|
COMPLICATIONS OF TREATMENT WITH CC
|
Facility
|
IP
|
$34,530.10
|
|
|
Service Code
|
MSDRG 920
|
| Min. Negotiated Rate |
$10,513.97 |
| Max. Negotiated Rate |
$34,530.10 |
| Rate for Payer: Aetna Commercial |
$23,983.44
|
| Rate for Payer: Aetna Medicare Advantage |
$34,530.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,958.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,958.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11,067.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23,958.83
|
| Rate for Payer: Cigna Commercial |
$18,757.04
|
| Rate for Payer: Cigna Medicare Advantage |
$11,067.34
|
| Rate for Payer: Clover Medicare Advantage |
$10,513.97
|
| Rate for Payer: EmblemHealth Commercial |
$33,202.02
|
| Rate for Payer: Humana Medicare Advantage |
$11,399.36
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11,067.34
|
| Rate for Payer: Oxford Commercial |
$13,480.93
|
| Rate for Payer: UnitedHealthcare Commercial |
$23,639.25
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11,067.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$11,067.34
|
|
|
COMPLICATIONS OF TREATMENT WITH MCC
|
Facility
|
IP
|
$61,308.56
|
|
|
Service Code
|
MSDRG 919
|
| Min. Negotiated Rate |
$18,667.67 |
| Max. Negotiated Rate |
$61,308.56 |
| Rate for Payer: Aetna Commercial |
$42,383.28
|
| Rate for Payer: Aetna Medicare Advantage |
$61,308.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$42,335.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$42,335.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$19,650.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$42,335.02
|
| Rate for Payer: Cigna Commercial |
$34,261.59
|
| Rate for Payer: Cigna Medicare Advantage |
$19,650.18
|
| Rate for Payer: Clover Medicare Advantage |
$18,667.67
|
| Rate for Payer: EmblemHealth Commercial |
$58,950.54
|
| Rate for Payer: Humana Medicare Advantage |
$20,239.69
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$19,650.18
|
| Rate for Payer: Oxford Commercial |
$24,624.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$43,179.42
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$19,650.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$19,650.18
|
|
|
COMPLICATIONS OF TREATMENT WITHOUT CC/MCC
|
Facility
|
IP
|
$24,384.33
|
|
|
Service Code
|
MSDRG 921
|
| Min. Negotiated Rate |
$7,424.72 |
| Max. Negotiated Rate |
$24,384.33 |
| Rate for Payer: Aetna Commercial |
$17,012.12
|
| Rate for Payer: Aetna Medicare Advantage |
$24,384.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$16,282.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$16,282.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7,815.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$16,282.70
|
| Rate for Payer: Cigna Commercial |
$12,882.72
|
| Rate for Payer: Cigna Medicare Advantage |
$7,815.49
|
| Rate for Payer: Clover Medicare Advantage |
$7,424.72
|
| Rate for Payer: EmblemHealth Commercial |
$23,446.47
|
| Rate for Payer: Humana Medicare Advantage |
$8,049.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$7,815.49
|
| Rate for Payer: Oxford Commercial |
$9,258.98
|
| Rate for Payer: UnitedHealthcare Commercial |
$16,235.91
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7,815.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$7,815.49
|
|
|
COMPLIC REM FB FROM FOOT
|
Facility
|
OP
|
$6,598.80
|
|
|
Service Code
|
HCPCS 28193
|
| Hospital Charge Code |
16000905
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$159.03 |
| Max. Negotiated Rate |
$7,082.74 |
| 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 |
$7,082.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,082.74
|
| 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 |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,082.74
|
| 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 |
$1,979.64
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$989.82
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,593.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$159.03
|
| 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 |
$174.87
|
|
|
COMPLIC REM FB FROM FOOT
|
Facility
|
IP
|
$6,598.80
|
|
|
Service Code
|
HCPCS 28193
|
| Hospital Charge Code |
16000905
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$989.82 |
| Max. Negotiated Rate |
$989.82 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$989.82
|
|
|
COMPLX RE>2.5 CM TONG OR MOUTH
|
Facility
|
OP
|
$3,238.00
|
|
|
Service Code
|
HCPCS 41252
|
| Hospital Charge Code |
5780195
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$85.81 |
| Max. Negotiated Rate |
$1,015.70 |
| 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 |
$1,015.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,015.70
|
| 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 |
$331.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,015.70
|
| 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 |
$971.40
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$485.70
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$281.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$281.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$85.81
|
|
|
COMPLX RE>2.5 CM TONG OR MOUTH
|
Facility
|
IP
|
$3,238.00
|
|
|
Service Code
|
HCPCS 41252
|
| Hospital Charge Code |
5780195
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$485.70 |
| Max. Negotiated Rate |
$485.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$485.70
|
|
|
COMPLX REP POST 1/3 TONGUE
|
Facility
|
OP
|
$1,453.00
|
|
|
Service Code
|
HCPCS 41251
|
| Hospital Charge Code |
5780190
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$1,015.70 |
