|
CRANIO SHEET
|
Facility
|
IP
|
$87.00
|
|
| Hospital Charge Code |
270335604
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$13.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.05
|
|
|
CRANIOTOME ADULT 3CR MEDNEXT
|
Facility
|
OP
|
$186.00
|
|
| Hospital Charge Code |
270335590
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Aetna Commercial |
$70.68
|
| Rate for Payer: Aetna Medicare Advantage |
$55.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47.43
|
| Rate for Payer: Cigna Commercial |
$93.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.80
|
| Rate for Payer: Oxford Commercial |
$37.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$37.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.93
|
|
|
CRANIOTOME ADULT 3CR MEDNEXT
|
Facility
|
IP
|
$186.00
|
|
| Hospital Charge Code |
270335590
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$27.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.90
|
|
|
CRANIOTOME BUR PED 2CR MEDNEXT
|
Facility
|
IP
|
$180.00
|
|
| Hospital Charge Code |
270335589
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.00
|
|
|
CRANIOTOME BUR PED 2CR MEDNEXT
|
Facility
|
OP
|
$180.00
|
|
| Hospital Charge Code |
270335589
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna Commercial |
$68.40
|
| Rate for Payer: Aetna Medicare Advantage |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$45.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$45.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$45.90
|
| Rate for Payer: Cigna Commercial |
$90.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.00
|
| Rate for Payer: Oxford Commercial |
$36.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$36.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.77
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC
|
Facility
|
IP
|
$102,628.59
|
|
|
Service Code
|
MSDRG 026
|
| Min. Negotiated Rate |
$31,249.09 |
| Max. Negotiated Rate |
$102,628.59 |
| Rate for Payer: Aetna Medicare Advantage |
$102,628.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$68,619.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$68,619.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$32,893.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$68,619.95
|
| Rate for Payer: Cigna Commercial |
$58,185.57
|
| Rate for Payer: Cigna Medicare Advantage |
$32,893.78
|
| Rate for Payer: Clover Medicare Advantage |
$31,249.09
|
| Rate for Payer: EmblemHealth Commercial |
$98,681.34
|
| Rate for Payer: Humana Medicare Advantage |
$33,880.59
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$32,893.78
|
| Rate for Payer: Oxford Commercial |
$41,818.74
|
| Rate for Payer: UnitedHealthcare Commercial |
$73,330.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$32,893.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$32,893.78
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$149,090.92
|
|
|
Service Code
|
MSDRG 025
|
| Min. Negotiated Rate |
$45,396.27 |
| Max. Negotiated Rate |
$149,090.92 |
| Rate for Payer: Aetna Medicare Advantage |
$149,090.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$102,813.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$102,813.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$47,785.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$102,813.62
|
| Rate for Payer: Cigna Commercial |
$85,086.94
|
| Rate for Payer: Cigna Medicare Advantage |
$47,785.55
|
| Rate for Payer: Clover Medicare Advantage |
$45,396.27
|
| Rate for Payer: EmblemHealth Commercial |
$143,356.65
|
| Rate for Payer: Humana Medicare Advantage |
$49,219.12
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$47,785.55
|
| Rate for Payer: Oxford Commercial |
$61,153.11
|
| Rate for Payer: UnitedHealthcare Commercial |
$107,233.92
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$47,785.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$47,785.55
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$83,678.40
|
|
|
Service Code
|
MSDRG 027
|
| Min. Negotiated Rate |
$25,479.00 |
| Max. Negotiated Rate |
$83,678.40 |
| Rate for Payer: Aetna Medicare Advantage |
$83,678.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$56,524.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$56,524.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$26,820.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$56,524.23
|
| Rate for Payer: Cigna Commercial |
$47,213.55
|
| Rate for Payer: Cigna Medicare Advantage |
$26,820.00
|
| Rate for Payer: Clover Medicare Advantage |
$25,479.00
|
| Rate for Payer: EmblemHealth Commercial |
$80,460.00
|
| Rate for Payer: Humana Medicare Advantage |
$27,624.60
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$26,820.00
|
| Rate for Payer: Oxford Commercial |
$33,933.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$59,502.60
