|
CFH FP CHEM CAUT.GRAN TISSUE
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
HCPCS 17250
|
| Hospital Charge Code |
83652087
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$91.80
|
|
|
CFH FP CHEM CAUT.GRAN TISSUE
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
HCPCS 17250
|
| Hospital Charge Code |
83652087
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$864.65 |
| Rate for Payer: Aetna Commercial |
$648.34
|
| Rate for Payer: Aetna Medicare Advantage |
$772.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$864.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$864.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$238.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$47.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$864.65
|
| Rate for Payer: Cigna Commercial |
$477.79
|
| Rate for Payer: Cigna Medicare Advantage |
$238.36
|
| Rate for Payer: Clover Medicare Advantage |
$226.44
|
| Rate for Payer: EmblemHealth Commercial |
$715.08
|
| Rate for Payer: Humana Medicare Advantage |
$245.51
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$238.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$159.12
|
| Rate for Payer: Oxford Commercial |
$122.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$91.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$122.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.38
|
|
|
CFH FP DEBRID SKIN 10% BODY
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
HCPCS 11000
|
| Hospital Charge Code |
83652013
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$44.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$44.55
|
|
|
CFH FP DEBRID SKIN 10% BODY
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
HCPCS 11000
|
| Hospital Charge Code |
83652013
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8.43 |
| Max. Negotiated Rate |
$1,751.90 |
| Rate for Payer: Aetna Commercial |
$1,313.62
|
| Rate for Payer: Aetna Medicare Advantage |
$1,564.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,751.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,751.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$482.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$30.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,751.90
|
| Rate for Payer: Cigna Commercial |
$968.07
|
| Rate for Payer: Cigna Medicare Advantage |
$482.95
|
| Rate for Payer: Clover Medicare Advantage |
$458.80
|
| Rate for Payer: EmblemHealth Commercial |
$1,448.85
|
| Rate for Payer: Humana Medicare Advantage |
$497.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$482.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$77.22
|
| Rate for Payer: Oxford Commercial |
$59.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$44.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$59.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.39
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$1,639.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.43
|
|
|
CFH FP DRESS/DEBRID LARGE
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
83652079
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$1,313.62
|
| Rate for Payer: Aetna Medicare Advantage |
$1,564.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,751.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,751.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$482.95
|
| 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 |
$1,751.90
|
| Rate for Payer: Cigna Commercial |
$968.07
|
| Rate for Payer: Cigna Medicare Advantage |
$482.95
|
| Rate for Payer: Clover Medicare Advantage |
$458.80
|
| Rate for Payer: EmblemHealth Commercial |
$1,448.85
|
| Rate for Payer: Humana Medicare Advantage |
$497.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$482.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$159.12
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$91.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.38
|
|
|
CFH FP DRESS/DEBRID LARGE
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
83652079
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$91.80
|
|
|
CFH FP DRESSING/DEBRID MEDIUM
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
HCPCS 16020
|
| Hospital Charge Code |
83652077
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$91.80
|
|
|
CFH FP DRESSING/DEBRID MEDIUM
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
HCPCS 16020
|
| Hospital Charge Code |
83652077
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$648.34
|
| Rate for Payer: Aetna Medicare Advantage |
$772.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$864.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$864.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$238.36
|
| 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 |
$864.65
|
| Rate for Payer: Cigna Commercial |
$477.79
|
| Rate for Payer: Cigna Medicare Advantage |
$238.36
|
| Rate for Payer: Clover Medicare Advantage |
$226.44
|
| Rate for Payer: EmblemHealth Commercial |
$715.08
|
| Rate for Payer: Humana Medicare Advantage |
$245.51
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$238.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$159.12
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$91.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.38
|
|
|
CFH FP EKG 12 LEADS
|
Facility
|
IP
|
$658.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
