|
TOMOSYNTHESIS SCREEN BREST UNI
|
Facility
|
IP
|
$130.10
|
|
|
Service Code
|
HCPCS 7706352
|
| Hospital Charge Code |
94061472
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$19.52 |
| Max. Negotiated Rate |
$19.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.52
|
|
|
TOMOSYNTHESIS SCREEN BREST UNI
|
Facility
|
OP
|
$130.10
|
|
|
Service Code
|
HCPCS 7706352
|
| Hospital Charge Code |
94061472
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$1,884.00 |
| Rate for Payer: Aetna Commercial |
$49.44
|
| Rate for Payer: Aetna Medicare Advantage |
$39.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$33.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$33.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$33.18
|
| Rate for Payer: Cigna Commercial |
$65.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.83
|
| Rate for Payer: Oxford Commercial |
$1,688.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,884.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.69
|
|
|
TOMOSYNTHESIS SCREEN BRST UNI
|
Facility
|
IP
|
$130.10
|
|
|
Service Code
|
HCPCS 7706352
|
| Hospital Charge Code |
94061473
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$19.52 |
| Max. Negotiated Rate |
$19.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.52
|
|
|
TOMOSYNTHESIS SCREEN BRST UNI
|
Facility
|
OP
|
$130.10
|
|
|
Service Code
|
HCPCS 7706352
|
| Hospital Charge Code |
94061473
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$1,884.00 |
| Rate for Payer: Aetna Commercial |
$49.44
|
| Rate for Payer: Aetna Medicare Advantage |
$39.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$33.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$33.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$33.18
|
| Rate for Payer: Cigna Commercial |
$65.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.83
|
| Rate for Payer: Oxford Commercial |
$1,688.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,884.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.69
|
|
|
TONSIL & ADENOID KIT
|
Facility
|
IP
|
$76.00
|
|
| Hospital Charge Code |
270338752
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.40
|
|
|
TONSIL & ADENOID KIT
|
Facility
|
OP
|
$76.00
|
|
| Hospital Charge Code |
270338752
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Aetna Commercial |
$28.88
|
| Rate for Payer: Aetna Medicare Advantage |
$22.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.38
|
| Rate for Payer: Cigna Commercial |
$38.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.76
|
| Rate for Payer: Oxford Commercial |
$15.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$15.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.16
|
|
|
TONSIL AND ADENOID PROCEDURES
|
Facility
|
IP
|
$32,795.12
|
|
|
Service Code
|
APR-DRG 0974
|
| Min. Negotiated Rate |
$32,152.08 |
| Max. Negotiated Rate |
$32,795.12 |
| Rate for Payer: UnitedHealthcare Community & State |
$32,152.08
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$32,795.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$32,152.08
|
|
|
TONSIL AND ADENOID PROCEDURES
|
Facility
|
IP
|
$10,930.33
|
|
|
Service Code
|
APR-DRG 0972
|
| Min. Negotiated Rate |
$10,716.01 |
| Max. Negotiated Rate |
$10,930.33 |
| Rate for Payer: UnitedHealthcare Community & State |
$10,716.01
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$10,930.33
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10,716.01
|
|
|
TONSIL AND ADENOID PROCEDURES
|
Facility
|
IP
|
$7,427.74
|
|
|
Service Code
|
APR-DRG 0971
|
| Min. Negotiated Rate |
$7,282.10 |
| Max. Negotiated Rate |
$7,427.74 |
| Rate for Payer: UnitedHealthcare Community & State |
$7,282.10
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$7,427.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7,282.10
|
|
|
TONSIL AND ADENOID PROCEDURES
|
Facility
|
IP
|
$17,383.40
|
|
|
Service Code
|
APR-DRG 0973
|
| Min. Negotiated Rate |
$17,042.55 |
| Max. Negotiated Rate |
$17,383.40 |
| Rate for Payer: UnitedHealthcare Community & State |
$17,042.55
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$17,383.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17,042.55
|
|
|
TONSILLECTOMY - AGE 12 OR MORE
|
Facility
|
OP
|
$22,083.40
|
|
|
Service Code
|
HCPCS 42826
|
| Hospital Charge Code |
1600000282
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$627.17 |
| Max. Negotiated Rate |
$14,288.18 |
| Rate for Payer: Aetna Commercial |
$10,713.67
|
| Rate for Payer: Aetna Medicare Advantage |
$12,761.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14,288.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14,288.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,938.85
|
| 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 |
$14,288.18
|
| Rate for Payer: Cigna Commercial |
$7,895.42
|
| Rate for Payer: Cigna Medicare Advantage |
$3,938.85
|
| Rate for Payer: Clover Medicare Advantage |
$3,741.91
|
| Rate for Payer: EmblemHealth Commercial |
$11,816.55
|
| Rate for Payer: Humana Medicare Advantage |
$4,057.02
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,938.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,741.68
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,312.51
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$697.84
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,938.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,938.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$627.17
|
|
|
TONSILLECTOMY - AGE 12 OR MORE
|
Facility
|
IP
|
$22,083.40
|
|
|
Service Code
|
HCPCS 42826
|
| Hospital Charge Code |
1600000282
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,312.51 |
| Max. Negotiated Rate |
$3,312.51 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,312.51
|
|
|
TONSILLECTOMY - AGE 12 OR MORE
|
Facility
|
IP
|
$22,083.40
|
|
|
Service Code
|
HCPCS 42826
|
| Hospital Charge Code |
1600000294
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,312.51 |
| Max. Negotiated Rate |
$3,312.51 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,312.51
|
|
|
TONSILLECTOMY - AGE 12 OR MORE
|
Facility
|
OP
|
$22,083.40
|
|
|
Service Code
|
HCPCS 42826
|
| Hospital Charge Code |
1600000294
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$627.17 |
| Max. Negotiated Rate |
$14,288.18 |
| Rate for Payer: Aetna Commercial |
$10,713.67
|
| Rate for Payer: Aetna Medicare Advantage |
