|
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC
|
Facility
|
IP
|
$174,958.68
|
|
|
Service Code
|
MSDRG 239
|
| Min. Negotiated Rate |
$53,272.68 |
| Max. Negotiated Rate |
$174,958.68 |
| Rate for Payer: Aetna Commercial |
$126,466.10
|
| Rate for Payer: Aetna Medicare Advantage |
$174,958.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$133,261.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$133,261.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$56,076.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$133,261.05
|
| Rate for Payer: Cigna Commercial |
$109,719.46
|
| Rate for Payer: Cigna Medicare Advantage |
$56,076.50
|
| Rate for Payer: Clover Medicare Advantage |
$53,272.68
|
| Rate for Payer: EmblemHealth Commercial |
$168,229.50
|
| Rate for Payer: Humana Medicare Advantage |
$57,758.79
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$56,076.50
|
| Rate for Payer: Oxford Commercial |
$86,720.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$116,078.29
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$56,076.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$56,076.50
|
|
|
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC
|
Facility
|
IP
|
$63,202.74
|
|
|
Service Code
|
MSDRG 241
|
| Min. Negotiated Rate |
$19,244.43 |
| Max. Negotiated Rate |
$63,202.74 |
| Rate for Payer: Aetna Commercial |
$46,872.25
|
| Rate for Payer: Aetna Medicare Advantage |
$63,202.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$38,509.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$38,509.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$20,257.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$38,509.95
|
| Rate for Payer: Cigna Commercial |
$30,862.43
|
| Rate for Payer: Cigna Medicare Advantage |
$20,257.29
|
| Rate for Payer: Clover Medicare Advantage |
$19,244.43
|
| Rate for Payer: EmblemHealth Commercial |
$60,771.87
|
| Rate for Payer: Humana Medicare Advantage |
$20,865.01
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$20,257.29
|
| Rate for Payer: Oxford Commercial |
$24,393.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$32,651.07
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$20,257.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$20,257.29
|
|
|
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
|
IP
|
$91,362.12
|
|
|
Service Code
|
MSDRG 475
|
| Min. Negotiated Rate |
$27,818.59 |
| Max. Negotiated Rate |
$91,362.12 |
| Rate for Payer: Aetna Commercial |
$66,927.65
|
| Rate for Payer: Aetna Medicare Advantage |
$91,362.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$59,288.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$59,288.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$29,282.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$59,288.70
|
| Rate for Payer: Cigna Commercial |
$50,732.18
|
| Rate for Payer: Cigna Medicare Advantage |
$29,282.73
|
| Rate for Payer: Clover Medicare Advantage |
$27,818.59
|
| Rate for Payer: EmblemHealth Commercial |
$87,848.19
|
| Rate for Payer: Humana Medicare Advantage |
$30,161.21
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$29,282.73
|
| Rate for Payer: Oxford Commercial |
$40,097.83
|
| Rate for Payer: UnitedHealthcare Commercial |
$53,672.38
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$29,282.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$29,282.73
|
|
|
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
|
IP
|
$155,092.67
|
|
|
Service Code
|
MSDRG 474
|
| Min. Negotiated Rate |
$47,223.73 |
| Max. Negotiated Rate |
$155,092.67 |
| Rate for Payer: Aetna Commercial |
$112,317.28
|
| Rate for Payer: Aetna Medicare Advantage |
$155,092.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$119,131.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$119,131.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$49,709.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$119,131.50
|
| Rate for Payer: Cigna Commercial |
$95,701.62
|
| Rate for Payer: Cigna Medicare Advantage |
$49,709.19
|
| Rate for Payer: Clover Medicare Advantage |
$47,223.73
|
| Rate for Payer: EmblemHealth Commercial |
$149,127.57
|
| Rate for Payer: Humana Medicare Advantage |
$51,200.47
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$49,709.19
|
| Rate for Payer: Oxford Commercial |
$75,640.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$101,248.05
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$49,709.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$49,709.19
|
|
|
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$56,751.36
|
|
|
Service Code
|
MSDRG 476
|
| Min. Negotiated Rate |
$17,280.06 |
| Max. Negotiated Rate |
$56,751.36 |
| Rate for Payer: Aetna Commercial |
$42,277.49
|
| Rate for Payer: Aetna Medicare Advantage |
$56,751.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$32,691.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$32,691.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18,189.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$32,691.90
|
| Rate for Payer: Cigna Commercial |
$26,310.20
|
| Rate for Payer: Cigna Medicare Advantage |
$18,189.54
|
| Rate for Payer: Clover Medicare Advantage |
$17,280.06
|
| Rate for Payer: EmblemHealth Commercial |
$54,568.62
|
| Rate for Payer: Humana Medicare Advantage |
$18,735.23
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$18,189.54
|
| Rate for Payer: Oxford Commercial |