83652369
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$98.70 |
| Max. Negotiated Rate |
$98.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$98.70
|
|
|
CFH FP EKG 12 LEADS
|
Facility
|
OP
|
$658.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
83652369
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$18.69 |
| Max. Negotiated Rate |
$879.00 |
| Rate for Payer: Aetna Commercial |
$190.62
|
| Rate for Payer: Aetna Medicare Advantage |
$227.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$254.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$254.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$70.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$67.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$254.22
|
| Rate for Payer: Cigna Commercial |
$140.48
|
| Rate for Payer: Cigna Medicare Advantage |
$70.08
|
| Rate for Payer: Clover Medicare Advantage |
$66.58
|
| Rate for Payer: EmblemHealth Commercial |
$210.24
|
| Rate for Payer: Humana Medicare Advantage |
$72.18
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$70.08
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$171.08
|
| Rate for Payer: Oxford Commercial |
$659.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$98.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$879.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.79
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$70.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$70.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.69
|
|
|
CFH FP EKG-INTER&REPORT ONLY
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS 93010
|
| Hospital Charge Code |
83652371
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$879.00 |
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: Aetna Medicare Advantage |
$14.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.49
|
| Rate for Payer: Cigna Commercial |
$24.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.74
|
| Rate for Payer: Oxford Commercial |
$659.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$879.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.39
|
|
|
CFH FP EKG-INTER&REPORT ONLY
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS 93010
|
| Hospital Charge Code |
83652371
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$7.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.35
|
|
|
CFH FP ER HIGH SEVERITY
|
Professional
|
Both
|
$369.00
|
|
|
Service Code
|
HCPCS 99284
|
| Hospital Charge Code |
83652455
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$77.06 |
| Max. Negotiated Rate |
$368.37 |
| Rate for Payer: Aetna Commercial |
$129.98
|
| Rate for Payer: Aetna Medicare Advantage |
$124.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$368.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$368.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$368.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$368.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$368.37
|
| Rate for Payer: Cigna Commercial |
$263.84
|
| Rate for Payer: Cigna Medicare Advantage |
$263.84
|
| Rate for Payer: Clover Medicare Advantage |
$123.08
|
| Rate for Payer: Fidelis All Plans |
$77.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.66
|
| Rate for Payer: UnitedHealthcare Community & State |
$124.66
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.66
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$114.61
|
|
|
CFH FP ER MODERATE SEVERITY
|
Professional
|
Both
|
$237.00
|
|
|
Service Code
|
HCPCS 99283
|
| Hospital Charge Code |
83652453
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$45.12 |
| Max. Negotiated Rate |
$195.47 |
| Rate for Payer: Aetna Commercial |
$69.36
|
| Rate for Payer: Aetna Medicare Advantage |
$54.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$195.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$195.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$195.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$195.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$195.47
|
| Rate for Payer: Cigna Commercial |
$155.45
|
| Rate for Payer: Cigna Medicare Advantage |
$155.45
|
| Rate for Payer: Clover Medicare Advantage |
$72.21
|
| Rate for Payer: Fidelis All Plans |
$45.12
|
| Rate for Payer: Marpai Administrators LLC Commercial |
$53.33
|
| Rate for Payer: UnitedHealthcare Commercial |
$97.09
|
| Rate for Payer: UnitedHealthcare Community & State |
$97.09
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$97.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$73.68
|
|
|
CFH FP ER MODERATE SEVERITY
|
Professional
|
Both
|
$237.00
|
|
|
Service Code
|
HCPCS 99283
|
| Hospital Charge Code |
83652451
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$45.12 |
| Max. Negotiated Rate |
$195.47 |
| Rate for Payer: Aetna Commercial |
$69.36
|
| Rate for Payer: Aetna Medicare Advantage |
$54.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$195.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$195.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$195.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$195.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$195.47
|
| Rate for Payer: Cigna Commercial |
$155.45
|
| Rate for Payer: Cigna Medicare Advantage |
$155.45
|
| Rate for Payer: Clover Medicare Advantage |
$72.21
|
| Rate for Payer: Fidelis All Plans |
$45.12
|