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$26,820.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$26,820.00
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$51,548.43
|
|
|
Service Code
|
APR-DRG 9103
|
| Min. Negotiated Rate |
$50,537.68 |
| Max. Negotiated Rate |
$51,548.43 |
| Rate for Payer: UnitedHealthcare Community & State |
$50,537.68
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$51,548.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$50,537.68
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$32,779.51
|
|
|
Service Code
|
APR-DRG 9101
|
| Min. Negotiated Rate |
$32,136.77 |
| Max. Negotiated Rate |
$32,779.51 |
| Rate for Payer: UnitedHealthcare Community & State |
$32,136.77
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$32,779.51
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$32,136.77
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$34,504.38
|
|
|
Service Code
|
APR-DRG 9102
|
| Min. Negotiated Rate |
$33,827.82 |
| Max. Negotiated Rate |
$34,504.38 |
| Rate for Payer: UnitedHealthcare Community & State |
$33,827.82
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$34,504.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$33,827.82
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$219,694.33
|
|
|
Service Code
|
MSDRG 955
|
| Min. Negotiated Rate |
$66,894.11 |
| Max. Negotiated Rate |
$219,694.33 |
| Rate for Payer: Aetna Commercial |
$151,212.37
|
| Rate for Payer: Aetna Medicare Advantage |
$219,694.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$141,659.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$141,659.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$70,414.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$141,659.49
|
| Rate for Payer: Cigna Commercial |
$125,965.81
|
| Rate for Payer: Cigna Medicare Advantage |
$70,414.85
|
| Rate for Payer: Clover Medicare Advantage |
$66,894.11
|
| Rate for Payer: EmblemHealth Commercial |
$211,244.55
|
| Rate for Payer: Humana Medicare Advantage |
$72,527.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$70,414.85
|
| Rate for Payer: Oxford Commercial |
$90,533.29
|
| Rate for Payer: UnitedHealthcare Commercial |
$158,752.99
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$70,414.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$70,414.85
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$82,674.61
|
|
|
Service Code
|
APR-DRG 9104
|
| Min. Negotiated Rate |
$81,053.54 |
| Max. Negotiated Rate |
$82,674.61 |
| Rate for Payer: UnitedHealthcare Community & State |
$81,053.54
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$82,674.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$81,053.54
|
|
|
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR ANTINEOPLASTIC IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR
|
Facility
|
IP
|
$187,346.86
|
|
|
Service Code
|
MSDRG 023
|
| Min. Negotiated Rate |
$57,044.72 |
| Max. Negotiated Rate |
$187,346.86 |
| Rate for Payer: Aetna Medicare Advantage |
$187,346.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$60,047.07
|
| Rate for Payer: Cigna Commercial |
$107,236.83
|
| Rate for Payer: Cigna Medicare Advantage |
$60,047.07
|
| Rate for Payer: Clover Medicare Advantage |
$57,044.72
|
| Rate for Payer: EmblemHealth Commercial |
$180,141.21
|
| Rate for Payer: Humana Medicare Advantage |
$61,848.48
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$60,047.07
|
| Rate for Payer: Oxford Commercial |
$77,072.54
|
| Rate for Payer: UnitedHealthcare Commercial |
$135,149.13
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$60,047.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$60,047.07
|
|
|
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR
|
Facility
|
IP
|
$187,346.86
|
|
|
Service Code
|
MSDRG 023
|
| Min. Negotiated Rate |
$57,044.72 |
| Max. Negotiated Rate |
$187,346.86 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$131,889.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$131,889.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$131,889.87
|
|
|
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC
|
Facility
|
IP
|
$128,573.17
|
|
|
Service Code
|
MSDRG 024
|
| Min. Negotiated Rate |
$39,148.88 |
| Max. Negotiated Rate |
$128,573.17 |
| Rate for Payer: Aetna Medicare Advantage |
$128,573.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$88,159.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$88,159.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$41,209.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$88,159.19
|
| Rate for Payer: Cigna Commercial |
$73,207.30
|
| Rate for Payer: Cigna Medicare Advantage |
$41,209.35
|
| Rate for Payer: Clover Medicare Advantage |
$39,148.88
|
| Rate for Payer: EmblemHealth Commercial |
$123,628.05
|
| Rate for Payer: Humana Medicare Advantage |
$42,445.63