$20,795.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$27,835.02
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18,189.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$18,189.54
|
|
|
AMPUTATION MC W FING/THUMB
|
Facility
|
OP
|
$26,471.80
|
|
|
Service Code
|
HCPCS 26910
|
| Hospital Charge Code |
16000861
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$751.80 |
| 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 |
$6,882.67
|
| Rate for Payer: Oxford Commercial |
$9,354.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,970.77
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,269.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$836.51
|
| 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 |
$751.80
|
|
|
AMPUTATION MC W FING/THUMB
|
Facility
|
IP
|
$26,471.80
|
|
|
Service Code
|
HCPCS 26910
|
| Hospital Charge Code |
16000861
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,970.77 |
| Max. Negotiated Rate |
$3,970.77 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,970.77
|
|
|
AMPUTATION MID FOOT
|
Facility
|
OP
|
$15,871.38
|
|
|
Service Code
|
HCPCS 28800
|
| Hospital Charge Code |
1600000456
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$450.75 |
| 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 |
$4,126.56
|
| Rate for Payer: Oxford Commercial |
$9,354.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,380.71
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,269.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$501.54
|
| 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 |
$450.75
|
|
|
AMPUTATION MID FOOT
|
Facility
|
IP
|
$15,871.38
|
|
|
Service Code
|
HCPCS 28800
|
| Hospital Charge Code |
1600000456
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,380.71 |
| Max. Negotiated Rate |
$2,380.71 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,380.71
|
|
|
AMPUTATION OF FINGER/THUMB
|
Facility
|
OP
|
$17,164.20
|
|
|
Service Code
|
HCPCS 26952
|
| Hospital Charge Code |
1600000869
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$487.46 |
| 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 |
$4,462.69
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,574.63
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$542.39
|
| 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 |
$487.46
|
|
|
AMPUTATION OF FINGER/THUMB
|
Facility
|
IP
|
$17,164.20
|
|
|
Service Code
|
HCPCS 26952
|
| Hospital Charge Code |
1600000869
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,574.63 |
| Max. Negotiated Rate |
$2,574.63 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,574.63
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
|
IP
|
$28,514.57
|
|
|
Service Code
|
APR-DRG 3053
|
| Min. Negotiated Rate |
$27,955.46 |
| Max. Negotiated Rate |
$28,514.57 |
| Rate for Payer: UnitedHealthcare Community & State |
$27,955.46
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$28,514.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27,955.46
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
|
IP
|
$51,084.40
|
|
|
Service Code
|
APR-DRG 3054
|
| Min. Negotiated Rate |
$50,082.75 |
| Max. Negotiated Rate |
$51,084.40 |
| Rate for Payer: UnitedHealthcare Community & State |
$50,082.75
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$51,084.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$50,082.75
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
|
IP
|
$14,300.78
|
|
|
Service Code
|
APR-DRG 3051
|
| Min. Negotiated Rate |
$14,020.37 |
| Max. Negotiated Rate |
$14,300.78 |
| Rate for Payer: UnitedHealthcare Community & State |
$14,020.37
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$14,300.78
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14,020.37
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
|
IP
|
$19,030.78
|
|
|
Service Code
|
APR-DRG 3052
|
| Min. Negotiated Rate |
$18,657.63 |
| Max. Negotiated Rate |
$19,030.78 |
| Rate for Payer: UnitedHealthcare Community & State |
$18,657.63
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$19,030.78
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18,657.63
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC
|
Facility
|
IP
|
$78,554.11
|
|
|
Service Code
|
MSDRG 617
|
| Min. Negotiated Rate |
$23,918.72 |
| Max. Negotiated Rate |
$78,554.11 |
| Rate for Payer: Aetna Commercial |
$57,805.65
|
| Rate for Payer: Aetna Medicare Advantage |
$78,554.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$54,855.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$54,855.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$25,177.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$54,855.90
|
| Rate for Payer: Cigna Commercial |
$41,694.60
|
| Rate for Payer: Cigna Medicare Advantage |
$25,177.60
|
| Rate for Payer: Clover Medicare Advantage |
$23,918.72
|
| Rate for Payer: EmblemHealth Commercial |
$75,532.80
|
| Rate for Payer: Humana Medicare Advantage |
$25,932.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$25,177.60
|
| Rate for Payer: Oxford Commercial |
$32,954.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$44,111.03
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$25,177.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$25,177.60
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC
|
Facility
|
IP
|
$129,644.05
|
|
|
Service Code
|
MSDRG 616
|
| Min. Negotiated Rate |
$39,474.95 |
| Max. Negotiated Rate |
