|
DESTROY L/S FACET JNT ADDL
|
Facility
|
OP
|
$2,817.00
|
|
|
Service Code
|
HCPCS 64536
|
| Hospital Charge Code |
1600000397
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$1,070.46
|
| Rate for Payer: Aetna Medicare Advantage |
$845.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$718.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$718.34
|
| 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 |
$718.34
|
| Rate for Payer: Cigna Commercial |
$1,408.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$732.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$422.55
|
| Rate for Payer: UnitedHealthcare Community & State |
$89.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$80.00
|
|
|
DESTROY L/S FACET JNT ADDL
|
Facility
|
IP
|
$2,817.00
|
|
|
Service Code
|
HCPCS 64536
|
| Hospital Charge Code |
1600000397
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$422.55 |
| Max. Negotiated Rate |
$422.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$422.55
|
|
|
DESTROY LUMB/SAC FACET JNT
|
Facility
|
OP
|
$10,782.78
|
|
|
Service Code
|
HCPCS 64635
|
| Hospital Charge Code |
321564635
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$306.23 |
| Max. Negotiated Rate |
$8,415.40 |
| Rate for Payer: Aetna Commercial |
$6,310.10
|
| Rate for Payer: Aetna Medicare Advantage |
$7,516.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,415.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,415.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,319.89
|
| 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 |
$8,415.40
|
| Rate for Payer: Cigna Commercial |
$4,650.22
|
| Rate for Payer: Cigna Medicare Advantage |
$2,319.89
|
| Rate for Payer: Clover Medicare Advantage |
$2,203.90
|
| Rate for Payer: EmblemHealth Commercial |
$6,959.67
|
| Rate for Payer: Humana Medicare Advantage |
$2,389.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,319.89
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,803.52
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,617.42
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$340.74
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,319.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,319.89
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$306.23
|
|
|
DESTROY LUMB/SAC FACET JNT
|
Facility
|
IP
|
$10,093.90
|
|
|
Service Code
|
HCPCS 64635
|
| Hospital Charge Code |
16000524
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,514.09 |
| Max. Negotiated Rate |
$1,514.09 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,514.09
|
|
|
DESTROY LUMB/SAC FACET JNT
|
Facility
|
OP
|
$10,093.90
|
|
|
Service Code
|
HCPCS 64635
|
| Hospital Charge Code |
16000524
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$286.67 |
| Max. Negotiated Rate |
$8,415.40 |
| Rate for Payer: Aetna Commercial |
$6,310.10
|
| Rate for Payer: Aetna Medicare Advantage |
$7,516.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,415.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,415.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,319.89
|
| 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 |
$8,415.40
|
| Rate for Payer: Cigna Commercial |
$4,650.22
|
| Rate for Payer: Cigna Medicare Advantage |
$2,319.89
|
| Rate for Payer: Clover Medicare Advantage |
$2,203.90
|
| Rate for Payer: EmblemHealth Commercial |
$6,959.67
|
| Rate for Payer: Humana Medicare Advantage |
$2,389.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,319.89
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,624.41
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,514.09
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$318.97
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,319.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,319.89
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$286.67
|
|
|
DESTROY LUMB/SAC FACET JNT
|
Facility
|
IP
|
$10,782.78
|
|
|
Service Code
|
HCPCS 64635
|
| Hospital Charge Code |
321564635
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,617.42 |
| Max. Negotiated Rate |
$1,617.42 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,617.42
|
|
|
DESTROY,VULVA LESIONS,SIM
|
Facility
|
OP
|
$33,410.80
|
|
|
Service Code
|
HCPCS 56501
|
| Hospital Charge Code |
16001003
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$708.84 |
| Max. Negotiated Rate |
$8,891.84 |
| Rate for Payer: Aetna Commercial |
$6,667.35
|
| Rate for Payer: Aetna Medicare Advantage |
$7,941.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,891.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,891.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,451.23
|
| 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 |
$8,891.84
|
| Rate for Payer: Cigna Commercial |
$4,913.48
|
| Rate for Payer: Cigna Medicare Advantage |
$2,451.23
|
| Rate for Payer: Clover Medicare Advantage |
$2,328.67
|
| Rate for Payer: EmblemHealth Commercial |
$7,353.69
|
| Rate for Payer: Humana Medicare Advantage |
$2,524.77
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,451.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,686.81
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,011.62
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,055.78
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,451.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,451.23
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$723.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$708.84
|
|
|
DESTROY,VULVA LESIONS,SIM
|
Facility
|
IP
|
$33,410.80
|
|
|
Service Code
|
HCPCS 56501
|
| Hospital Charge Code |
16001003
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,011.62 |
| Max. Negotiated Rate |
$5,011.62 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,011.62
|
|
|
DESTROY VULVA LESIONS SIMPL
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 56501
|
| Hospital Charge Code |