| 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 |
$1,015.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,015.70
|
| 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 |
$105.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,015.70
|
| 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 |
$435.90
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$217.95
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$281.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$281.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.50
|
|
|
COMPLX REP POST 1/3 TONGUE
|
Facility
|
IP
|
$1,453.00
|
|
|
Service Code
|
HCPCS 41251
|
| Hospital Charge Code |
5780190
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$217.95 |
| Max. Negotiated Rate |
$217.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$217.95
|
|
|
COMP METABOLIC PANEL***
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS 80053
|
| Hospital Charge Code |
3004885
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.90
|
|
|
COMP METABOLIC PANEL***
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS 80053
|
| Hospital Charge Code |
3004885
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$28.72
|
| Rate for Payer: Aetna Medicare Advantage |
$34.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$38.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$38.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$10.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$38.12
|
| Rate for Payer: Cigna Commercial |
$13.00
|
| Rate for Payer: Cigna Medicare Advantage |
$10.56
|
| Rate for Payer: Clover Medicare Advantage |
$10.03
|
| Rate for Payer: EmblemHealth Commercial |
$31.68
|
| Rate for Payer: Humana Medicare Advantage |
$10.88
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$10.56
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.45
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$10.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.56
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.69
|
|
|
COMPNT BMT FEM 12 140 162902
|
Facility
|
IP
|
$4,496.00
|
|
| Hospital Charge Code |
270620763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.40 |
| Max. Negotiated Rate |
$1,088.03 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$899.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,088.03
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$989.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$674.40
|
|
|
COMPNT BMT FEM 12 140 162902
|
Facility
|
OP
|
$4,496.00
|
|
| Hospital Charge Code |
270620763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.35 |
| Max. Negotiated Rate |
$2,248.00 |
| Rate for Payer: Aetna Commercial |
$1,708.48
|
| Rate for Payer: Aetna Medicare Advantage |
$1,348.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,146.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,146.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$899.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,146.48
|
| Rate for Payer: Cigna Commercial |
$2,248.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,088.03
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$989.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$674.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$108.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$119.14
|
|
|
COMPNT BMT FEM BIMETRIC 162353
|
Facility
|
OP
|
$18,035.00
|
|
| Hospital Charge Code |
270611437
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.64 |
| Max. Negotiated Rate |
$9,017.50 |
| Rate for Payer: Aetna Commercial |
$6,853.30
|
| Rate for Payer: Aetna Medicare Advantage |
$5,410.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,598.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,598.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,607.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,598.93
|
| Rate for Payer: Cigna Commercial |
$9,017.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,364.47
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,967.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,705.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$434.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$477.93
|
|
|
COMPNT BMT FEM BIMETRIC 162353
|
Facility
|
IP
|
$18,035.00
|
|
| Hospital Charge Code |
270611437
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,705.25 |
| Max. Negotiated Rate |
$4,364.47 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,607.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,364.47
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,967.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,705.25
|
|
|
COMPNT BMT FEM HEAD 38 173660
|
Facility
|
OP
|
$4,870.75
|
|
| Hospital Charge Code |
270628145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$117.39 |
| Max. Negotiated Rate |
$2,435.38 |
| Rate for Payer: Aetna Commercial |
$1,850.88
|
| Rate for Payer: Aetna Medicare Advantage |
$1,461.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,242.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,242.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$974.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,242.04
|
| Rate for Payer: Cigna Commercial |
$2,435.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,178.72
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,071.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$730.61
|
| Rate for Payer: UnitedHealthcare Community & State |
$117.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$129.07
|
|
|
COMPNT BMT FEM HEAD 38 173660
|
Facility
|
IP
|
$4,870.75
|
|
| Hospital Charge Code |
