|
UNLISTED PROCEDURE NOSE
|
Facility
|
OP
|
$1,367.40
|
|
|
Service Code
|
HCPCS 30999
|
| Hospital Charge Code |
1600000471
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$38.83 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$765.35
|
| Rate for Payer: Aetna Medicare Advantage |
$911.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,020.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,020.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$281.38
|
| 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 |
$1,020.71
|
| Rate for Payer: Cigna Commercial |
$564.04
|
| Rate for Payer: Cigna Medicare Advantage |
$281.38
|
| Rate for Payer: Clover Medicare Advantage |
$267.31
|
| Rate for Payer: EmblemHealth Commercial |
$844.14
|
| Rate for Payer: Humana Medicare Advantage |
$289.82
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$281.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$355.52
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$205.11
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$43.21
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$281.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$281.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.83
|
|
|
UNLISTED PROCEDURE NOSE
|
Facility
|
IP
|
$1,367.40
|
|
|
Service Code
|
HCPCS 30999
|
| Hospital Charge Code |
1600000471
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$205.11 |
| Max. Negotiated Rate |
$205.11 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$205.11
|
|
|
UNLISTED PROCEDURE, RECTUM
|
Facility
|
OP
|
$4,007.70
|
|
|
Service Code
|
CPT 45999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,049.57 |
| Max. Negotiated Rate |
$4,007.70 |
| Rate for Payer: Aetna Commercial |
$3,005.08
|
| Rate for Payer: Aetna Medicare Advantage |
$3,579.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,007.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,007.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,104.81
|
| 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 |
$4,007.70
|
| Rate for Payer: Cigna Commercial |
$2,214.60
|
| Rate for Payer: Cigna Medicare Advantage |
$1,104.81
|
| Rate for Payer: Clover Medicare Advantage |
$1,049.57
|
| Rate for Payer: EmblemHealth Commercial |
$3,314.43
|
| Rate for Payer: Humana Medicare Advantage |
$1,137.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,104.81
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,104.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,104.81
|
|
|
UNLISTED PROCEDURE,SPINE
|
Facility
|
IP
|
$859.60
|
|
|
Service Code
|
HCPCS 22899
|
| Hospital Charge Code |
16000442
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$128.94 |
| Max. Negotiated Rate |
$128.94 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.94
|
|
|
UNLISTED PROCEDURE,SPINE
|
Facility
|
OP
|
$859.60
|
|
|
Service Code
|
HCPCS 22899
|
| Hospital Charge Code |
16000442
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$24.41 |
| Max. Negotiated Rate |
$3,536.00 |
| 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 |
$223.50
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.16
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.41
|
|
|
UNLISTED PROCEDURE URINARY SYS
|
Facility
|
IP
|
$1,355.15
|
|
|
Service Code
|
HCPCS 53899
|
| Hospital Charge Code |
321053899
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$203.27 |
| Max. Negotiated Rate |
$203.27 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.27
|
|
|
UNLISTED PROCEDURE URINARY SYS
|
Facility
|
IP
|
$1,355.15
|
|
|
Service Code
|
HCPCS 53899
|
| Hospital Charge Code |
2600153
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$203.27 |
| Max. Negotiated Rate |
$203.27 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.27
|
|
|
UNLISTED PROCEDURE URINARY SYS
|
Facility
|
OP
|
$1,355.15
|
|
|
Service Code
|
HCPCS 53899
|
| Hospital Charge Code |
2600153
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$38.49 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$807.38
|
| Rate for Payer: Aetna Medicare Advantage |
$961.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,076.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,076.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$296.83
|
| 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 |
$1,076.75
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: Cigna Medicare Advantage |
$296.83
|
| Rate for Payer: Clover Medicare Advantage |
$281.99
|
| Rate for Payer: EmblemHealth Commercial |
$890.49
|
| Rate for Payer: Humana Medicare Advantage |
$305.73
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$296.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$352.34
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.27
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.49
|
|
|
UNLISTED PROCEDURE URINARY SYS
|
Facility
|
OP
|
$1,355.15
|
|
|
Service Code
|
HCPCS 53899
|
| Hospital Charge Code |
321053899
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$38.49 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$807.38
|
| Rate for Payer: Aetna Medicare Advantage |
$961.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,076.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,076.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$296.83
|
| 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 |
$1,076.75
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: Cigna Medicare Advantage |
$296.83
|
| Rate for Payer: Clover Medicare Advantage |
$281.99
|
| Rate for Payer: EmblemHealth Commercial |
$890.49
|
| Rate for Payer: Humana Medicare Advantage |