83652125
|
|
Hospital Revenue Code
|
514
|
| Min. Negotiated Rate |
$21.16 |
| Max. Negotiated Rate |
$8,891.84 |
| Rate for Payer: Aetna Commercial |
$6,667.35
|
| Rate for Payer: Aetna Medicare Advantage |
$7,941.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,891.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,891.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,451.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$39.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,891.84
|
| Rate for Payer: Cigna Commercial |
$4,913.48
|
| Rate for Payer: Cigna Medicare Advantage |
$2,451.23
|
| Rate for Payer: Clover Medicare Advantage |
$2,328.67
|
| Rate for Payer: EmblemHealth Commercial |
$7,353.69
|
| Rate for Payer: Humana Medicare Advantage |
$2,524.77
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,451.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$193.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.54
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,451.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,451.23
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$723.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21.16
|
|
|
DESTROY VULVA LESIONS SIMPL
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 56501
|
| Hospital Charge Code |
83652125
|
|
Hospital Revenue Code
|
514
|
| Min. Negotiated Rate |
$111.75 |
| Max. Negotiated Rate |
$111.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.75
|
|
|
DESTR PARAVERTEBRL N ADDON 50
|
Facility
|
IP
|
$3,580.00
|
|
|
Service Code
|
HCPCS 64636
|
| Hospital Charge Code |
1600000432
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$537.00 |
| Max. Negotiated Rate |
$537.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$537.00
|
|
|
DESTR PARAVERTEBRL N ADDON 50
|
Facility
|
OP
|
$3,580.00
|
|
|
Service Code
|
HCPCS 64636
|
| Hospital Charge Code |
1600000432
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$101.67 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$1,360.40
|
| Rate for Payer: Aetna Medicare Advantage |
$1,074.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$912.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$912.90
|
| 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 |
$912.90
|
| Rate for Payer: Cigna Commercial |
$1,790.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$930.80
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$537.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$113.13
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$101.67
|
|
|
DESTR PARAVERTEBRL NERVE C/T-
|
Facility
|
OP
|
$4,344.06
|
|
|
Service Code
|
HCPCS 64633
|
| Hospital Charge Code |
160000249
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$123.37 |
| Max. Negotiated Rate |
$8,415.40 |
| Rate for Payer: Aetna Commercial |
$6,310.10
|
| Rate for Payer: Aetna Medicare Advantage |
$7,516.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,415.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,415.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,319.89
|
| 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 |
$8,415.40
|
| Rate for Payer: Cigna Commercial |
$4,650.22
|
| Rate for Payer: Cigna Medicare Advantage |
$2,319.89
|
| Rate for Payer: Clover Medicare Advantage |
$2,203.90
|
| Rate for Payer: EmblemHealth Commercial |
$6,959.67
|
| Rate for Payer: Humana Medicare Advantage |
$2,389.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,319.89
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,129.46
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$651.61
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$137.27
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,319.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,319.89
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$123.37
|
|
|
DESTR PARAVERTEBRL NERVE C/T-
|
Facility
|
IP
|
$4,344.06
|
|
|
Service Code
|
HCPCS 64633
|
| Hospital Charge Code |
160000249
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$651.61 |
| Max. Negotiated Rate |
$651.61 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$651.61
|
|
|
DESTRUCT B9 LESION 1-14
|
Facility
|
OP
|
$994.50
|
|
|
Service Code
|
HCPCS 17110
|
| Hospital Charge Code |
16000321
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$28.24 |
| 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 |
$258.57
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$149.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$31.43
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.24
|
|
|
DESTRUCT B9 LESION 1-14
|
Facility
|
IP
|
$994.50
|
|
|
Service Code
|
HCPCS 17110
|
| Hospital Charge Code |
16000321
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$149.18 |
| Max. Negotiated Rate |
$149.18 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$149.18
|
|
|
DESTRUCTION ANAL LESIONS
|
Facility
|
IP
|
$1,330.15
|
|
|
Service Code
|
HCPCS 46900
|
| Hospital Charge Code |
87502935
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$199.52 |
| Max. Negotiated Rate |
$199.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$199.52
|
|
|
DESTRUCTION ANAL LESIONS
|
Facility
|
OP
|
$1,330.15
|
|
|
Service Code
|
HCPCS 46900
|
| Hospital Charge Code |
87502935
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.78 |
| 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 |
$40.70
|
| 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 |
$345.84
|
| Rate for Payer: Oxford Commercial |
$266.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$199.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$266.03
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.03
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$37.78
|
|
|
DESTRUCTION BY NEUROLYTIC AGENT, WITH OR WITHOUT RADIOLOGIC MONITORING; SUPERIOR HYPOGASTRIC PLEXUS
|
Facility
|
OP
|
$3,811.70
|
|
|
Service Code
|
