|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$8,206.69
|
|
|
Service Code
|
APR-DRG 0421
|
| Min. Negotiated Rate |
$8,045.77 |
| Max. Negotiated Rate |
$8,206.69 |
| Rate for Payer: UnitedHealthcare Community & State |
$8,045.77
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$8,206.69
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8,045.77
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC
|
Facility
|
IP
|
$77,220.50
|
|
|
Service Code
|
MSDRG 056
|
| Min. Negotiated Rate |
$23,512.65 |
| Max. Negotiated Rate |
$77,220.50 |
| Rate for Payer: Aetna Medicare Advantage |
$77,220.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$55,593.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$55,593.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$24,750.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$55,593.79
|
| Rate for Payer: Cigna Commercial |
$43,474.49
|
| Rate for Payer: Cigna Medicare Advantage |
$24,750.16
|
| Rate for Payer: Clover Medicare Advantage |
$23,512.65
|
| Rate for Payer: EmblemHealth Commercial |
$74,250.48
|
| Rate for Payer: Humana Medicare Advantage |
$25,492.66
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$24,750.16
|
| Rate for Payer: Oxford Commercial |
$31,245.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$54,790.31
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$24,750.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$24,750.16
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$44,010.03
|
|
|
Service Code
|
MSDRG 057
|
| Min. Negotiated Rate |
$13,400.49 |
| Max. Negotiated Rate |
$44,010.03 |
| Rate for Payer: Aetna Medicare Advantage |
$44,010.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31,634.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31,634.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14,105.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$31,634.96
|
| Rate for Payer: Cigna Commercial |
$24,245.86
|
| Rate for Payer: Cigna Medicare Advantage |
$14,105.78
|
| Rate for Payer: Clover Medicare Advantage |
$13,400.49
|
| Rate for Payer: EmblemHealth Commercial |
$42,317.34
|
| Rate for Payer: Humana Medicare Advantage |
$14,528.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14,105.78
|
| Rate for Payer: Oxford Commercial |
$17,425.82
|
| Rate for Payer: UnitedHealthcare Commercial |
$30,556.73
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14,105.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$14,105.78
|
|
|
DEHYDROEPIANDROSTERONE
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82626
|
| Hospital Charge Code |
401182626
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$68.73
|
| Rate for Payer: Aetna Medicare Advantage |
$81.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$91.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$91.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$25.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$71.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$91.22
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$25.27
|
| Rate for Payer: Clover Medicare Advantage |
$24.01
|
| Rate for Payer: EmblemHealth Commercial |
$75.81
|
| Rate for Payer: Humana Medicare Advantage |
$26.03
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$25.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.22
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$25.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
DEHYDROEPIANDROSTERONE
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82626
|
| Hospital Charge Code |
401182626
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
DEHYDROEPIANDROSTERONE (DHEA)
|
Facility
|
OP
|
$880.00
|
|
|
Service Code
|
HCPCS 82626
|
| Hospital Charge Code |
38472248
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.22 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: Aetna Commercial |
$68.73
|
| Rate for Payer: Aetna Medicare Advantage |
$81.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$91.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$91.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$25.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$71.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$91.22
|
| Rate for Payer: Cigna Commercial |
$440.00
|
| Rate for Payer: Cigna Medicare Advantage |
$25.27
|
| Rate for Payer: Clover Medicare Advantage |
$24.01
|
| Rate for Payer: EmblemHealth Commercial |
$75.81
|
| Rate for Payer: Humana Medicare Advantage |
$26.03
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$25.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$264.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$132.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.22
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$25.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.32
|
|
|
DEHYDROEPIANDROSTERONE (DHEA)
|
Facility
|
IP
|
$880.00
|
|
|
Service Code
|
HCPCS 82626
|
| Hospital Charge Code |
38472248
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$132.00
|
|
|
DEHYDROEPIANDROSTERONE SULFATE
|
Facility
|
OP
|
$880.00
|
|
|
Service Code
|
HCPCS 82627
|
| Hospital Charge Code |
38472251
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.78 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: Aetna Commercial |