$305.73
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$296.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$352.34
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.27
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.49
|
|
|
UNLISTED PX ANUS
|
Facility
|
IP
|
$3,926.45
|
|
|
Service Code
|
HCPCS 46999
|
| Hospital Charge Code |
5792294
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$588.97 |
| Max. Negotiated Rate |
$588.97 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$588.97
|
|
|
UNLISTED PX ANUS
|
Facility
|
OP
|
$3,926.45
|
|
|
Service Code
|
HCPCS 46999
|
| Hospital Charge Code |
5792294
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.51 |
| Max. Negotiated Rate |
$4,007.70 |
| Rate for Payer: Aetna Commercial |
$3,005.08
|
| Rate for Payer: Aetna Medicare Advantage |
$3,579.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,007.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,007.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,104.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,007.70
|
| Rate for Payer: Cigna Commercial |
$2,214.60
|
| Rate for Payer: Cigna Medicare Advantage |
$1,104.81
|
| Rate for Payer: Clover Medicare Advantage |
$1,049.57
|
| Rate for Payer: EmblemHealth Commercial |
$3,314.43
|
| Rate for Payer: Humana Medicare Advantage |
$1,137.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,104.81
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,020.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$588.97
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,104.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,104.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$111.51
|
|
|
UNLISTED PX DIAPHRAGM
|
Facility
|
IP
|
$46,087.00
|
|
|
Service Code
|
HCPCS 39599
|
| Hospital Charge Code |
1600000605
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,913.05 |
| Max. Negotiated Rate |
$6,913.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,913.05
|
|
|
UNLISTED PX DIAPHRAGM
|
Facility
|
OP
|
$46,087.00
|
|
|
Service Code
|
HCPCS 39599
|
| Hospital Charge Code |
1600000605
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,308.87 |
| Max. Negotiated Rate |
$23,043.50 |
| Rate for Payer: Aetna Commercial |
$17,513.06
|
| Rate for Payer: Aetna Medicare Advantage |
$13,826.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11,752.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11,752.18
|
| 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 |
$11,752.18
|
| Rate for Payer: Cigna Commercial |
$23,043.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11,982.62
|
| Rate for Payer: Oxford Commercial |
$9,354.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,913.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,269.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,456.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,308.87
|
|
|
UNLISTED PX LEG/ANKLE
|
Facility
|
OP
|
$999.15
|
|
|
Service Code
|
HCPCS 27899
|
| Hospital Charge Code |
5792291
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$28.38 |
| Max. Negotiated Rate |
$1,063.04 |
| 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) 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 |
$259.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$149.87
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.38
|
|
|
UNLISTED PX LEG/ANKLE
|
Facility
|
IP
|
$999.15
|
|
|
Service Code
|
HCPCS 27899
|
| Hospital Charge Code |
5792291
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.87 |
| Max. Negotiated Rate |
$149.87 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$149.87
|
|
|
UNLISTED PX LUNG/PLEURA
|
Facility
|
IP
|
$3,630.70
|
|
|
Service Code
|
HCPCS 32999
|
| Hospital Charge Code |
2692117
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$544.61 |
| Max. Negotiated Rate |
$544.61 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$544.61
|
|
|
UNLISTED PX LUNG/PLEURA
|
Facility
|
OP
|
$3,630.70
|
|
|
Service Code
|
HCPCS 32999
|
| Hospital Charge Code |
321032999
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$103.11 |
| Max. Negotiated Rate |
$3,629.00 |
| Rate for Payer: Aetna Commercial |
$2,027.08
|
| Rate for Payer: Aetna Medicare Advantage |
$2,414.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,703.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,703.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$745.25
|
| 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 |
$2,703.39
|
| Rate for Payer: Cigna Commercial |
$1,493.86
|
| Rate for Payer: Cigna Medicare Advantage |
$745.25
|
| Rate for Payer: Clover Medicare Advantage |
$707.99
|
| Rate for Payer: EmblemHealth Commercial |
$2,235.75
|
| Rate for Payer: Humana Medicare Advantage |
$767.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$745.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$943.98
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$544.61
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$114.73
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$745.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$745.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$103.11
|
|
|
UNLISTED PX LUNG/PLEURA
|
Facility
|
IP
|
$3,630.70
|
|
|
Service Code
|
HCPCS 32999
|
| Hospital Charge Code |
321032999
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$544.61 |
| Max. Negotiated Rate |
$544.61 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$544.61
|
|
|
UNLISTED PX LUNG/PLEURA
|
Facility
|
IP
|
$2,883.20
|
|
|
Service Code
|
HCPCS 32999
|
| Hospital Charge Code |
7411389