CPT 64681
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$998.24 |
| Max. Negotiated Rate |
$3,811.70 |
| Rate for Payer: Aetna Commercial |
$2,858.12
|
| Rate for Payer: Aetna Medicare Advantage |
$3,404.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,811.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,811.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,050.78
|
| 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 |
$3,811.70
|
| Rate for Payer: Cigna Commercial |
$2,106.27
|
| Rate for Payer: Cigna Medicare Advantage |
$1,050.78
|
| Rate for Payer: Clover Medicare Advantage |
$998.24
|
| Rate for Payer: EmblemHealth Commercial |
$3,152.34
|
| Rate for Payer: Humana Medicare Advantage |
$1,082.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,050.78
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,050.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,050.78
|
|
|
DESTRUCTION OF RECTAL TUMOR (EG, ELECTRODESICCATION, ELECTROSURGERY, LASER ABLATION, LASER RESECTION, CRYOSURGERY) TRANSANAL APPROACH
|
Facility
|
OP
|
$11,961.90
|
|
|
Service Code
|
CPT 45190
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,132.68 |
| Max. Negotiated Rate |
$11,961.90 |
| Rate for Payer: Aetna Commercial |
$8,969.36
|
| Rate for Payer: Aetna Medicare Advantage |
$10,684.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11,961.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11,961.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,297.56
|
| 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 |
$11,961.90
|
| Rate for Payer: Cigna Commercial |
$6,609.93
|
| Rate for Payer: Cigna Medicare Advantage |
$3,297.56
|
| Rate for Payer: Clover Medicare Advantage |
$3,132.68
|
| Rate for Payer: EmblemHealth Commercial |
$9,892.68
|
| Rate for Payer: Humana Medicare Advantage |
$3,396.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,297.56
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,297.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,297.56
|
|
|
DESTRUCTION PENIS LESION (S)
|
Facility
|
IP
|
$10,771.05
|
|
|
Service Code
|
HCPCS 54065
|
| Hospital Charge Code |
1600000336
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,615.66 |
| Max. Negotiated Rate |
$1,615.66 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,615.66
|
|
|
DESTRUCTION PENIS LESION (S)
|
Facility
|
OP
|
$10,771.05
|
|
|
Service Code
|
HCPCS 54065
|
| Hospital Charge Code |
1600000336
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$305.90 |
| Max. Negotiated Rate |
$8,891.84 |
| Rate for Payer: Aetna Commercial |
$6,667.35
|
| Rate for Payer: Aetna Medicare Advantage |
$7,941.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,891.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,891.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,451.23
|
| 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 |
$8,891.84
|
| Rate for Payer: Cigna Commercial |
$4,913.48
|
| Rate for Payer: Cigna Medicare Advantage |
$2,451.23
|
| Rate for Payer: Clover Medicare Advantage |
$2,328.67
|
| Rate for Payer: EmblemHealth Commercial |
$7,353.69
|
| Rate for Payer: Humana Medicare Advantage |
$2,524.77
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,451.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,800.47
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,615.66
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$340.37
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,451.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,451.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$305.90
|
|
|
DESTR W NEUROLYTIC,OTHER PE
|
Facility
|
IP
|
$7,956.80
|
|
|
Service Code
|
HCPCS 64640
|
| Hospital Charge Code |
16000525
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,193.52 |
| Max. Negotiated Rate |
$1,193.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,193.52
|
|
|
DESTR W NEUROLYTIC,OTHER PE
|
Facility
|
OP
|
$7,956.80
|
|
|
Service Code
|
HCPCS 64640
|
| Hospital Charge Code |
16000525
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$251.43 |
| Max. Negotiated Rate |
$3,811.70 |
| Rate for Payer: Aetna Commercial |
$2,858.12
|
| Rate for Payer: Aetna Medicare Advantage |
$3,404.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,811.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,811.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,050.78
|
| 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 |
$3,811.70
|
| Rate for Payer: Cigna Commercial |
$2,106.27
|
| Rate for Payer: Cigna Medicare Advantage |
$1,050.78
|
| Rate for Payer: Clover Medicare Advantage |
$998.24
|
| Rate for Payer: EmblemHealth Commercial |
$3,152.34
|
| Rate for Payer: Humana Medicare Advantage |
$1,082.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,050.78
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,068.77
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,193.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$251.43
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,050.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,050.78
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$2,311.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2,266.41
|
|
|
DETACHMENT HANDLE
|
Facility
|
OP
|
$1,250.00
|
|
| Hospital Charge Code |
270673588O
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.50 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: Aetna Commercial |
$475.00
|
| Rate for Payer: Aetna Medicare Advantage |
$375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$318.75
|
| Rate for Payer: Cigna Commercial |
$625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$325.00
|
| Rate for Payer: Oxford Commercial |
$250.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$250.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$39.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.50
|
|