$129,644.05 |
| Rate for Payer: Aetna Commercial |
$94,192.48
|
| Rate for Payer: Aetna Medicare Advantage |
$129,644.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$109,711.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$109,711.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$41,552.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$109,711.80
|
| Rate for Payer: Cigna Commercial |
$77,744.61
|
| Rate for Payer: Cigna Medicare Advantage |
$41,552.58
|
| Rate for Payer: Clover Medicare Advantage |
$39,474.95
|
| Rate for Payer: EmblemHealth Commercial |
$124,657.74
|
| Rate for Payer: Humana Medicare Advantage |
$42,799.16
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$41,552.58
|
| Rate for Payer: Oxford Commercial |
$61,447.99
|
| Rate for Payer: UnitedHealthcare Commercial |
$82,250.33
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$41,552.58
|
| Rate for Payer: Wellcare Medicare Advantage |
$41,552.58
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$64,273.75
|
|
|
Service Code
|
MSDRG 618
|
| Min. Negotiated Rate |
$19,570.53 |
| Max. Negotiated Rate |
$64,273.75 |
| Rate for Payer: Aetna Commercial |
$47,635.01
|
| Rate for Payer: Aetna Medicare Advantage |
$64,273.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$32,137.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$32,137.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$20,600.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$32,137.80
|
| Rate for Payer: Cigna Commercial |
$31,618.16
|
| Rate for Payer: Cigna Medicare Advantage |
$20,600.56
|
| Rate for Payer: Clover Medicare Advantage |
$19,570.53
|
| Rate for Payer: EmblemHealth Commercial |
$61,801.68
|
| Rate for Payer: Humana Medicare Advantage |
$21,218.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$20,600.56
|
| Rate for Payer: Oxford Commercial |
$24,990.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$33,450.61
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$20,600.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$20,600.56
|
|
|
AMPUTATION OF THE LOWER LEG
|
Facility
|
IP
|
$12,406.91
|
|
|
Service Code
|
HCPCS 27882
|
| Hospital Charge Code |
160000210
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,861.04 |
| Max. Negotiated Rate |
$1,861.04 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,861.04
|
|
|
AMPUTATION OF THE LOWER LEG
|
Facility
|
OP
|
$12,406.91
|
|
|
Service Code
|
HCPCS 27882
|
| Hospital Charge Code |
160000210
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$352.36 |
| 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 |
$3,225.80
|
| Rate for Payer: Oxford Commercial |
$13,407.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,861.04
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,869.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$392.06
|
| 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 |
$352.36
|
|
|
AMPUTATION,TOE & METATARSAL
|
Facility
|
OP
|
$19,998.60
|
|
|
Service Code
|
HCPCS 28810
|
| Hospital Charge Code |
16000352
|
|
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
|
|
|
AMPUTATION,TOE & METATARSAL
|
Facility
|
IP
|
$19,998.60
|
|
|
Service Code
|
HCPCS 28810
|
| Hospital Charge Code |
16000352
|
|
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
|
|
|
AMS 700 LGX MS PUMP 12MMX18CM
|
Facility
|
OP
|
$75,950.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
270705746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,156.98 |
| Max. Negotiated Rate |
$37,975.00 |
| Rate for Payer: Aetna Commercial |
$28,861.00
|
| Rate for Payer: Aetna Medicare Advantage |
$22,785.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19,367.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19,367.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15,190.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19,367.25
|
| Rate for Payer: Cigna Commercial |
$37,975.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18,379.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11,392.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$2,400.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2,156.98
|
|
|
AMS 700 LGX MS PUMP 12MMX18CM
|
Facility
|
IP
|
$75,950.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
270705746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,392.50 |
| Max. Negotiated Rate |
$18,379.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15,190.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18,379.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11,392.50
|
|
|
AMS CX MS PENILE PROS 12MMX24C
|
Facility
|
OP
|
$73,850.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270705408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,097.34 |
| Max. Negotiated Rate |
$36,925.00 |
| Rate for Payer: Aetna Commercial |
$28,063.00
|
| Rate for Payer: Aetna Medicare Advantage |
$22,155.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18,831.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18,831.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14,770.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18,831.75
|
| Rate for Payer: Cigna Commercial |
$36,925.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17,871.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11,077.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$2,333.66
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2,097.34
|
|