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$432.48 |
| Max. Negotiated Rate |
$432.48 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$432.48
|
|
|
UNLISTED PX LUNG/PLEURA
|
Facility
|
OP
|
$3,630.70
|
|
|
Service Code
|
HCPCS 32999
|
| Hospital Charge Code |
2692117
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$103.11 |
| Max. Negotiated Rate |
$3,629.00 |
| Rate for Payer: Aetna Commercial |
$2,027.08
|
| Rate for Payer: Aetna Medicare Advantage |
$2,414.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,703.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,703.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$745.25
|
| 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 |
$2,703.39
|
| Rate for Payer: Cigna Commercial |
$1,493.86
|
| Rate for Payer: Cigna Medicare Advantage |
$745.25
|
| Rate for Payer: Clover Medicare Advantage |
$707.99
|
| Rate for Payer: EmblemHealth Commercial |
$2,235.75
|
| Rate for Payer: Humana Medicare Advantage |
$767.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$745.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$943.98
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$544.61
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$114.73
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$745.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$745.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$103.11
|
|
|
UNLISTED PX LUNG/PLEURA
|
Facility
|
OP
|
$2,883.20
|
|
|
Service Code
|
HCPCS 32999
|
| Hospital Charge Code |
7411389
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$81.88 |
| Max. Negotiated Rate |
$3,629.00 |
| Rate for Payer: Aetna Commercial |
$2,027.08
|
| Rate for Payer: Aetna Medicare Advantage |
$2,414.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,703.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,703.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$745.25
|
| 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 |
$2,703.39
|
| Rate for Payer: Cigna Commercial |
$1,493.86
|
| Rate for Payer: Cigna Medicare Advantage |
$745.25
|
| Rate for Payer: Clover Medicare Advantage |
$707.99
|
| Rate for Payer: EmblemHealth Commercial |
$2,235.75
|
| Rate for Payer: Humana Medicare Advantage |
$767.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$745.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$749.63
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$432.48
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$91.11
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$745.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$745.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$81.88
|
|
|
UNLISTED PX, SMALL INTESTINE
|
Facility
|
OP
|
$11,542.70
|
|
|
Service Code
|
HCPCS 44799
|
| Hospital Charge Code |
1600000469
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$327.81 |
| Max. Negotiated Rate |
$5,347.00 |
| Rate for Payer: Aetna Commercial |
$2,930.85
|
| Rate for Payer: Aetna Medicare Advantage |
$3,491.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,908.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,908.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,077.52
|
| 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 |
$3,908.70
|
| Rate for Payer: Cigna Commercial |
$2,159.89
|
| Rate for Payer: Cigna Medicare Advantage |
$1,077.52
|
| Rate for Payer: Clover Medicare Advantage |
$1,023.64
|
| Rate for Payer: EmblemHealth Commercial |
$3,232.56
|
| Rate for Payer: Humana Medicare Advantage |
$1,109.85
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,077.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,001.10
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,731.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$364.75
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,077.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,077.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$327.81
|
|
|
UNLISTED PX, SMALL INTESTINE
|
Facility
|
IP
|
$11,542.70
|
|
|
Service Code
|
HCPCS 44799
|
| Hospital Charge Code |
1600000469
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,731.40 |
| Max. Negotiated Rate |
$1,731.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,731.40
|
|
|
UNLISTED SURG PATHOLOGY PROCD
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
HCPCS 88399
|
| Hospital Charge Code |
38477060
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$224.58 |
| Rate for Payer: Aetna Commercial |
$168.40
|
| Rate for Payer: Aetna Medicare Advantage |
$200.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$224.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$224.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$61.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$224.58
|
| Rate for Payer: Cigna Commercial |
$124.10
|
| Rate for Payer: Cigna Medicare Advantage |
$61.91
|
| Rate for Payer: Clover Medicare Advantage |
$58.81
|
| Rate for Payer: EmblemHealth Commercial |
$185.73
|
| Rate for Payer: Humana Medicare Advantage |
$63.77
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$61.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17.16
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.09
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$61.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$61.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.87
|
|
|
UNLISTED SURG PATHOLOGY PROCD
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS 88399
|
| Hospital Charge Code |
38477060
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$9.90 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.90
|
|