270628145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$730.61 |
| Max. Negotiated Rate |
$1,178.72 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$974.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,178.72
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,071.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$730.61
|
|
|
COMPNT BMT FEM LT 60MM 140071
|
Facility
|
IP
|
$7,916.85
|
|
| Hospital Charge Code |
270609001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,187.53 |
| Max. Negotiated Rate |
$1,915.88 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,583.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,915.88
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,741.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,187.53
|
|
|
COMPNT BMT FEM LT 60MM 140071
|
Facility
|
OP
|
$7,916.85
|
|
| Hospital Charge Code |
270609001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$190.80 |
| Max. Negotiated Rate |
$3,958.43 |
| Rate for Payer: Aetna Commercial |
$3,008.40
|
| Rate for Payer: Aetna Medicare Advantage |
$2,375.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,018.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,018.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,583.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,018.80
|
| Rate for Payer: Cigna Commercial |
$3,958.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,915.88
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,741.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,187.53
|
| Rate for Payer: UnitedHealthcare Community & State |
$190.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$209.80
|
|
|
COMPNT BMT FEM LT 60MM 144171
|
Facility
|
OP
|
$13,420.00
|
|
| Hospital Charge Code |
270628234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$323.42 |
| Max. Negotiated Rate |
$6,710.00 |
| Rate for Payer: Aetna Commercial |
$5,099.60
|
| Rate for Payer: Aetna Medicare Advantage |
$4,026.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,422.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,422.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,684.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,422.10
|
| Rate for Payer: Cigna Commercial |
$6,710.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,247.64
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,952.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,013.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$323.42
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$355.63
|
|
|
COMPNT BMT FEM LT 60MM 144171
|
Facility
|
IP
|
$13,420.00
|
|
| Hospital Charge Code |
270628234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,013.00 |
| Max. Negotiated Rate |
$3,247.64 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,684.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,247.64
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,952.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,013.00
|
|
|
COMPNT BMT FEM LT 65MM 145132
|
Facility
|
IP
|
$6,630.45
|
|
| Hospital Charge Code |
270609397
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$994.57 |
| Max. Negotiated Rate |
$1,604.57 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,326.09
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,604.57
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,458.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$994.57
|
|
|
COMPNT BMT FEM LT 65MM 145132
|
Facility
|
OP
|
$6,630.45
|
|
| Hospital Charge Code |
270609397
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$159.79 |
| Max. Negotiated Rate |
$3,315.22 |
| Rate for Payer: Aetna Commercial |
$2,519.57
|
| Rate for Payer: Aetna Medicare Advantage |
$1,989.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,690.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,690.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,326.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,690.76
|
| Rate for Payer: Cigna Commercial |
$3,315.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,604.57
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,458.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$994.57
|
| Rate for Payer: UnitedHealthcare Community & State |
$159.79
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$175.71
|
|
|
COMPNT BMT FEM LT 75MM 145134
|
Facility
|
OP
|
$6,629.65
|
|
| Hospital Charge Code |
270606321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$159.77 |
| Max. Negotiated Rate |
$3,314.82 |
| Rate for Payer: Aetna Commercial |
$2,519.27
|
| Rate for Payer: Aetna Medicare Advantage |
$1,988.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,690.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,690.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,325.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,690.56
|
| Rate for Payer: Cigna Commercial |
$3,314.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,604.38
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,458.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$994.45
|
| Rate for Payer: UnitedHealthcare Community & State |
$159.77
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$175.69
|
|
|
COMPNT BMT FEM LT 75MM 145134
|
Facility
|
IP
|
$6,629.65
|
|
| Hospital Charge Code |
270606321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$994.45 |
| Max. Negotiated Rate |
$1,604.38 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,325.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,604.38
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,458.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$994.45
|
|