$60.47
|
| Rate for Payer: Aetna Medicare Advantage |
$72.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$80.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$80.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$22.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$71.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$80.24
|
| Rate for Payer: Cigna Commercial |
$440.00
|
| Rate for Payer: Cigna Medicare Advantage |
$22.23
|
| Rate for Payer: Clover Medicare Advantage |
$21.12
|
| Rate for Payer: EmblemHealth Commercial |
$66.69
|
| Rate for Payer: Humana Medicare Advantage |
$22.90
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$22.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$264.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$132.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.78
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$22.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.32
|
|
|
DEHYDROEPIANDROSTERONE SULFATE
|
Facility
|
IP
|
$880.00
|
|
|
Service Code
|
HCPCS 82627
|
| Hospital Charge Code |
38472251
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$132.00
|
|
|
DEKOMPRESSOR KIT 0407-250-000
|
Facility
|
IP
|
$10,280.00
|
|
| Hospital Charge Code |
270643646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,542.00 |
| Max. Negotiated Rate |
$1,542.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,542.00
|
|
|
DEKOMPRESSOR KIT 0407-250-000
|
Facility
|
OP
|
$10,280.00
|
|
| Hospital Charge Code |
270643646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$247.75 |
| Max. Negotiated Rate |
$5,140.00 |
| Rate for Payer: Aetna Commercial |
$3,906.40
|
| Rate for Payer: Aetna Medicare Advantage |
$3,084.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,621.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,621.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,621.40
|
| Rate for Payer: Cigna Commercial |
$5,140.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,084.00
|
| Rate for Payer: Oxford Commercial |
$2,056.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,542.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,056.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$247.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$272.42
|
|
|
DEL ACCUCHECK (EACH TIME)
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS 82948
|
| Hospital Charge Code |
73190083
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$8.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.40
|
|
|
DEL ACCUCHECK (EACH TIME)
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS 82948
|
| Hospital Charge Code |
73190083
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$13.71
|
| Rate for Payer: Aetna Medicare Advantage |
$16.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.19
|
| Rate for Payer: Cigna Commercial |
$28.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.04
|
| Rate for Payer: Clover Medicare Advantage |
$4.79
|
| Rate for Payer: EmblemHealth Commercial |
$15.12
|
| Rate for Payer: Humana Medicare Advantage |
$5.19
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.03
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.48
|
|
|
DEL AMNIOCENTESIS
|
Facility
|
OP
|
$1,480.00
|
|
|
Service Code
|
HCPCS 59000
|
| Hospital Charge Code |
73190015
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$4,601.00 |
| Rate for Payer: Aetna Commercial |
$2,976.31
|
| Rate for Payer: Aetna Medicare Advantage |
$3,545.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,949.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,949.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,094.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$142.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,949.84
|
| Rate for Payer: Cigna Commercial |
$2,193.38
|
| Rate for Payer: Cigna Medicare Advantage |
$1,094.23
|
| Rate for Payer: Clover Medicare Advantage |
$1,039.52
|
| Rate for Payer: EmblemHealth Commercial |
$3,282.69
|
| Rate for Payer: Humana Medicare Advantage |
$1,127.06
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,094.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$444.00
|
| Rate for Payer: Oxford Commercial |
$2,624.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$222.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,601.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.67
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,094.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,094.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$39.22
|
|
|
DEL AMNIOCENTESIS
|
Facility
|
IP
|
$1,480.00
|
|
|
Service Code
|
HCPCS 59000
|
| Hospital Charge Code |
73190015
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$222.00
|
|
|
DEL AMNIOINFUSION
|
Facility
|
IP
|
$3,138.00
|
|
|
Service Code
|
HCPCS 59070
|
| Hospital Charge Code |
73190005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$470.70 |
| Max. Negotiated Rate |
$470.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$470.70
|
|
|
DEL AMNIOINFUSION
|
Facility
|
OP
|
$3,138.00
|
|
|
Service Code
|
HCPCS 59070
|
| Hospital Charge Code |
73190005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$75.63 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$984.72
|
| Rate for Payer: Aetna Medicare Advantage |