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$41,209.35
|
| Rate for Payer: Oxford Commercial |
$52,615.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$92,262.16
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$41,209.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$41,209.35
|
|
|
CRANK HANDLE C TORQ
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
270657347
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$281.25 |
| Max. Negotiated Rate |
$281.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$281.25
|
|
|
CRANK HANDLE C TORQ
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
270657347
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.19 |
| Max. Negotiated Rate |
$937.50 |
| Rate for Payer: Aetna Commercial |
$712.50
|
| Rate for Payer: Aetna Medicare Advantage |
$562.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$478.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$478.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$478.12
|
| Rate for Payer: Cigna Commercial |
$937.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$562.50
|
| Rate for Payer: Oxford Commercial |
$375.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$281.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$375.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$45.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$49.69
|
|
|
CRASH CART
|
Facility
|
OP
|
$6,034.10
|
|
| Hospital Charge Code |
270590014
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$145.42 |
| Max. Negotiated Rate |
$3,017.05 |
| Rate for Payer: Aetna Commercial |
$2,292.96
|
| Rate for Payer: Aetna Medicare Advantage |
$1,810.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,538.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,538.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,538.70
|
| Rate for Payer: Cigna Commercial |
$3,017.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,810.23
|
| Rate for Payer: Oxford Commercial |
$1,206.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$905.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,206.82
|
| Rate for Payer: UnitedHealthcare Community & State |
$145.42
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$159.90
|
|
|
CRASH CART
|
Facility
|
OP
|
$1,890.00
|
|
| Hospital Charge Code |
2705900014
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$45.55 |
| Max. Negotiated Rate |
$945.00 |
| Rate for Payer: Aetna Commercial |
$718.20
|
| Rate for Payer: Aetna Medicare Advantage |
$567.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$481.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$481.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$481.95
|
| Rate for Payer: Cigna Commercial |
$945.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$567.00
|
| Rate for Payer: Oxford Commercial |
$378.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$283.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$378.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$45.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$50.09
|
|
|
CRASH CART
|
Facility
|
IP
|
$1,890.00
|
|
| Hospital Charge Code |
2705900014
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$283.50 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$283.50
|
|
|
CRASH CART
|
Facility
|
IP
|
$6,034.10
|
|
| Hospital Charge Code |
270590014
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$905.12 |
| Max. Negotiated Rate |
$905.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$905.12
|
|
|
CRASH CART******
|
Facility
|
OP
|
$1,890.00
|
|
|
Service Code
|
HCPCS 99999
|
| Hospital Charge Code |
5900014
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$45.55 |
| Max. Negotiated Rate |
$945.00 |
| Rate for Payer: Aetna Commercial |
$718.20
|
| Rate for Payer: Aetna Medicare Advantage |
$567.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$481.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$481.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$481.95
|
| Rate for Payer: Cigna Commercial |
$945.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$567.00
|
| Rate for Payer: Oxford Commercial |
$378.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$283.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$378.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$45.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$50.09
|
|
|
CRASH CART******
|
Facility
|
IP
|
$1,890.00
|
|
|
Service Code
|
HCPCS 99999
|
| Hospital Charge Code |
5900014
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$283.50 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$283.50
|
|
|
CRASH CART-MEDS
|
Facility
|
IP
|
$573.00
|
|
| Hospital Charge Code |
60635246
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$85.95 |
| Max. Negotiated Rate |
$85.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$85.95
|
|