| Rate for Payer: Marpai Administrators LLC Commercial |
$53.33
|
| Rate for Payer: UnitedHealthcare Commercial |
$97.09
|
| Rate for Payer: UnitedHealthcare Community & State |
$97.09
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$97.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$73.68
|
|
|
CFH FP EXC. DIAM. 0.6-1.0 CM
|
Facility
|
IP
|
$824.00
|
|
|
Service Code
|
HCPCS 11401
|
| Hospital Charge Code |
83652039
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.60 |
| Max. Negotiated Rate |
$123.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.60
|
|
|
CFH FP EXC. DIAM. 0.6-1.0 CM
|
Facility
|
OP
|
$824.00
|
|
|
Service Code
|
HCPCS 11401
|
| Hospital Charge Code |
83652039
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$1,751.90 |
| Rate for Payer: Aetna Commercial |
$1,313.62
|
| Rate for Payer: Aetna Medicare Advantage |
$1,564.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,751.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,751.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$482.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$49.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,751.90
|
| Rate for Payer: Cigna Commercial |
$968.07
|
| Rate for Payer: Cigna Medicare Advantage |
$482.95
|
| Rate for Payer: Clover Medicare Advantage |
$458.80
|
| Rate for Payer: EmblemHealth Commercial |
$1,448.85
|
| Rate for Payer: Humana Medicare Advantage |
$497.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$482.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$214.24
|
| Rate for Payer: Oxford Commercial |
$164.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$164.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.04
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$1,058.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.40
|
|
|
CFH FP EXC DIAM 1.1-2.0 CM
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
HCPCS 11402
|
| Hospital Charge Code |
83652041
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.04 |
| Max. Negotiated Rate |
$3,051.74 |
| 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 |
$62.26
|
| 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 |
$238.42
|
| Rate for Payer: Oxford Commercial |
$183.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$137.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$183.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.98
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.04
|
|
|
CFH FP EXC DIAM 1.1-2.0 CM
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
HCPCS 11402
|
| Hospital Charge Code |
83652041
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.55 |
| Max. Negotiated Rate |
$137.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$137.55
|
|
|
CFH FP EXC.DIAM 2.1-3.0 CM
|
Facility
|
IP
|
$1,049.00
|
|
|
Service Code
|
HCPCS 11403
|
| Hospital Charge Code |
83652043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.35 |
| Max. Negotiated Rate |
$157.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.35
|
|
|
CFH FP EXC.DIAM 2.1-3.0 CM
|
Facility
|
OP
|
$1,049.00
|
|
|
Service Code
|
HCPCS 11403
|
| Hospital Charge Code |
83652043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.79 |
| Max. Negotiated Rate |
$3,051.74 |
| 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 |
$117.51
|
| 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 |
$272.74
|
| Rate for Payer: Oxford Commercial |
$209.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$209.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$33.15
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.79
|
|
|
CFH FP EXC. DIAM. OVER 4.0
|
Facility
|
IP
|
$1,683.00
|
|
|
Service Code
|
HCPCS 11406
|
| Hospital Charge Code |
83652045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$252.45 |
| Max. Negotiated Rate |
$252.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$252.45
|
|
|
CFH FP EXC. DIAM. OVER 4.0
|
Facility
|
OP
|
$1,683.00
|
|
|
Service Code
|
HCPCS 11406
|
| Hospital Charge Code |
83652045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.80 |
| 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 |
$73.92
|
| 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 |
$437.58
|
| Rate for Payer: Oxford Commercial |
$336.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$252.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$336.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$53.18
|
| 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 |
$47.80
|
|
|
CFH FP EXC.PILONIDAL CYST
|
Facility
|
OP
|
$1,490.00
|
|
|
Service Code
|
HCPCS 11770
|
| Hospital Charge Code |
83652059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.32 |
| 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 |
$166.10
|
| 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 |
$387.40
|
| Rate for Payer: Oxford Commercial |
$298.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$223.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$298.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$47.08
|
| 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 |
$42.32
|
|
|
CFH FP EXC.PILONIDAL CYST
|
Facility
|
IP
|
$1,490.00
|
|
|
Service Code
|
HCPCS 11770
|
| Hospital Charge Code |
83652059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$223.50 |
| Max. Negotiated Rate |
$223.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$223.50
|
|
