HCPCS 27592
|
| Hospital Charge Code |
1600000418
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$934.68 |
| Max. Negotiated Rate |
$934.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$934.68
|
|
|
AMPUTATE TOE,IP JOINT-T6
|
Facility
|
IP
|
$19,998.60
|
|
|
Service Code
|
HCPCS 28825
|
| Hospital Charge Code |
16000295
|
|
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
|
|
|
AMPUTATE TOE,IP JOINT-T6
|
Facility
|
OP
|
$19,998.60
|
|
|
Service Code
|
HCPCS 28825
|
| Hospital Charge Code |
16000295
|
|
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
|
|
|
AMPUTATE TOE,MTP JOINT
|
Facility
|
OP
|
$19,998.60
|
|
|
Service Code
|
HCPCS 28820
|
| Hospital Charge Code |
16000306
|
|
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
|
|
|
AMPUTATE TOE,MTP JOINT
|
Facility
|
IP
|
$19,998.60
|
|
|
Service Code
|
HCPCS 28820
|
| Hospital Charge Code |
16000306
|
|
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
|
|
|
AMPUTAT FING/TH SGL,W DIR CL
|
Facility
|
IP
|
$14,854.00
|
|
|
Service Code
|
HCPCS 26951
|
| Hospital Charge Code |
16000621
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,228.10 |
| Max. Negotiated Rate |
$2,228.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,228.10
|
|
|
AMPUTAT FING/TH SGL,W DIR CL
|
Facility
|
OP
|
$14,854.00
|
|
|
Service Code
|
HCPCS 26951
|
| Hospital Charge Code |
16000621
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$421.85 |
| 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 |
$3,862.04
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,228.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$469.39
|
| 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 |
$421.85
|
|
|
AMPUTATION FINGER/THUMB
|
Facility
|
IP
|
$15,508.45
|
|
|
Service Code
|
HCPCS 26951
|
| Hospital Charge Code |
323026951
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,326.27 |
| Max. Negotiated Rate |
$2,326.27 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,326.27
|
|
|
AMPUTATION FINGER/THUMB
|
Facility
|
OP
|
$15,508.45
|
|
|
Service Code
|
HCPCS 26951
|
| Hospital Charge Code |
323026951
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| 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 |
$140.91
|
| 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 |
$4,032.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,326.27
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| 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 |
$440.44
|
|
|
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC
|
Facility
|
IP
|
$109,522.11
|
|
|
Service Code
|
MSDRG 240
|
| Min. Negotiated Rate |
$33,348.08 |
| Max. Negotiated Rate |
$109,522.11 |
| Rate for Payer: Aetna Commercial |
$79,861.40
|
| Rate for Payer: Aetna Medicare Advantage |
$109,522.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$77,851.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$77,851.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$35,103.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$77,851.05
|
| Rate for Payer: Cigna Commercial |
$63,546.20
|
| Rate for Payer: Cigna Medicare Advantage |
$35,103.24
|
| Rate for Payer: Clover Medicare Advantage |
$33,348.08
|
| Rate for Payer: EmblemHealth Commercial |
$105,309.72
|
| Rate for Payer: Humana Medicare Advantage |
$36,156.34
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$35,103.24
|
| Rate for Payer: Oxford Commercial |
$50,225.81
|
| Rate for Payer: UnitedHealthcare Commercial |
$67,229.04
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$35,103.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$35,103.24
|
|