$12,761.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14,288.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14,288.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,938.85
|
| 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 |
$14,288.18
|
| Rate for Payer: Cigna Commercial |
$7,895.42
|
| Rate for Payer: Cigna Medicare Advantage |
$3,938.85
|
| Rate for Payer: Clover Medicare Advantage |
$3,741.91
|
| Rate for Payer: EmblemHealth Commercial |
$11,816.55
|
| Rate for Payer: Humana Medicare Advantage |
$4,057.02
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,938.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,741.68
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,312.51
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$697.84
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,938.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,938.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$627.17
|
|
|
TONSILLECTOMY AGE LESS THAN AG
|
Facility
|
OP
|
$42,339.20
|
|
|
Service Code
|
HCPCS 42825
|
| Hospital Charge Code |
1600000625
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,202.43 |
| Max. Negotiated Rate |
$25,511.88 |
| Rate for Payer: Aetna Commercial |
$19,129.52
|
| Rate for Payer: Aetna Medicare Advantage |
$22,786.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$25,511.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$25,511.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7,032.91
|
| 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 |
$25,511.88
|
| Rate for Payer: Cigna Commercial |
$14,097.46
|
| Rate for Payer: Cigna Medicare Advantage |
$7,032.91
|
| Rate for Payer: Clover Medicare Advantage |
$6,681.26
|
| Rate for Payer: EmblemHealth Commercial |
$21,098.73
|
| Rate for Payer: Humana Medicare Advantage |
$7,243.90
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$7,032.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11,008.19
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,350.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,337.92
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7,032.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$7,032.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,202.43
|
|
|
TONSILLECTOMY AGE LESS THAN AG
|
Facility
|
IP
|
$42,339.20
|
|
|
Service Code
|
HCPCS 42825
|
| Hospital Charge Code |
1600000625
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,350.88 |
| Max. Negotiated Rate |
$6,350.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,350.88
|
|
|
TOOL 14CM 5MM BA
|
Facility
|
OP
|
$812.25
|
|
| Hospital Charge Code |
270657312
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.07 |
| Max. Negotiated Rate |
$406.12 |
| Rate for Payer: Aetna Commercial |
$308.65
|
| Rate for Payer: Aetna Medicare Advantage |
$243.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$207.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$207.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$207.12
|
| Rate for Payer: Cigna Commercial |
$406.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$211.19
|
| Rate for Payer: Oxford Commercial |
$162.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$121.84
|
| Rate for Payer: UnitedHealthcare Commercial |
$162.45
|
| Rate for Payer: UnitedHealthcare Community & State |
$25.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.07
|
|
|
TOOL 14CM 5MM BA
|
Facility
|
IP
|
$812.25
|
|
| Hospital Charge Code |
270657312
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$121.84 |
| Max. Negotiated Rate |
$121.84 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$121.84
|
|
|
TOOL,BALL MIDAS REX LEGEND
|
Facility
|
OP
|
$845.50
|
|
| Hospital Charge Code |
270690928
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.01 |
| Max. Negotiated Rate |
$422.75 |
| Rate for Payer: Aetna Commercial |
$321.29
|
| Rate for Payer: Aetna Medicare Advantage |
$253.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$215.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$215.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$215.60
|
| Rate for Payer: Cigna Commercial |
$422.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.83
|
| Rate for Payer: Oxford Commercial |
$169.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$126.83
|
| Rate for Payer: UnitedHealthcare Commercial |
$169.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.72
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.01
|
|
|
TOOL,BALL MIDAS REX LEGEND
|
Facility
|
IP
|
$845.50
|
|
| Hospital Charge Code |
270690928
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.83 |
| Max. Negotiated Rate |
$126.83 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$126.83
|
|
|
TOOL METAL GUIDEWIRE INSERTION
|
Facility
|
IP
|
$19.30
|
|
| Hospital Charge Code |
270637999N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$2.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.90
|
|
|
TOOL METAL GUIDEWIRE INSERTION
|
Facility
|
OP
|
$19.30
|
|
| Hospital Charge Code |
270637999N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$9.65 |
| Rate for Payer: Aetna Commercial |
$7.33
|
| Rate for Payer: Aetna Medicare Advantage |
$5.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.92
|
| Rate for Payer: Cigna Commercial |
$9.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.02
|
| Rate for Payer: Oxford Commercial |
$3.86
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.86
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.55
|
|
|
TOOL METAL GUIDEWIRE INSERTION
|
Facility
|
IP
|
$19.30
|
|
| Hospital Charge Code |
270637999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$2.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.90
|
|
|
TOOL METAL GUIDEWIRE INSERTION
|
Facility
|
IP
|
$19.30
|
|
| Hospital Charge Code |
270637999S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$2.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.90
|
|
|
TOOL METAL GUIDEWIRE INSERTION
|
Facility
|
OP
|
$19.30
|
|
| Hospital Charge Code |
270637999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$9.65 |
| Rate for Payer: Aetna Commercial |
$7.33
|
| Rate for Payer: Aetna Medicare Advantage |
$5.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.92
|
| Rate for Payer: Cigna Commercial |
$9.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.02
|
| Rate for Payer: Oxford Commercial |
$3.86
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.86
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.55
|
|