$1,172.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,306.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,306.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$362.03
|
| 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 |
$1,306.82
|
| Rate for Payer: Cigna Commercial |
$725.69
|
| Rate for Payer: Cigna Medicare Advantage |
$362.03
|
| Rate for Payer: Clover Medicare Advantage |
$343.93
|
| Rate for Payer: EmblemHealth Commercial |
$1,086.09
|
| Rate for Payer: Humana Medicare Advantage |
$372.89
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$362.03
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$941.40
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$470.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$75.63
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$362.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$362.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$83.16
|
|
|
DEL ANE IV CON SEDT >5 1ST 30M
|
Facility
|
IP
|
$1,937.60
|
|
| Hospital Charge Code |
73190123
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$290.64 |
| Max. Negotiated Rate |
$290.64 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$290.64
|
|
|
DEL ANE IV CON SEDT >5 1ST 30M
|
Facility
|
OP
|
$1,937.60
|
|
| Hospital Charge Code |
73190123
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$46.70 |
| Max. Negotiated Rate |
$968.80 |
| Rate for Payer: Aetna Commercial |
$736.29
|
| Rate for Payer: Aetna Medicare Advantage |
$581.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$494.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$494.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$494.09
|
| Rate for Payer: Cigna Commercial |
$968.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$581.28
|
| Rate for Payer: Oxford Commercial |
$387.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$290.64
|
| Rate for Payer: UnitedHealthcare Commercial |
$387.52
|
| Rate for Payer: UnitedHealthcare Community & State |
$46.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$51.35
|
|
|
DEL ANESTHESIA EPIDURAL
|
Facility
|
OP
|
$2,433.20
|
|
| Hospital Charge Code |
73190131
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$58.64 |
| Max. Negotiated Rate |
$1,216.60 |
| Rate for Payer: Aetna Commercial |
$924.62
|
| Rate for Payer: Aetna Medicare Advantage |
$729.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$620.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$620.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$620.47
|
| Rate for Payer: Cigna Commercial |
$1,216.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$729.96
|
| Rate for Payer: Oxford Commercial |
$486.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$364.98
|
| Rate for Payer: UnitedHealthcare Commercial |
$486.64
|
| Rate for Payer: UnitedHealthcare Community & State |
$58.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$64.48
|
|
|
DEL ANESTHESIA EPIDURAL
|
Facility
|
IP
|
$2,433.20
|
|
| Hospital Charge Code |
73190131
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$364.98 |
| Max. Negotiated Rate |
$364.98 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$364.98
|
|
|
DEL ANESTHESIA GENERAL
|
Facility
|
IP
|
$3,172.40
|
|
| Hospital Charge Code |
73190121
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$475.86 |
| Max. Negotiated Rate |
$475.86 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$475.86
|
|
|
DEL ANESTHESIA GENERAL
|
Facility
|
OP
|
$3,172.40
|
|
| Hospital Charge Code |
73190121
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$76.45 |
| Max. Negotiated Rate |
$1,586.20 |
| Rate for Payer: Aetna Commercial |
$1,205.51
|
| Rate for Payer: Aetna Medicare Advantage |
$951.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$808.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$808.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$808.96
|
| Rate for Payer: Cigna Commercial |
$1,586.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$951.72
|
| Rate for Payer: Oxford Commercial |
$634.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$475.86
|
| Rate for Payer: UnitedHealthcare Commercial |
$634.48
|
| Rate for Payer: UnitedHealthcare Community & State |
$76.45
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$84.07
|
|
|
DEL ANESTHESIA LOCAL
|
Facility
|
IP
|
$329.00
|
|
| Hospital Charge Code |
73190127
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$49.35 |
| Max. Negotiated Rate |
$49.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.35
|
|
|
DEL ANESTHESIA LOCAL
|
Facility
|
OP
|
$329.00
|
|
| Hospital Charge Code |
73190127
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$164.50 |
| Rate for Payer: Aetna Commercial |
$125.02
|
| Rate for Payer: Aetna Medicare Advantage |
$98.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$83.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$83.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$83.89
|
| Rate for Payer: Cigna Commercial |
$164.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$98.70
|
| Rate for Payer: Oxford Commercial |
$65.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$65.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.93
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.72
|
|
